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Symptoms and Signs – Differential Diagnosis of Butterfly Rash
While a butterfly rash is commonly associated with systemic lupus erythematosus (SLE), it can also indicate the presence of dermatological diseases. Commonly, butterfly rash manifests as a malar dispersion spanning the nose and cheeks. Consult the document "Recognizing Butterfly Rash." Analogous rashes may manifest on the cervical region, cranial region, and other anatomical regions. Butterfly rash is occasionally confused with sunburn because to its susceptibility to exposure to UV radiation, but it possesses more substance, is more clearly defined, and has a denser texture compared to the surrounding skin.
Histories and Physical Assessment
Seek information from the patient regarding the initial observation of the butterfly rash and any recent sun exposure. Does he have any other cutaneous lesions on his body? Request information regarding recent weight loss or hair loss. Does he have a familial predisposition to lupus? Has he been prescribed hydralazine or procainamide, which are often associated with drug-induced lupus erythematosus (LE)?
Examine the rash, making a note of any discernible macules, papules, pustules, or scaling. Does the skin rash exhibit edema? Are regions exhibiting either hypopigmentation or hyperpigmentation? Seek out blisters or ulcers in the oral cavity, and make a note of any irritated lesions. Assess for any cutaneous eruptions on other areas of the body.
Identification of Butterfly Rash
Lesions on the cheekbones and the bridge of the nose form a distinctive butterfly pattern in cases of typical butterfly rash. The rash can range in intensity from redness of the skin to large, raised lesions known as plaques.
Differential Diagnosis of Butterfly Rash
Discoid lupus erythematosus
In cases of discoid lupus erythematosus, a specific type of lupus erythematosus, patients may present at your facility with a unilateral or butterfly rash characterized by red, elevated, well defined plaques with follicular plugging and central atrophy. In addition, the rash may affect the scalp, ears, chest, or any other body area that is exposed to sunlight. Late on, telangiectasia, scarring alopecia, and either hypopigmentation or hyperpigmentation may develop. Additional symptoms include redness of the conjunctiva, distended capillaries in the nail fold, enlargement of the parotid glands on both sides, lesions in the mouth, and spotted, reddish blue skin on the legs.
Erysipelas
Erysipelas results in rose or crimson enlarged lesions, mostly manifesting on the neck and head, and sometimes along the nasolabial fold. This condition can result in hemorrhagic pus-filled blisters. Other manifestations include pyrexia, rigor, cervical lymph node involvement, and fatigue.
Polymorphous light eruption.
The butterfly rash manifests as redness, vesicles, plaques, and several small raised lesions that may subsequently develop eczema, lichenification, and excoriation. Induced by UV radiation, the rash manifests on the cheeks and nasal bridge, the hands and arms, and other regions, commencing a few hours to several days following exposure. It may be accompanied by sensations of itching.
Rosacea
At first, butterfly rash may manifest as a conspicuous, non-scaling, sporadic redness confined to the lower portion of the nose or that extends to the chin, cheeks, and center forehead. The duration of the rash in rosacea grows as it progresses; rather than resolving after each episode, the rash fluctuates in intensity and is often accompanied with telangiectasia. The skin in advanced rosacea is greasy, with papules, pustules, nodules, and telangiectasis confined to the center oval of the face. The presence of rhinophyma, a thickened, lobulated overgrowth of sebaceous glands and epithelial connective tissue on the bottom half of the nose and maybe the neighboring cheeks, may be observed in men with severe rosacea, in addition to butterfly rash. This is particularly prevalent among geriatric people.
Seborrheic dermatitis
Butterfly rash manifests as oily, scaling, somewhat yellow patches and raised bumps of different sizes on the cheeks and the bridge of the nose, arranged in a pattern resembling a butterfly. Furthermore, the scalp, beard, eyebrows, areas of the forehead above the nasal bridge, nasolabial fold, or trunk may also be affected.
be involved. Correlating indications and manifestations include the presence of crusts and fissures (especially when the outer ear and scalp are affected), itching, redness, inflammation of the eyes, styes, intense acne, and oily skin. Concurrent with acquired immunodeficiency syndrome is the development of severe seborrheic dermatitis of the face.
Systemic lupus erythematosus.
Occurring in around 40% of individuals with this connective tissue condition, butterfly rash manifests as a red, typically scaly, well defined macular eruption. The rash can be temporary in patients with acute systemic lupus erythematosus (SLE) or may gradually advance to encompass the forehead, chin, ear region, and other areas at risk. Scaling, patchy alopecia, mucous membrane lesions, mottled erythema of the palms and fingers, periungual erythema with edema, reddish purple macular lesions on the volar surfaces of the fingers, telangiectasia of the base of the nails or eyelids, purpura, petechiae, and ecchymoses are typical skin findings associated with this condition.
Joint pain, stiffness, and abnormalities, including ulnar deviation of the fingers and subluxation of the proximal interphalangeal joints, may also be present in cases with butterfly rash. The associated symptoms include swelling around the eyes and face, difficulty breathing, a mild temperature, general malaise, weakness, exhaustion, loss of weight, lack of appetite, nausea, vomiting, swelling of the lymph nodes, sensitivity to light, and enlargement of the liver and spleen.
Other Causes Pharmaceuticals. The combination of hydralazine and procainamide can induce a lupus-like condition.
Points of Special Consideration
Set the patient up for immunologic tests, a comprehensive blood count, and potentially, liver tests. Obtain a urine sample, if necessary. Do not administer photosensitizing medications, including phenothiazines, sulfonamides, sulfonylureas, and thiazide diuretics. Advise the patient to refrain from any contact with sunlight or to apply sunscreen. Propose the use of hypoallergenic cosmetics to effectively mask face lesions.
Therapeutic Counseling for Patients
Suggest the usage of sunscreen and emphasize the need of avoiding sun exposure. Promote the application of hypoallergenic cosmetics for the purpose of concealing facial lesions. Brief the patient on available support resources, such as the Lupus Foundation of America.
Guidelines for Pediatric Populations
Minimal in occurrence among children, a butterfly rash can manifest as a component of an infectious condition such as erythema infectiosum, sometimes known as "slapped cheek syndrome."
While a butterfly rash is commonly associated with systemic lupus erythematosus (SLE), it can also indicate the presence of dermatological diseases. Commonly, butterfly rash manifests as a malar dispersion spanning the nose and cheeks. Consult the document "Recognizing Butterfly Rash." Analogous rashes may manifest on the cervical region, cranial region, and other anatomical regions. Butterfly rash is occasionally confused with sunburn because to its susceptibility to exposure to UV radiation, but it possesses more substance, is more clearly defined, and has a denser texture compared to the surrounding skin.
Histories and Physical Assessment
Seek information from the patient regarding the initial observation of the butterfly rash and any recent sun exposure. Does he have any other cutaneous lesions on his body? Request information regarding recent weight loss or hair loss. Does he have a familial predisposition to lupus? Has he been prescribed hydralazine or procainamide, which are often associated with drug-induced lupus erythematosus (LE)?
Examine the rash, making a note of any discernible macules, papules, pustules, or scaling. Does the skin rash exhibit edema? Are regions exhibiting either hypopigmentation or hyperpigmentation? Seek out blisters or ulcers in the oral cavity, and make a note of any irritated lesions. Assess for any cutaneous eruptions on other areas of the body.
Identification of Butterfly Rash
Lesions on the cheekbones and the bridge of the nose form a distinctive butterfly pattern in cases of typical butterfly rash. The rash can range in intensity from redness of the skin to large, raised lesions known as plaques.
Differential Diagnosis of Butterfly Rash
Discoid lupus erythematosus
In cases of discoid lupus erythematosus, a specific type of lupus erythematosus, patients may present at your facility with a unilateral or butterfly rash characterized by red, elevated, well defined plaques with follicular plugging and central atrophy. In addition, the rash may affect the scalp, ears, chest, or any other body area that is exposed to sunlight. Late on, telangiectasia, scarring alopecia, and either hypopigmentation or hyperpigmentation may develop. Additional symptoms include redness of the conjunctiva, distended capillaries in the nail fold, enlargement of the parotid glands on both sides, lesions in the mouth, and spotted, reddish blue skin on the legs.
Erysipelas
Erysipelas results in rose or crimson enlarged lesions, mostly manifesting on the neck and head, and sometimes along the nasolabial fold. This condition can result in hemorrhagic pus-filled blisters. Other manifestations include pyrexia, rigor, cervical lymph node involvement, and fatigue.
Polymorphous light eruption.
The butterfly rash manifests as redness, vesicles, plaques, and several small raised lesions that may subsequently develop eczema, lichenification, and excoriation. Induced by UV radiation, the rash manifests on the cheeks and nasal bridge, the hands and arms, and other regions, commencing a few hours to several days following exposure. It may be accompanied by sensations of itching.
Rosacea
At first, butterfly rash may manifest as a conspicuous, non-scaling, sporadic redness confined to the lower portion of the nose or that extends to the chin, cheeks, and center forehead. The duration of the rash in rosacea grows as it progresses; rather than resolving after each episode, the rash fluctuates in intensity and is often accompanied with telangiectasia. The skin in advanced rosacea is greasy, with papules, pustules, nodules, and telangiectasis confined to the center oval of the face. The presence of rhinophyma, a thickened, lobulated overgrowth of sebaceous glands and epithelial connective tissue on the bottom half of the nose and maybe the neighboring cheeks, may be observed in men with severe rosacea, in addition to butterfly rash. This is particularly prevalent among geriatric people.
Seborrheic dermatitis
Butterfly rash manifests as oily, scaling, somewhat yellow patches and raised bumps of different sizes on the cheeks and the bridge of the nose, arranged in a pattern resembling a butterfly. Furthermore, the scalp, beard, eyebrows, areas of the forehead above the nasal bridge, nasolabial fold, or trunk may also be affected.
be involved. Correlating indications and manifestations include the presence of crusts and fissures (especially when the outer ear and scalp are affected), itching, redness, inflammation of the eyes, styes, intense acne, and oily skin. Concurrent with acquired immunodeficiency syndrome is the development of severe seborrheic dermatitis of the face.
Systemic lupus erythematosus.
Occurring in around 40% of individuals with this connective tissue condition, butterfly rash manifests as a red, typically scaly, well defined macular eruption. The rash can be temporary in patients with acute systemic lupus erythematosus (SLE) or may gradually advance to encompass the forehead, chin, ear region, and other areas at risk. Scaling, patchy alopecia, mucous membrane lesions, mottled erythema of the palms and fingers, periungual erythema with edema, reddish purple macular lesions on the volar surfaces of the fingers, telangiectasia of the base of the nails or eyelids, purpura, petechiae, and ecchymoses are typical skin findings associated with this condition.
Joint pain, stiffness, and abnormalities, including ulnar deviation of the fingers and subluxation of the proximal interphalangeal joints, may also be present in cases with butterfly rash. The associated symptoms include swelling around the eyes and face, difficulty breathing, a mild temperature, general malaise, weakness, exhaustion, loss of weight, lack of appetite, nausea, vomiting, swelling of the lymph nodes, sensitivity to light, and enlargement of the liver and spleen.
Other Causes Pharmaceuticals. The combination of hydralazine and procainamide can induce a lupus-like condition.
Points of Special Consideration
Set the patient up for immunologic tests, a comprehensive blood count, and potentially, liver tests. Obtain a urine sample, if necessary. Do not administer photosensitizing medications, including phenothiazines, sulfonamides, sulfonylureas, and thiazide diuretics. Advise the patient to refrain from any contact with sunlight or to apply sunscreen. Propose the use of hypoallergenic cosmetics to effectively mask face lesions.
Therapeutic Counseling for Patients
Suggest the usage of sunscreen and emphasize the need of avoiding sun exposure. Promote the application of hypoallergenic cosmetics for the purpose of concealing facial lesions. Brief the patient on available support resources, such as the Lupus Foundation of America.
Guidelines for Pediatric Populations
Minimal in occurrence among children, a butterfly rash can manifest as a component of an infectious condition such as erythema infectiosum, sometimes known as "slapped cheek syndrome."
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