What to Know About a Malar Rash

A malar rash is an outbreak on the face that appears as redness of the skin on the nose, cheeks, and chin. It's a unique rash because it can be associated with different medical conditions, such as those that will trigger the immune system to be hyperactive. When the immune system is activated against itself, conditions known as autoimmune disorders can develop.

Autoimmune disorders occur when the immune system—which normally attacks viruses and bacteria—makes a mistake and starts attacking itself. Some autoimmune disorders are central causes of malar rash.

This article teaches about the common causes of malar rash, how they are diagnosed, and how they are treated. 

What Is a Malar Rash?

Malar rash—sometimes called a butterfly rash—is an eruption on the skin that makes specific regions of skin on the face appear red. A malar rash in itself is not usually itchy or painful. Instead, malar rash is most noticeable as a deep red or pink color that spreads across the nose and the cheeks. The red color is known by the medical term "erythema."

Typically, a malar rash—or erythema on the face—is an indicator of another condition causing the body's immune system to respond negatively. The skin can become inflamed and turn red when the immune system starts attacking itself, which can be the case with certain autoimmune conditions.

Aside from changing your facial appearance, a malar rash is not usually responsible for causing any other issues. Instead, it often indicates other health conditions that may be present.

Symptoms

Symptoms of a malar rash include redness around the nose and cheeks. Importantly, a malar rash does not appear on the region of skin around the lips and next to the nose, known as the nasolabial fold. Additional symptoms that can be associated with some disorders linked to malar rash are:

• Fatigue
• Joint pain
• Muscle pain and aches
• Fever
• Chills
• Sensitivity to Light
• Ulcers or sores in the mouth

Causes

A malar rash is a type of skin eruption that can occur with many conditions, including autoimmune conditions. One of the autoimmune conditions associated with a malar rash is the condition systemic lupus erythematosus—or lupus for short.

While a malar rash is associated with lupus, there are many potential causes of malar rash. Some of the other common conditions that can cause a malar rash include:

• Drug-induced lupus
• Dermatomyositis
• Rosacea

It is important to note that having a malar rash does not mean that you have these conditions. Rather, a malar rash is just one of the many different elements that these conditions may cause. As a result, if you believe you have a malar rash, you should always have a medical professional evaluate you. Additional testing and blood work is always needed to diagnose an autoimmune condition.

The diagnostic tests for causes of a malar rash can include blood tests and skin tests. A skin test is performed by removing a small amount of affected skin, a test known as a biopsy. 

• Complete blood count (CBC)
• Erythrocyte sedimentation rate  
• Complete metabolic panel (CMP)
• Antinuclear antibody 
• Anti-dsDNA antibody 
• Anti-smith antibody
• Anti-U1RNP antibody 
• Urine testing 
• Skin biopsy 
  

Malar Rash and Lupus

While malar rash can be commonly associated with lupus, it is not always the case. Some people with lupus never experience a malar rash and instead develop other more spot-like rashes, known as discoid lupus. In some cases, the rash may only appear when exposed to the sun, known as photosensitivity.

Only around 10% of people with lupus will develop cutaneous lupus—lupus that affects the skin.

Treatment

The treatment for malar rash is dependent on the underlying diagnosis.

Different treatments are required for each cause of malar rash, though most will target the immune system. Immunosuppressant drugs that turn down the activity of the immune system can help reduce the inflammation of malar rash. If you have an autoimmune condition such as lupus, treatment will often require care from a specialist such as a rheumatologist who has expertise in managing autoimmune conditions.

Some of the common immunosuppressive treatments for lupus include:

• Nonsteroidal anti-inflammatory drugs (NSAIDS) including ibuprofen (Advil or Motrin)
• Corticosteroids 
• Imuran (azathioprine)
• Plaquenil (hydroxychloroquine)
• CellCept (mycophenolate mofetil)
• Benlysta (belimumab)
  

Life-Threatening Complications

Malar rash itself should prompt medical evaluation and treatment, but a malar rash alone is rarely life-threatening.

If you are experiencing any additional symptoms, such as difficulty breathing, fatigue, weakness, or difficulty with urination, you may need to seek urgent medical care. If you have recently started a new medication and notice symptoms such as  a malar rash, plan for more urgent medical evaluation. Some forms of lupus may be triggered by medications and require prompt medical treatment and discontinuation of the offending drug.

Summary

A malar rash is a red eruption on the skin of the face. It is most often associated with autoimmune conditions such as systemic lupus erythematosus (SLE) or cutaneous lupus syndromes. The diagnosis and treatment of a malar rash are contingent on the underlying cause and can involve medications such as corticosteroids.  

A Word From Verywell

A malar rash, or butterfly rash, on the face, can be an alarming finding. However, it is best to work with a healthcare provider to evaluate potential causes. A malar rash can appear similar to common issues like sunburn or rosacea. In some cases, a malar rash is an indicator of lupus.