Butterfly facial rashes do not always indicate systemic lupus erythematosus

Lupus Systemic lupus erythematosus

Systemic lupus erythematosus, (SLE) commonly known as lupus, is a complex autoimmune disease that affects multiple organs. As an autoimmune disease, it can lead to inflammation and damage various organs. The most recognizable feature of SLE is the butterfly rash, a facial rash that spreads across the cheeks and bridge of the nose resembling the wings of the butterfly called a malar rash or lupus rash.  Although commonly noted in lupus, having a facial rash is not mandatory for diagnosing lupus. It is crucial to understand that not all facial rashes indicate SLE.

The butterfly faces rash and its characteristics 

The butterfly rash is one of the hallmark symptoms of SLE. It is called a butterfly rash because of its distinctive appearance, spanning across the cheeks and the bridge of the nose, often sparing the nasolabial folds. The rash’s sensitivity to sunlight is a common feature, often worsening with sun exposure.

Other potential causes of facial rashes:

There are several other facial rashes that may be mistaken for SLE. Additionally, butterfly rashes can also develop in various local and systematic disorders and some of them are listed below: 

Erysipelas: It is a skin infection that affects the upper layers of the skin and lymphatic system. It is characterized by a painful, red rash that spreads quickly and has a distinct border. The affected area may also appear shiny and swollen around hair follicles. Symptoms can include fever, chills, and overall feeling of illness.  

Dermatitis: Various forms of dermatitis can result in localized redness, itching, and inflammation on the face, sometimes giving the appearance of a butterfly rash. Careful history-taking and clinical examination help differentiate dermatitis from other conditions. 

Photosensitivity: Certain medications, underlying conditions, or photodermatitis can lead to sun-induced skin sensitivity and rash on sun-exposed areas, mimicking the butterfly rash. This often requires a correlation between medical history and medication use. 

Rosacea: Rosacea is a chronic skin condition that causes redness, acne-like symptoms, and visible blood vessels on the face. It is common in middle-aged individuals with fair skin and can be triggered by hot drinks, stress, or alcohol. It is not a systemic illness and is caused by both genetic and environmental factors. 

Allergic reaction: Allergies to foods, medicines, or skincare products can cause facial redness, swelling, and facial redness, swelling, and rash that might be mistaken for a butterfly rash. A thorough review of the allergen exposure is key to its diagnosis. 

Eczema: Eczema is an inflammatory skin condition that causes itchiness, dry skin, rashes, scaly patches, blisters, and infections on the face that might appear as a butterfly rash. Additional eczema features like dryness and scaling provide clues to diagnosis. 

Lupus miliaris disseminates faciei (LMDF): This rare condition presents small red papules and pustules on the face, resembling a butterfly rash. Despite its name, it is distinct from SLE and often requires histopathological examination for confirmation. 

Melasma: Although not a true butterfly rash, melasma can cause brown or gray patches on the face, sharing a similar distribution. Hormonal changes and sun exposure are triggers. 

Parvovirus B19 Infection: In children, parvovirus infection can result in a slapped cheek rash that might look like a butterfly rash.  Accompanying symptoms and the timing of the rash can help in diagnosis. 

Misconceptions about the butterfly rash and SLE:  

a) All facial rashes are not SLE: While the butterfly rash is strongly associated with SLE, it is crucial to recognize that other conditions can cause similar facial rashes. Depending solely on the butterfly rash for diagnosis can result in delayed or incorrect identification of other underlying medical issues. 

b) Variability in the presentation: The butterfly rash may not appear in all individuals with SLE, and its characteristics can vary among those affected. Some may experience milder or atypical rashes, making diagnosis challenging. 


If an individual experiences a facial rash or any skin condition, it is best to avoid panicking and instead seek medical evaluation from a dermatologist or rheumatologist. They can conduct a thorough examination, review medical history, and perform appropriate testing to accurately identify the underlying cause. Understanding this complex landscape of differential diagnosis, medical experts can offer precise and individualized treatment for each patients specific condition.