Does Everyone with Lupus Have a Butterfly Rash?

Reviewed on 4/7/2022

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A malar rash (butterfly rash) affects about half of all patients with lupus.

Not everyone with lupus has a butterfly rash (so-named because it resembles a butterfly), also called a malar rash. A malar rash affects about half of all patients with lupus.

The butterfly-shaped rash on the cheeks and nose can happen spontaneously or after sun exposure. The rash usually looks red and raised, may be scaly, and usually does not affect the nasal folds. The butterfly rash may occur on its own, but sometimes the rash indicates an oncoming flare-up. 

In addition to the butterfly rash, symptoms of lupus may include:

What Is Lupus?

Lupus is a chronic autoimmune disease in which the body’s immune system mistakenly attacks its own organs and tissues, causing inflammation and pain, commonly in the skin, joints, and internal organs such as the heart and kidneys, though it can affect any part of the body. 

The different types of lupus include: 

What Causes Lupus?

The cause of lupus is unknown, but it is believed to have genetic, hormonal, immunologic, and/or environmental triggers. 

How Is Lupus Diagnosed?

There is no single test to diagnose lupus. Tests used to help diagnose lupus or to rule out other conditions include:

  • Blood tests 
    • Complete blood count (CBC
    • Antibody tests 
    • Blood clotting time tests 
    • Erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) levels
    • Complement tests 
    • Creatinine
    • Protein electrophoresis
    • ANA 
    • Anti-double-stranded DNA (anti-dsDNA)
    • Antiphospholipid antibodies (lupus anticoagulant [LA], immunoglobulin [Ig] G and IgM anticardiolipin [aCL] antibodies, and IgG and IgM anti-beta2-glycoprotein [GP] 1)
    • C3 and C4 or CH50 complement levels
    • Urine protein-to-creatinine ratio
    • Serologic studies for infection
    • Rheumatoid factor and anti-cyclic citrullinated peptide antibodies
    • Creatine kinase (CK)
  • Urine tests
  • Tissue or organ biopsies
  • Electrocardiography 
  • Tests to check for pulmonary embolism 
  • Diffusing capacity for carbon monoxide 
  • X-rays of swollen joints
  • Chest X-rays
  • Ultrasound 
  • Echocardiography 
  • Computed tomography (CT) scan 
  • Magnetic resonance imaging (MRI)


Lupus is an infection. See Answer

What Is the Treatment for Lupus?

Lupus is usually treated with medications to help manage symptoms, such as:

  • Anticoagulants 
  • Anti-inflammatories and steroids 
  • Antimalarials (to help protect skin from rashes and UV light)
  • Biologics 
  • Immunosuppressives 

Other steps to help patients manage symptoms of lupus include:

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Reviewed on 4/7/2022
Image Source: Getty Images