What is Malar Rash (Butterfly Rash)?
A malar rash, also commonly known as a butterfly rash, is a type of skin issue that affects the face and can be related to various conditions. This rash is typically reddish and can be either flat or slightly raised on the skin. You’ll usually find this rash spreading across the nose and cheek areas, but it generally doesn’t affect the folds between your nose and lip area. The rash might appear and vanish temporarily, or it could progressively affect other parts of the facial skin.
The malar rash is mostly associated with a disease named systemic lupus erythematosus. According to the American College of Rheumatology, having a malar rash is one of the factors considered when diagnosing this disease. However, malar rash can be found in other kinds of lupus too, such as discoid lupus and subacute cutaneous lupus.
If you have a malar rash, it might not necessarily mean that you have lupus. It could also indicate other diseases like cellulitis, rosacea, erysipelas, dermatomyositis, and pellagra. These are all potential alternative diagnoses if you have a malar rash.
Treatment for a malar rash often begins with taking steps to protect your skin from sun exposure as sunlight can worsen the rash. This can include wearing the right sort of clothing, using sunscreens, and changing your habits to avoid being out in the sun unnecessarily. It is also vital to treat the underlying disease that is causing the rash.
nasolabial folds.
What Causes Malar Rash (Butterfly Rash)?
Malar rash, also known as a butterfly rash, is a symptom that can occur due to various illnesses. Some common causes are:
1. Erysipelas
2. Cellulitis
3. Systemic lupus erythematosus
4. Rosacea
5. Pellagra
6. Dermatomyositis
Erysipelas is a type of skin infection that occurs on the upper layers of skin and affects the tiny tubes that carry lymph fluid through the body. It usually involves a painful and rapidly spreading red, shiny blotch on the skin, along with swelling and bumpiness (called “peau d’orange”). This infection often comes with body-wide symptoms like fever, chills, and generally feeling sick.
Cellulitis is also a skin infection, but it affects the deeper layers of the skin and the fat underneath. It’s different from erysipelas because the borders of the infection aren’t as clear, there is little or no swell, and it doesn’t usually cause body-wide symptoms. If such symptoms do appear, the disease usually progresses more slowly.
Systemic lupus erythematosus (SLE) is a medical condition where the body’s own immune system mistakenly attacks healthy parts of the body, like the kidneys, joints, skin, brain, and heart. It can cause mild symptoms like rashes and joint inflammation, but can also lead to high fever, joint pain, fatigue, severe organ damage, and can be life-threatening.
Rosacea is a long-term skin condition that especially affects the face among middle-aged people. It is the most common cause of malar rash. It usually appears in people with fair skin and affects the cheeks, chin, nose, forehead, and eyelids. The key signs of rosacea are redness, visible tiny blood vessels, and small, red, pus-filled bumps or pimples. Consumption of hot drinks, stress, or alcohol can often lead to skin flare-ups. It’s important to note that unlike some of the other conditions, rosacea doesn’t cause sickness in other parts of the body.
Pellagra is a disease caused by a lack of niacin, a type of B vitamin, in the body. It’s known by four “D’s”: dermatitis (skin inflammation), dementia, diarrhea, and death. The dermatitis in pellagra often appears as a symmetrical rash on skin exposed to the sun and can be painful. Diagnosing pellagra can be difficult without these visible skin symptoms.
Dermatomyositis (DM) is a rare, inflammatory disease that leads to muscle weakness and skin changes. It often presents with varied skin symptoms, among which poikiloderma is significant. Poikiloderma involves a combination of changes in skin color and texture and the appearance of tiny blood vessels. Although poikiloderma can be seen in multiple skin disorders, it’s specific to certain areas in DM, including the face, elbows, knees, knuckles, chest, and back. The poikiloderma that occurs in dermatomyositis has a purple color, different from the one seen in lupus.
Risk Factors and Frequency for Malar Rash (Butterfly Rash)
Cellulitis and Erysipelas are common infections affecting people of all racial and ethnic groups. However, it’s hard to determine their exact prevalence because they’re not officially tracked disorders.
Rosacea, a long-term skin inflammation mostly affecting the face, affects approximately 5.46% of the population across the world. It typically affects fair-skinned Caucasians who have sun-sensitive skin, with the occurrence rate in this group ranging from 2 to 22%.
- Systemic Lupus Erythematosus (SLE), also known as Lupus, is estimated to affect at least 1.5 million people, according to the Lupus Foundation of America.
- The highest frequency of Lupus is observed in North America, while the lowest is in Northern Australia.
- Lupus affects more women than men across all ages and ethnic groups.
- People of African ethnicity tend to have the highest prevalence of Lupus, while those of the White race have the lowest.
Pellagra was once widespread in the United States, but it now only occurs sporadically. It’s often found in people with digestive disorders, alcoholism, drug dependency, and those who follow certain extreme dietary habits.
Dermatomyositis, a condition causing muscle weakness and skin rash, affects approximately 9.63 people in every million. It often appears in two age groups – children aged 5 to 15 and adults aged 45 to 60.
Signs and Symptoms of Malar Rash (Butterfly Rash)
Malar rash, or a rash that appears on the cheeks, can be a symptom of several different health conditions. Diagnosing the root cause of a malar rash can be tough because there are so many possible causes. In order to make an accurate diagnosis, doctors need to gather a detailed medical history, investigate all symptoms, and conduct a comprehensive physical examination.
Testing for Malar Rash (Butterfly Rash)
Determining the cause of a malar rash, which is a rash that appears on your cheeks and across the bridge of your nose, differs based on the condition causing it.
For skin infections like cellulitis and erysipelas, you usually don’t need to have a lab test if it’s a straightforward case. However, if you’re feeling really unwell, your doctor may order some blood tests like a complete blood count, which checks the types and number of cells in your blood, and tests that look at inflammation in your body, such as an erythrocyte sedimentation rate (ESR) and a C-reactive protein (CRP) test.
In cases where the malar rash is a sign of a disease known as systemic lupus erythematosus (SLE), it can appear alongside other symptoms or might show up months or even years earlier. For patients with SLE, the blood tests might show a positive result for ‘ANA’, which are antibodies commonly found in people with this disease, and elevated levels of CRP and ESR. Certain skin tests can also help confirm the diagnosis.
When the malar rash is a symptom of a condition called dermatomyositis, which affects your muscles and skin, a skin biopsy is often used for diagnosis. If you only have skin symptoms at first, your doctor will check regularly to see if you start to develop muscle symptoms as well. They might monitor certain blood tests, like serum CK level and aldolase, which check for muscle damage, and examine your muscles every few months.
For rosacea, a skin condition causing redness and visible blood vessels on your face, a diagnosis is usually made just by looking at your skin symptoms.
Lastly, for a condition known as pellagra, caused by a lack of vitamin B3, diagnosis is based on the symptoms you’re experiencing and if those symptoms get better when you’re treated with niacin, which is vitamin B3. To support a pellagra diagnosis, doctors could run several tests, like checking your blood count (for anemia), measuring your protein, phosphorus, and calcium levels, and looking at your niacin levels in the blood and urine. The levels of chemicals called NADP and NAD, which need niacin to be produced, could also be checked.
Treatment Options for Malar Rash (Butterfly Rash)
If you have a malar or butterfly rash, the way to manage it depends on the underlying cause. Here’s how these rashes are treated depending on the condition that caused them:
Cellulitis and Erysipelas:
The main way to handle these conditions is through antibiotics. You may take oral antibiotics (pills or liquid) or get antibiotics through an IV (intravenous) in a clinic or hospital.
SLE (Systemic Lupic Erythematosus) and Dermatomyositis:
With these conditions, treatment begins with sun protection. This includes wearing suitable clothing to block the sun, applying sunscreen, and changing your habits so that you’re out of the sun whenever possible. If that’s not enough, your doctor may propose other treatments, like using corticosteroids, either topically (as a cream or ointment) or via intralesional injection (where a medicine is injected into a specific area). You might also be given antimalarial medications or immunosuppressive agents, both of which help to control your immune system and prevent it from attacking your skin.
Rosacea:
If you have rosacea, your doctor may advise using certain skin creams or gels to fortify your skin and decrease its redness. Sometimes, antibiotic treatments are also used to control the inflammation.
Pellagra:
For pellagra, taking oral niacin or nicotinamide (types of vitamin B3) is typically effective in relieving the symptoms.
What else can Malar Rash (Butterfly Rash) be?
If you notice a rash on your cheeks (also called a malar rash), it may be due to several conditions. The issues that could potentially cause this type of rash include:
- Cellulitis – a common bacterial skin infection
- Dermatomyositis – an inflammatory disease leading to muscle weakness and skin rashes
- Erysipelas – a similar infectious disease of the upper layer of the skin, usually by a bacterium
- Pellagra – a disease resulting from niacin (Vitamin B3) deficiency
- Rosacea – a condition that causes redness and often small, red, pus-filled bumps on the face
- Systemic lupus erythematosus – an autoimmune disease causing inflammation to the skin, joints, and organs
What to expect with Malar Rash (Butterfly Rash)
The conditions that cause malar rash, or a rash on the cheeks and the bridge of the nose, can lead to different degrees of illness and risk of death. If the malar rash is caused by conditions like erysipelas (a bacterial skin infection) or cellulitis (a common skin infection), it can get better with the right antibiotics.
Rosacea, another cause of malar rash, may stay the same or worsen over time in some people. Similarly, the outcomes for Systemic Lupus Erythematosus (SLE, a disease where the immune system mistakenly attacks healthy tissues) and dermatomyositis (a rare muscle disease characterized by inflammation and rashes) depend on how active these diseases are.
On the other hand, pellagra (a disease caused by lack of niacin or Vitamin B3) can be effectively treated, and usually has good outcomes.
Preventing Malar Rash (Butterfly Rash)
Malar rash, or a rash on the cheeks and bridge of the nose, is treated differently depending on what’s causing it. If the rash is due to conditions like cellulitis, erysipelas, or pellagra, it usually gets better with the right treatment. Cellulitis is a common bacterial skin infection, erysipelas is a bacterial infection in the upper layers of the skin, and pellagra is a disease caused by a lack of vitamin B3.
On the other hand, if you have a malar rash due to rosacea, a common skin condition that causes redness and visible blood vessels in your face, the condition might come and go. You may need to visit a dermatologist, a doctor who specializes in skin conditions, multiple times to manage this condition effectively.
Lastly, if the malar rash is caused by Systemic Lupus Erythematosus (SLE) or dermatomyositis, which are autoimmune diseases, you will need to be monitored regularly by a rheumatologist. A rheumatologist is a doctor who specializes in the diagnosis and treatment of diseases that affect your joints, muscles, and bones. This monitoring is important as these conditions can affect other parts of your body and require ongoing treatment.