Malar rash concern

Overview

A malar rash is a red or purple rash that spreads across both cheeks and the bridge of the nose, often in a shape like a butterfly. It can be a sign of a health condition, most commonly lupus (an autoimmune disease where the body attacks its own tissues). But it can also be caused by other things such as rosacea (a skin condition) or a reaction to sun or medicine.

Malar rash itself is not very common, but it is a well-known sign that doctors look for when checking for autoimmune conditions.

It can affect people of any age, but when it is linked to lupus, it is more common in women between the ages of 15 and 44.

Symptoms

Common symptoms

• A red or purple rash that covers the cheeks and bridge of the nose, often in a butterfly shape
• The rash may be flat or slightly raised, and is usually not itchy or painful
• The rash may come and go, and can get worse after being in the sun
• Other symptoms may appear with the rash, such as joint pain, tiredness, or fever

Symptoms in children

• Children with a malar rash may also have a high temperature, sore joints, or feeling very tired
• The rash may look similar to a sunburn, but it does not fade like a sunburn does

Symptoms in older adults

• In older adults, a malar rash can be mistaken for rosacea (a common red rash on the face) or a simple sunburn
• It may be accompanied by dry skin or flushing

Causes

Main causes

• Lupus (systemic lupus erythematosus) – the most common cause when the rash is part of a wider illness
• Rosacea – a skin condition that can cause redness and visible blood vessels on the face
• Seborrheic dermatitis – a condition causing red, scaly patches on oily areas of skin
• Sunburn – if the rash only appears after strong sun exposure
• Medication reactions – some drugs can cause a facial rash that looks like a malar rash
• Other autoimmune diseases – such as dermatomyositis (a rare muscle and skin condition)

Risk factors

• Being a woman of childbearing age (higher risk for lupus)
• Having a family member with an autoimmune disease
• Being exposed to strong sunlight, which can trigger the rash in people who are prone to it
• Taking certain medicines, such as some blood pressure drugs or antibiotics, that can cause a lupus-like rash

When to see a doctor

See a doctor urgently if:

• The rash comes on suddenly with a high fever, joint pain, or feeling very unwell
• You have difficulty breathing, chest pain, or severe fatigue that affects your daily life

Book a routine appointment if:

• You notice a red rash on your face that does not go away after a few weeks
• The rash keeps coming back, especially after sun exposure
• You are worried about the rash and want to find out what is causing it

Diagnosis

A doctor will look at the rash and ask about your symptoms, medical history, and any family history of autoimmune diseases. They will also check for other signs like joint pain, mouth ulcers, or hair loss.

Tests that may be done

• Blood tests – such as an antinuclear antibody (ANA) test, which is often positive in lupus
• Complete blood count – to check for anaemia or low blood cell counts
• Skin biopsy – a small sample of the rash may be taken and examined under a microscope
• Urinalysis – if the doctor suspects kidney involvement

What to expect at your appointment

The diagnosis may involve a visit to your GP first. If lupus or another autoimmune condition is suspected, your GP will refer you to a specialist, such as a rheumatologist (a doctor specialising in autoimmune diseases) or a dermatologist (a skin doctor). The process may take a few visits and tests, but most people get a clear answer.

Treatment

Treatment for a malar rash depends entirely on what is causing it. If the cause is a skin condition like rosacea, treatment focuses on calming the skin. If it is lupus, treatment aims to reduce inflammation and control the overactive immune system. Your doctor will create a plan based on your specific needs.

Self-care at home

• Protect your face from the sun every day – use a broad-spectrum sunscreen with at least SPF 50 and a high UVA star rating
• Wear a wide-brimmed hat and sunglasses when outdoors
• Avoid known triggers, such as very strong sunlight or certain skin products
• Keep your skin clean and moisturised, using gentle, fragrance-free products
• Avoid smoking, as it can worsen autoimmune conditions

Medical treatments

Medical treatments may include creams or ointments that reduce inflammation (steroid creams are one example). For lupus or other autoimmune causes, doctors may prescribe medicines that calm the immune system or reduce inflammation throughout the body. These are given only after a thorough diagnosis and are tailored to each person. It is very important to follow your doctor's instructions and not to stop medication suddenly.

When is surgery considered?

Surgery is not used to treat a malar rash.

Living with this condition

Living with a malar rash means paying attention to your skin and overall health. You may need to plan your day around sun protection – for example, avoiding the sun during peak hours (11am to 3pm). Keep a diary of when the rash appears and what you were doing, to help identify triggers.

Lifestyle tips

• Wear protective clothing and sunscreen every day, even in winter
• Stay hydrated and eat a balanced diet to support your immune system
• Manage stress through relaxation techniques, such as deep breathing or gentle exercise
• Get enough rest – fatigue is common with conditions linked to malar rash

Diet and exercise

A healthy diet rich in fruits, vegetables, and whole grains can help support your body. There is no special diet proven to cure malar rash, but some people find that reducing alcohol or processed foods helps. Moderate exercise such as walking, swimming, or yoga can improve mood and energy, but avoid sun exposure during outdoor activities.

Mental health and emotional wellbeing

Living with a visible rash and a possible chronic condition can be stressful. You may feel self-conscious or anxious. It is normal to feel this way. Talk to your doctor if these feelings affect your daily life. A counsellor or support group can help you cope. Remember, you are not alone.

Prevention

You cannot always prevent a malar rash because it is often linked to genetics or underlying conditions. However, you can reduce flare-ups by protecting your skin from the sun, avoiding known triggers, and staying healthy overall.

Vaccines

There are no vaccines to prevent malar rash. However, staying up to date with recommended vaccines (like the flu shot) can help prevent infections that might trigger flare-ups if you have lupus.

Screening programmes

There is no routine screening for malar rash. If you have a family history of lupus or other autoimmune diseases, you may want to talk to your doctor about any symptoms you notice.

Complications

If left untreated

• If the underlying cause is lupus and it is not treated, it may affect other organs, such as the kidneys (lupus nephritis), heart, or lungs
• Untreated severe lupus can lead to kidney failure, blood clots, or serious infections
• A malar rash caused by a drug reaction can get worse if the medicine is not stopped

Long-term outlook

For many people, a malar rash is a temporary condition or a mild symptom that can be managed well with proper care. When the rash is part of lupus, modern treatments allow most people to live full, active lives. The key is to work closely with your healthcare team, follow your treatment plan, and take good care of your overall health. With the right support, people with malar rash can feel better and stay healthy.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.