A malar rash, or butterfly rash, typically appears across the cheeks and bridge of the nose in a butterfly shape. Lupus and rosacea are two conditions that can cause a malar rash.

A malar rash can be flat or bumpy. It may appear red, pink, purple, or brown in color. The appearance of the rash may help determine whether it is a lupus rash or due to rosacea.

Lupus occurs when the immune system mistakenly attacks healthy cells and can affect many areas of the body. Rosacea is an inflammatory condition that affects the skin on the face.

This article discusses how lupus and rosacea can lead to malar rash, alongside more details about lupus and rosacea, other causes of malar rash, and whether a person can prevent the rash.

Both lupus and rosacea can cause a malar rash. Malar rashes have a similar appearance in both conditions, but there may also be some differences.

A small 2019 study suggests that, when a person has lupus, malar rash is more likely to present as reddish or salmon-colored dots with white outer circles. With rosacea, malar rash is more likely to also present with raised blood vessels. However, it is important to note that the study did not differentiate between skin colors. The rash may appear different on dark skin.

Malar rash is one of the diagnostic criteria of lupus. However, it can be more difficult to diagnose rosacea based on malar rash.

A healthcare professional will likely take a full medical history and perform a physical examination to identify the condition causing the rash. While both lupus and rosacea can cause a malar rash, their other symptoms differ. They can help determine the underlying cause.

Other symptoms of rosacea

Alongside malar rash, symptoms of rosacea can include:

  • red or discolored areas on the skin of the face
  • visible blood vessels on the surface of facial skin
  • thickening of the skin, typically on the nose
  • swelling, flaking, and itching of facial skin
  • inflammation of the eyes and eyelids

Other symptoms of lupus

Alongside malar rash, symptoms of lupus can include:

Learn about the early signs of lupus.

Malar rash may appear dark brown or dark purple when a person has a dark skin tone.

According to the Lupus Foundation of America, the purple or brown coloration of malar rash on dark skin tones can lead to a misdiagnosis if a healthcare professional does not have enough experience.

View the following slideshow for photos of malar rash.

Learn more about what lupus looks like.

A 2023 article suggests that rosacea is the most common cause of malar rash.

Rosacea is an inflammatory skin condition that typically affects the skin on the nose and cheeks. Rosacea usually causes visible blood vessels on the surface of the skin.

Symptoms of rosacea typically come and go. They can extend to other areas of the body, including the:

  • scalp
  • ears
  • neck
  • chest

Certain factors may trigger or worsen a person’s symptoms. These can include:

  • sunlight exposure
  • extreme weather
  • consuming alcohol
  • certain medications
  • stress

There is currently no cure for rosacea. However, several medications can help a person manage symptoms and prevent the condition from worsening.

Anybody can get rosacea, but it is more likely to develop in women and middle-aged and older adults. It is also more common in people with light skin. However, the National Institute of Arthritis and Musculoskeletal and Skin Diseases notes that the condition may be underdiagnosed in people with dark skin.

Lupus is an autoimmune disease that occurs when the immune system mistakenly attacks healthy cells. This can lead to inflammation and tissue damage in multiple areas, including the skin.

Symptoms of lupus can vary from person to person. They may come and go in flares, ranging from mild to severe.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), several factors can trigger lupus, including:

  • environmental factors
  • genetics
  • the body’s inability to remove dead or damaged cells

There is currently no cure for lupus. However, several treatment options can help a person manage symptoms.

Around 9 in 10 adults with lupus are women, according to the Office on Women’s Health. The condition is also more likely to develop:

  • in people between the ages of 15 and 44 years
  • in African American people
  • in people of Asian or Native American descent

Receiving treatment for lupus or rosacea can help manage a malar rash and other symptoms.

Treatments for rosacea can include:

  • oral medications such as antibiotics and retinoids
  • topical products that contain antibiotics, vasoconstrictors, or antiparasitics
  • laser therapy
  • surgery to remove thickened skin

Learn more about rosacea medications.

Treatment for symptoms of lupus can include:

  • anti-inflammatory medications
  • corticosteroids
  • antimalarials
  • immunosuppressants
  • biologics
  • complementary therapies

Learn more about lupus treatments.

Aside from lupus and rosacea, some other health conditions and other factors that can cause a malar rash include:

If a person has a malar rash, the doctor will perform a physical examination. In some cases, they may be able to confirm the diagnosis based on a person’s symptoms. They may also order tests to help reach an accurate diagnosis.

A person with lupus or rosacea may not be able to prevent malar rash. However, treating the condition may help reduce symptoms.

Both lupus and rosacea can cause a malar rash. Malar rash can appear flat or bumpy across the bridge of the nose and cheeks, resembling a butterfly shape.

With lupus, a malar rash may be red or salmon-colored, with white circles bordering the rash. On dark skin, it may appear dark purple or dark brown. Rosacea is more likely to cause a malar rash due to raised blood vessels.

There is currently no cure for either lupus or rosacea. However, several treatments can help a person manage each condition.