malar rash (butterfly rash)

Introduction

Butterfly shaped rash on face (maxillary nerve distribution)

Etiology

• 46-65% of patients with systemic lupus erythematosus

Clinical manifestations

• red or purplish & mildly scaly rash
• shape of a butterfly
• involves the bridge of the nose
• spares the nasolabial folds of the face & areas beneath the nose & lower lip

* images

Laboratory

• antinuclear antibody (ANA) & further testing for systemic lupus erythematosus if positive

Differential diagnosis

• disorders not sparing nasolabial folds
  • rosacea (facial flushing that flares with strong emotion, hot drinks)
  • dermatomyositis (heliotrope rash, Grotton's papules)
• erythema infectiosum due to parvovirus B19 infection (slapped cheek rash)
• erysipelas may spare nasolabial folds
  • sharply demarcated erythema may be at the border of the nasolabial folds
  • fever, chills, malaise, male

More general terms

• rash

Additional terms

• malar