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If you’re living with a rash that won’t go away or keeps coming back, it’s completely understandable to want answers. Figuring out what’s causing it can help ensure you get the right treatment.
If you’re unsure whether a rash might be related to lupus or rosacea, here’s what you need to know. With this information, you and your doctor can work together to find answers — and relief.
Lupus and rosacea are two very different conditions, but both can cause a rash on the face. That overlap can lead to confusion.
Sometimes, people get treated for one when they should be diagnosed with the other. This happened to one member of MyLupusTeam, who shared, “I was treated for rosacea for four years. My doctor sent me to a specialist who diagnosed discoid lupus. Ten years ago, I was diagnosed with SLE.” (SLE stands for systemic lupus erythematosus, the most common form of lupus.)
Medical staff may even assume that a rash has one cause without testing it. Another member said, “The dermatologist wouldn’t take a sample of my face rash. He said it is rosacea. I have had this for nearly 17 years. I have no itching or burning. Would it have hurt just to take a sample? Feeling frustrated.”
Making matters more complicated, some people live with both conditions — either at the same time or one after the other. A member who experienced this explained, “The malar rash has been really bad. It started to clear, and rosacea has shown up.”
Getting the right diagnosis matters because lupus and rosacea are treated differently. To create an effective care plan, it’s essential to understand which condition is causing your symptoms. Additionally, lupus can affect not just your skin but also your organs. Identifying it early can help prevent complications from untreated lupus.
Lupus can cause several types of skin rashes. Two common lupus-related rashes that may appear on the face are the malar rash and the discoid lupus rash.
The rash most likely to be confused with rosacea is called a malar rash, which often occurs in SLE. It usually appears across the cheeks and bridge of the nose, forming the shape of a butterfly. That’s why the malar rash is sometimes called a butterfly rash.
One key difference between a malar rash and rosacea is the pattern. The malar rash typically doesn’t appear in the lines between the nose and mouth (called the nasolabial folds or “laugh lines”). On lighter skin tones, the rash is usually red and inflamed. On darker skin tones, it may appear darker than your natural skin color.
The malar rash can be flat or raised, and the affected skin can become hard, rough, or scaly. The rash may also itch. It may come and go as you experience lupus flare-ups, and it can last for several weeks at a time. It may also be sensitive to sunlight.
A malar rash may occur alongside other common symptoms of lupus, like joint pain, fatigue, fever, and shortness of breath. In some cases, it’s one of the first symptoms of lupus — and also one of the most common.
Discoid lupus rashes differ from malar rashes in both appearance and location. While they can show up on the face and neck, they may also appear anywhere on the body. These rashes are typically disc-shaped and can be small or large.
Because they’re not usually limited to the face, discoid lupus rashes may be less likely to be mistaken for rosacea.
Rosacea is a chronic skin condition caused by inflammation. Most people who live with rosacea experience symptoms over the long term, although they can come and go in cycles.
With rosacea, the skin on the cheeks and the nose becomes inflamed and discolored — red or pink on lighter skin tones, and dusky brown or purplish on darker skin tones. The affected areas may look like a rash.
Although rosacea most often affects the cheeks and nose, it can also show up on the chin or forehead. It may look like:
Rosacea often flares up in response to certain triggers — such as stress, heat, or sun exposure — and may improve when those triggers are avoided.
Sometimes, rosacea can affect the eyes as well as the skin. Your eyes may burn, swell, or feel like there's something in them that you can’t get out. Over time, this irritation can affect your vision.
When comparing these two conditions, some key differences stand out. One is how long the rash tends to last. A lupus rash often stays for an extended period, while rosacea tends to flare and fade, depending on triggers. Both can be made worse by sun exposure.
While the rashes may look similar at first glance, there are specific differences in how they appear. Both can cause skin thickening, discoloration, and scaling. However, a lupus malar rash usually forms a distinct butterfly shape, while rosacea tends to cause more general discoloration in the same area.
Another difference is location. The malar rash typically affects only the cheeks and nose, while rosacea can also show up on the chin, forehead, or neck. Lupus rashes usually don’t cause pus-filled bumps or make blood vessels more visible — features that are more common in rosacea.
If your rash is itchy, that may point to lupus, as rosacea usually doesn’t itch — though it may cause a burning sensation.
Even with all the differences between lupus rashes and rosacea, these skin conditions can still look alike, especially at first. That’s why it’s important to talk to your doctor anytime a new rash appears. A healthcare provider can evaluate the rash and determine what’s really going on.
In some cases, your doctor may recommend a skin biopsy (a small sample of skin taken to help confirm a diagnosis). This step can be especially important for people with darker skin tones, where changes in color or texture may be harder to recognize with the naked eye.
Once you and your doctor understand what’s going on with your skin, you can work together to create a treatment plan that fits your needs. Your provider can tailor treatment to your specific condition — whether that’s lupus, rosacea, or something else — and help manage your care over time to make sure you’re getting the relief you need.
A doctor can also offer personalized advice, like how to manage your rash in different environments, what to do if it spreads to other parts of the body, or how to respond if your skin feels hot or irritated. If your treatment isn’t helping, be sure to follow up. Your doctor may need to adjust your care plan so your skin can start to heal.
On MyLupusTeam, the social network for people with lupus and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with lupus.
Have you had a lupus rash? What was it like for you? Share your experience in the comments below, or start a conversation by posting on your Activities page.
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