A malar rash is a skin outbreak or eruption on the cheeks and the bridge of the nose. The rash is red or purple and may be either blotchy or solid in appearance. It is commonly known as a "butterfly rash" due to its distinctive butterfly shape.

A malar rash may be flat or slightly raised, and it can feel rough and scaly. It may be itchy and, in severe cases, it may be painful.

Many health conditions can cause a malar or butterfly rash, including:

  • lupus
  • genetic disorders
  • bacterial infections
  • rosacea
  • sun exposure

In this article, we examine the possible conditions that could be behind a malar rash, along with other symptoms that may occur. We also look at diagnosis and treatment options.

Malar rash on faceShare on Pinterest
A malar rash occurs on the cheeks and bridge of the nose.

Causes of the malar rash include:

  • autoimmune diseases, such as lupus
  • bacterial infections, such as Lyme disease
  • inflammatory skin disorders, such as rosacea
  • vitamin deficiencies, such as pellagra
  • genetic disorders, such as Bloom syndrome
  • sensitivity to ultraviolet rays in sunlight

Lupus or SLE

Lupus is a chronic autoimmune condition where a person's immune system attacks healthy tissue. It is also known as systemic lupus erythematosus or SLE.

Lupus results in inflammation of joints, skin, and other organs. While there is no cure, treatment can improve some of the symptoms.

Around half of all people diagnosed with lupus will develop a malar rash as a symptom. One study recorded a prevalence of 61 percent.

Rosacea

This common skin condition affects 16 million Americans and 415 million people worldwide. It is characterized by:

  • redness of the skin
  • flushing
  • hard or pus-filled pimples

Seborrheic dermatitis

Seborrheic dermatitis is a common inflammatory disease of the skin characterized by greasy or dry scales usually on the scalp, hairline, and face, although it can affect many other areas of the body.

When someone has dandruff, they have a mild form of seborrheic dermatitis.

Cellulitis

Cellulitis is a type of bacterial infection that affects the deeper skin layers plus the layer of fat that is stored directly under the skin.

Lyme disease

This is caused by a tick bite, which then transmits bacteria into the body. Other symptoms may include:

Dermatomyositis

This is a condition involving inflammation of the muscles, connective tissues, and skin. Unlike SLE, the associated rash impacts the folds of skin that run from either side of the nose to the corners of the mouth.

Pellagra

When someone eats a diet that is extremely low in niacin, one of the B vitamins, it can lead to Pellagra.

This condition causes a range of symptoms that affect the skin, central nervous system, gastrointestinal system, and mucous membranes, such as the lining of the mouth. These symptoms can include pain and swelling.

Bloom syndrome

Bloom syndrome, which is also called Bloom-Torre-Machacek syndrome, is an inherited disorder that is characterized by short stature and elevated rates of most cancers.

Among other symptoms, it causes a malar rash and skin eruptions on other areas of the body.

Homocystinuria

Homocystinuria is a genetic disorder where the body is unable to process the amino acid methionine, leading to harmful levels of this and the chemical homocysteine in the blood and urine.

The condition can also result in vision problems, skeletal abnormalities, and intellectual disability.

Erysipelas

Erysipelas is a skin infection caused by Streptococcus bacteria. It results in acute skin inflammation. This is a rare cause, but it may also affect the ears and the face.

Photosensitivity

Sunburn or sensitivity to sunlight may cause a malar rash, and it may worsen one if it already exists.

Malar rash diagnosis requires physical examination Share on Pinterest
Due to the wide range of possible causes, a doctor will need to perform a physical examination during diagnosis.

Diagnosing the condition behind a malar rash can be difficult because of the wide range of possible causes.

A doctor will take a full and detailed medical history and investigate all other symptoms, as well as perform a thorough physical examination.

Infectious causes may be determined through a tissue biopsy or microbiological tests, while pellagra may be diagnosed through testing of niacin levels. Genetic studies may be carried out to confirm genetic disorders.

If the doctor suspects SLE, they will use blood and urine tests, such as:

  • SR (erythrocyte sedimentation rate) test to look for inflammation in the body
  • C-reaction protein test, as high CRP levels are another sign of inflammation
  • X-rays to check for organ damage
  • anti-nuclear antibody test

Treatment of a malar or butterfly rash depends on its cause.

Lupus

In the case of lupus, treatment involves:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Anti-inflammatory medications to reduce the inflammation and pain in muscles, joints, and other tissues.
  • Anti-malarial drugs: These may help with joint and skin conditions, as well as fatigue.
  • Steroids: Steroids work quickly to relieve pain, stiffness, and swelling. They have some unpleasant side effects, and the dosage is usually reduced once the disease is under control. Doctors can also prescribe steroidal creams.
  • Immunosuppressive medications: These drugs are now also used for the treatment of some autoimmune diseases, including lupus, as they help to suppress the immune system.

Rosacea

Treatment for rosacea may include creams or gels to help soothe and repair the skin and reduce redness, as well as oral antibiotics to control inflammation.

Bacterial infection

Causes linked to bacterial infection are treated with oral or topical antibiotics.

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Protecting a person's face from the sun may help the skin to heal, and prevent the rash from worsening.

Protecting the face from sun helps reduce malar rash. There are several ways people can help their skin to heal and prevent the rash from worsening, including:

  • protecting the face from the sun
  • using skin products for sensitive skin
  • eating a healthful, balanced diet

People are advised to avoid foods that increase inflammation, including:

  • red meat
  • dairy
  • fried food
  • refined and processed foods
  • saturated fats and hydrogenated fats
  • foods high in sugar

Malar rashes are relatively common, though rarely present a problem themselves.

Rashes caused by bacterial infections can be successfully treated and cured.

Chronic diseases or genetic conditions, such as SLE and Bloom syndrome, cannot be cured, but their rash symptoms may improve with treatment.