What Is Malar Rash?
Malar rash, also called a butterfly rash, is a common facial presentation of multiple disorders. A flat or raised rash across the bridge of the nose and cheeks typically characterizes it. It may be transient or progress to affect other areas of facial skin. Malar rash is primarily seen in people with systemic lupus erythematosus. It is one of the criteria for diagnosing systemic lupus erythematosus (SLE). It can also be present with other forms of lupus, such as discoid lupus and subacute cutaneous lupus. The rash may be scaly, itchy, and sometimes painful. They may come and go and persist for days or weeks.
What Causes Malar Rash?
Malar rash may happen in several diseases. Common causes of malar inflammation are:
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Erysipelas: This skin infection involves superficial lymphatics and the upper dermis. Blisters may also form. Other symptoms include fever, chills, and malaise.
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Cellulitis: It is a bacterial infection affecting the deeper skin layers, muscles, and connective tissue. Staphylococcus bacteria usually cause it. It causes the skin to become darker, sometimes purplish color.
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Systemic Lupus Erythematosus: This is a common cause of malar rashes. It is an autoimmune disorder involving multiple organs. In lupus, the immune system mistakenly attacks different body parts, including kidneys, joints, skin, brain, and heart. Some people with this condition can also have round, scaly patches of skin on the body, especially in sun-exposed places. Symptoms can range from mild rashes and arthritis to debilitating fever, joint pain, fatigue, severe organ damage, and life-threatening condition.
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Rosacea: It is the most common cause of malar rash causes. It is a skin condition that is not related to systemic disease. The condition is more common in fair-skinned people. About 22 % of people with fair skin may have rosacea. Malar rash from rosacea appears red with minor bumps and tiny broken blood vessels.
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Factors that can trigger rosacea include:
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Sunlight.
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Spicy foods.
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Alcoholic drinks.
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Hot drinks and hot baths.
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Hot, cold, or windy weather.
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Cosmetic products.
Rare Causes
Malar rash can also happen due to two rare conditions, such as:
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Pellagra: Pellagra is a systemic disease resulting from a lack of vitamin B3 (niacin). It is characterized by 4 "D's": dermatitis, dementia, diarrhea, and death. People with pellagra often get a skin rash that resembles sunburn at first. However, the rash turns darker with time, and the skin may blister and flake.
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Dermatomyositis: This rare disorder causes red rashes on sun-exposed skin. It often affects people between 50 and 70. Dermatomyositis has multiple skin manifestations, including red eyelids and hard calcium deposits under the skin. It also inflames and weakens muscles.
What Are the Symptoms of Malar Rash?
A malar rash appears as a red rash that occurs across the bridge of the nose and cheeks. The rases can be flat or raised bumps. One typical sign of a malar rash is that it usually spares the folds of skin that run from the nose to the lips. The rash may appear and go, or it may worsen gradually.
How Is Malar Rash Diagnosed?
Because a malar rash is a symptom of an underlying condition, the doctor diagnoses what is causing the rash. Diagnosing a malar rash can be challenging because there are many possible causes, each requiring specialized treatment. The doctor should take a medical history and review the symptoms to determine other possibilities. An accurate diagnosis requires a proper physical examination and a complete medical history, including medications. Sometimes doctors may order a skin biopsy and examine the tissue under a microscope.
How Are Malar Rashes Treated?
Malar rash treatment can vary from person to person based on the causative condition.
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Rosacea: Rosacea cannot be cured, but the symptoms can improve with treatment. Rosacea treatment includes creams or gels to repair the skin and reduce redness and oral antibiotics to control the inflammation. Steroid creams usually make the condition worse.
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Systemic Lupus Erythematosus: People with lupus should avoid sun exposure by wearing appropriate clothing and sunscreens and behavior change. Steroid injections and topical creams help improve the rash. In addition, the doctor may prescribe hydroxychloroquine, an oral medication that can reduce the immune response.
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Skin Infections: The mainstay of skin infection treatment is oral or intravenous antibiotic therapy.
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Pellagra: A person with pellagra usually improves within two days of starting treatment with niacin supplements. Oral niacin or nicotinamide effectively resolves the clinical symptoms of pellagra.
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Dermatomyositis: There is no specific treatment for dermatomyositis, but medications and physical therapy can benefit.
When To See a Doctor for a Malar Rash?
Although malar rashes are not severe, they can be signs of underlying conditions. Therefore, one should see a doctor for any inflammation if it:
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Covers the whole body.
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It appears suddenly and spreads rapidly.
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Accompanied by a fever.
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Causes pain.
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Creates blisters.
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Becomes infected.
Even if a malar rash may not meet any of these criteria, it can sometimes be itchy or painful. In addition, people with malar rash symptoms often see a doctor because of cosmetic concerns.
What Is the Outlook for Malar Rash?
A malar rash may have multiple causes, from sunburn to chronic diseases. Malar rash caused by erysipelas and cellulitis improves with proper antibiotic therapy. On the other hand, chronic conditions, such as systemic lupus erythematosus and rosacea, cannot be cured, but their symptoms may improve with treatment. The prognosis of lupus and dermatomyositis primarily depends on the disease's activity. Pellagra has a good prognosis with the proper treatment. See a doctor for a malar rash to determine the underlying cause and start on the appropriate treatment.
Conclusion
Many causative conditions can cause a malar rash. Because a malar rash is a symptom of an underlying condition, an excellent medical history, and physical examination are essential because the diagnosis may not be straightforward. Seeing a doctor helps determine the underlying cause of a rash, start the appropriate treatment, and get the best outcome.
