It appears by the malar area of the cheeks — around your cheekbones — “and it has the shape of a butterfly as it goes across the bridge of the nose,” says Dr. Werth. The rash can also occur on the arms, legs, and body, she adds.
“About 90 percent of patients who get malar rash have systemic lupus. This type of rash, as well as most lupus rashes, is generally inflamed, and so it’s edematous [swollen], it’s raised, and it’s red. It has a lot of mimics, or other conditions that can appear to be butterfly rash, so it needs to be distinguished from those,” says Stojan.
One way to make that diagnosis is through a biopsy, in which a doctor takes a tissue sample and examines it under a microscope. “Not all butterfly rashes are lupus — that’s important to note; eczema is one example of a skin condition that may look like butterfly rash,” he says.
Malar rash is a classic photosensitive rash; it tends to be induced by sun exposure, says Stojan. “Many patients will report that when they’re in the sun their rash worsens, or maybe they notice that their rash gets worse during the summer months,” he says.