Lupus is a complex and mysterious condition that is diagnosed in approximately 16,000 people in the U.S. every year. This autoimmune disorder causes a normally protective immune system to turn on itself, creating autoantibodies that begin to attack healthy tissues. The result of this attack is inflammation in the body, from the joints to the internal organs to the brain, and can even result in a lupus rash.

What is a lupus rash?

With many different characteristics and no clearly defined cause, this inflammation can present itself in different ways for different people. One of the most common signs of lupus is also one of the most distinctive – a lupus rash. This rash is often referred to as a butterfly or malar rash and appears in the early stages of lupus across the bridge of the nose and cheeks. Rosacea is another type of rash that can be confused with a lupus rash; here’s how to tell the difference.

A lupus rash usually has just one stage but can be of three types.

1. Acute cutaneous lupus

This type of lupus rash is the most common. This is the butterfly or malar rash that is what most people are referring to when they talk about a lupus rash. Acute cutaneous lupus can range from mild to severe, with a surface that is either flat or raised. The color of the rash ranges from red to purple, and the skin may feel hot to touch. It is generally not painful but can be itchy.

The shape of the rash is its calling card – the rash spreads across the bridge of the nose and onto the cheeks in a wing-like shape.

2. Subacute cutaneous lupus lesions

There are two categories in this type of lupus rash. The first category is a rash that is photosensitive, meaning that it can be triggered by sunlight. Exposure to sun can cause a pimple-like rash that appears on the arms, shoulders, neck, and trunk (less commonly on the face). Untreated, the lesions become larger, very itchy, and worse if exposed to sunlight.

The second category is a flat lupus rash that radiates out from where it started, eventually clearing up in the center and leaving a red ring. This type of rash can also worsen with sunlight and can leave a flat scar or discolored area.

3. Chronic cutaneous lupus (also called DLE, discoid lupus erythematosus)

This is the least common of all lupus rashes, occurring in only about 20% of patients. This type of rash occurs only in those patients who do not have systemic lupus but are diagnosed with discoid lupus. DLE lesions are raised and slightly pink. The lesion forms, gets flaky, and eventually scars over. The lesions can get larger and spread over time.

This type of lupus rash occurs mainly above the chin on the scalp and is related to hair loss that can be permanent where scarring is present.

Differences between lupus rash and rosacea rash

Rosacea has three distinct stages of development:

  1. Pre-rosacea: The skin on the face is flushed and reddened but returns to normal after a while.
  2. Vascular rosacea: As with pre-rosacea, the skin reddens easily, but the flush does not disappear as easily. The capillaries in the face are inflamed and irritated and may not return to their regular state quickly.
  3. Inflammatory rosacea: Although all stages of rosacea are a type of inflammation, this third and final stage occurs when skin flushes and stays that way. Cysts that resemble acne may occur in both genders, and men may experience an enlargement of the nose.

Rosacea often feels hot to the touch but can be treated with topical creams that cool and soothe. Over time rosacea can worsen, so seeking medical treatment in the early stages is the best way to manage it.

Managing a lupus rash

If you experience a persistent rash that doesn’t seem to be healing, it important to visit your doctor. She may ask about other symptoms you are experiencing in order to begin to rule out a lupus diagnosis.

Some common symptoms of lupus include:

  • Unexplained fever
  • Fatigue
  • Joint pain and swelling
  • Hair loss (more than 100 strands a day)
  • Anemia
  • Chest pain when breathing deeply
  • Mouth ulcers (usually painless and generally located on the roof of the mouth)

Getting a lupus diagnosis

Because many of these symptoms occur in other conditions, it may be difficult to get an immediate diagnosis of lupus without further examination.

There is no specific test specifically for lupus, so your doctor may follow the Eleven Criteria of Lupus as presented by the American College of Rheumatology when diagnosing lupus:

  1. Malar rash: Butterfly-shaped rash across cheeks and nose
    2. Discoid (skin) rash: Raised red patches
    3. Photosensitivity: Rash occurs as a result of exposure to the sun or indoor lighting on the same UV spectrum
    4. Mouth or nose ulcers: On the roof of the mouth and not painful
    5. Non-erosive arthritis: Painful swelling in two or more joints that does not cause bone damage
    6. Cardio-pulmonary involvement: Inflammation of the lining around the heart (pericarditis) and/or lungs (pleuritis) that causes pain when breathing deeply
    7. Neurologic disorder: Seizures and/or psychosis
    8. Renal (kidney) disorder: Excessive protein in the urine, or cellular casts in the urine
    9. Hematologic (blood) disorder: Hemolytic anemia, low white blood cell count, or low platelet count
    10. Immunologic disorder: Antibodies to double stranded DNA, antibodies to Sm, or antibodies to cardiolipin
    11. Antinuclear antibodies (ANA): Positive test in absence of drugs known to induce it

Some of these categories, such as numbers nine, ten, and eleven, can be discovered through blood tests. Others rely on a thorough physical examination and medical history. Because some of these criteria may be present and others may not, a definitive diagnosis can be difficult to reach quickly.

Regardless of the type of lupus rash, there are ways to treat an uncomfortable and embarrassing flare-up. Visit the Lupus Foundation of America for more information on lupus rash, other skin problems due to lupus, and potential treatments.


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