Based on NIH | What does a lupus-related skin rash look like, and where does it typically appear on the body?

A lupus-related skin rash often appears as a red or purple rash on sun‑exposed areas and can take several characteristic forms, most commonly the “butterfly” (malar) rash across the cheeks and bridge of the nose. ^[1] It may also present as scaly, raised patches or plaques that are pink to red, sometimes flaking or crusting on the surface. ^[2] Many people notice that rashes worsen with sunlight or UV exposure because lupus skin disease is frequently photosensitive. ^[3]

Common appearances

• Butterfly (malar) rash: This is a flat or slightly raised redness that spans both cheeks and the bridge of the nose, typically sparing the folds next to the nostrils; it can look vividly red in lighter skin and more violaceous (purple‑red) in darker skin. ^[1] A representative medical image shows the classic facial distribution including the nose. ^[4]
• Subacute cutaneous lesions: These are often red, scaly patches or ring‑shaped (annular) plaques that can merge, usually on the upper trunk and arms; they tend to heal without scarring but can leave color changes. ^[5]
• Discoid lesions: Thick, raised, scaly plaques that are round (“discoid”), most common on the face, ears, scalp, neck, and hands; they can leave dark or light spots and sometimes scarring, with scalp involvement risking permanent hair loss. ^[2]
• General cutaneous signs: Some people develop rashes or sores on the face, neck, scalp, ears, arms, chest, and other sun‑exposed areas and may also get painless mouth or nose ulcers. ^{[3] [6]}

Typical body locations

• Face and nose (malar area): The classic butterfly rash crosses the cheeks and bridge of the nose. ^{[1] [4]}
• Scalp, ears, neck, and hands: Discoid plaques commonly appear here and may scar; scalp plaques can damage hair follicles and lead to permanent hair loss. ^[2]
• Chest, shoulders, arms, and upper back: Subacute cutaneous lupus favors sun‑exposed regions of the upper trunk and extremities. ^[5]
• General sun‑exposed skin: Cutaneous lupus rashes often occur on areas that get sunlight, including the face, scalp, chest, and arms. ^{[7] [8]}

Photosensitivity and triggers

• UV light (sunlight and tanning beds) frequently triggers or worsens lupus rashes and flares, so even brief midday exposure can aggravate the skin. ^{[3] [9]}
• Many people with lupus are light‑sensitive, and rashes often appear or intensify after sun exposure. ^{[3] [10]}

How it feels

• Lupus rashes are often not itchy or painful, especially discoid plaques, though they can be cosmetically distressing and may scar. ^[2]
• Subacute and acute rashes can burn or feel tender in some people, but presentation varies. ^[5]

Quick comparison of common lupus rashes

Rash type	Look	Common sites	Scarring risk	Sun sensitivity
Butterfly (malar) rash	Flat or slightly raised red/purple rash across cheeks and nasal bridge	Face (cheeks, nose)	Low scarring risk	Often photosensitive [1] [4]
Subacute cutaneous	Red, scaly or ring‑shaped plaques; may merge	Upper back, shoulders, neck, chest, arms	Usually heals without scarring; may leave pigment change	Highly photosensitive [5]
Discoid (chronic cutaneous)	Thick, raised, scaly round plaques; pink‑red; may crust	Face, ears, scalp, neck, hands	Scarring common; scalp lesions can cause permanent hair loss	Often worsens with sun [2]

When to seek evaluation

• A new or changing rash on sun‑exposed areas, especially a butterfly pattern over the cheeks and nose, warrants medical assessment to differentiate lupus from other conditions like rosacea, seborrheic dermatitis, psoriasis, or contact dermatitis. ^[1]
• Because cutaneous lupus can be a sign of systemic lupus (involving joints and organs), clinicians may examine the rash, perform skin biopsy if needed, and order blood tests to check for autoantibodies and other markers. ^{[7] [5]}

Care tips and prevention

• Sun protection is central: limit midday sun (10 a.m.–4 p.m.), seek shade, wear wide‑brim hats and sun‑protective clothing, and apply broad‑spectrum sunscreen (SPF 30+), reapplying every two hours outdoors. ^[9]
• For persistent or scarring lesions, treatments may include topical steroids or calcineurin inhibitors; if needed, systemic medications such as hydroxychloroquine are commonly used to control skin disease. ^[5]

In summary, lupus skin rashes most often show up on sun‑exposed skin as a butterfly rash on the face or as scaly plaques on the face, scalp, ears, neck, chest, arms, and hands, with many cases clearly worsened by UV exposure. ^{[1] [2] [7] [3]}