Lupus Rash vs. Rosacea: How to Tell the Difference
, by Tatianna Gerard, 14 min reading time
If you’ve recently noticed changes in your skin, you may be wondering whether it’s lupus rash or rosacea. Lupus affects approximately 20,000 Australians, with 90% of those diagnosed being women, typically between the ages of 15 and 45. This autoimmune disease can cause a variety of symptoms, including the well-known butterfly rash across the face. On the other hand, rosacea is a chronic skin condition that affects around 5% of adults globally, with it being more common in women, especially those between the ages of 30 and 50. Rosacea often causes facial flushing, visible blood vessels, and persistent redness, primarily affecting the central part of the face.
While lupus rash and rosacea can both cause redness and irritation on the face, they each have distinct features, triggers, and symptoms.
What is a lupus rash?
Lupus butterfly rash on cheeks
A lupus rash is one of the most recognisable signs of lupus, an autoimmune disease where the body’s immune system mistakenly attacks its own tissues. Lupus can affect many parts of the body, including the skin, joints, kidneys, and other organs. When lupus affects the skin, it can lead to various types of rashes, but the most commonly known type is the butterfly rash that appears across the cheeks and nose, giving the appearance of a butterfly's wings. This is often one of the first signs that doctors look for when diagnosing lupus.
A lupus rash is typically red, raised, and flaky, often appearing in areas that are exposed to the sun. It's known for being photosensitive, meaning it can worsen with sunlight exposure, which is why people with lupus are advised to protect their skin from the sun as much as possible.
In addition to the butterfly-shaped rash, lupus can cause other types of skin lesions, including discoid lupus (round, scaly patches) and lupus panniculitis (deep, painful lumps under the skin). These rashes are not only uncomfortable but can also leave scars or cause permanent skin damage if not properly managed.
While the lupus rash is a classic symptom of the condition, it is just one part of the broader autoimmune disease, and it’s important to remember that lupus can affect different people in different ways. For some, the rash is the most noticeable symptom, while for others, it can be just one of many symptoms that come with the disease.
If you’re noticing unusual skin changes like a butterfly rash or other rashes that don’t seem to heal, it’s essential to consult with a healthcare provider to rule out lupus or other skin conditions.
What is rosacea?
Woman with Papulopustular rosacea
Rosacea is a chronic skin condition that primarily affects the face, causing persistent redness and visible blood vessels. It’s most common in adults, and tends to affect fair-skinned individuals, particularly those with blue eyes or those of Celtic or North European descent. However, it may be more difficult to recognise and diagnose in patients with skin of colour. While the exact cause of rosacea is unknown, it’s thought to be related to a combination of genetics and environmental factors. Rosacea can be triggered or worsened by various factors like hot weather, spicy foods, alcohol, stress, or even certain skincare products.
One of the hallmark symptoms of rosacea is facial flushing, or a redness of the skin, particularly on the cheeks, nose, forehead, and chin. This redness is often mistaken for the natural blush of the skin, but in rosacea, it’s persistent and can worsen over time. In addition to the redness, people with rosacea may notice visible blood vessels (also called telangiectasia) on their face, which appear as small, red lines or spider veins.
There are different subtypes of rosacea, each with its own set of symptoms:
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Erythematotelangiectatic rosacea: This subtype is characterised by persistent redness and visible blood vessels without the presence of pimples or pustules.
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Papulopustular rosacea: This type causes pimples, pustules, and swelling, resembling acne but without blackheads.
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Phymatous rosacea: In this subtype, the skin may thicken, particularly around the nose, causing a condition called rhinophyma, which can lead to a bulbous nose.
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Ocular rosacea: This affects the eyes, causing dryness, irritation, and redness, and can sometimes lead to vision problems if untreated.
Rosacea can be a lifelong condition, but with proper treatment, symptoms can be managed. Treatment typically involves topical medications, oral antibiotics, and lifestyle adjustments to avoid common triggers. If left untreated, rosacea can worsen over time, leading to more pronounced skin changes and even permanent skin damage.
Key differences between lupus rash and rosacea
Appearance:
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Lupus rash: The most distinctive feature of lupus rash is the butterfly-shaped rash across the cheeks and nose, resembling the wings of a butterfly. This rash is often raised, red, and flaky, and may be triggered or worsened by sun exposure.
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Rosacea: Rosacea causes persistent redness that typically affects the central face, including the cheeks, nose, forehead, and chin. The redness is often accompanied by visible blood vessels (telangiectasia) and may cause facial flushing that comes and goes.
Location:
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Lupus rash: The butterfly rash is typically found across the cheeks and the bridge of the nose, but lupus rash can appear on other parts of the body, especially on sun-exposed areas like the ears, neck, arms, and upper chest.
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Rosacea: Rosacea primarily affects the central part of the face, often the cheeks, nose, and forehead. It usually does not affect other parts of the body.
Triggers:
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Lupus rash: Lupus rash is often triggered or worsened by sunlight exposure (photosensitivity) and may flare up during times of stress or illness.
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Rosacea: Rosacea flare-ups are commonly triggered by heat, spicy foods, alcohol, stress, and even certain skincare products. Unlike lupus, rosacea is not typically triggered by sun exposure.
Associated symptoms:
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Lupus rash: Lupus is an autoimmune disease, so lupus rash may be accompanied by other systemic symptoms like joint pain, fatigue, fever, and internal organ involvement. People with lupus may also experience flare-ups in other parts of the body, such as the kidneys or heart.
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Rosacea: Rosacea is a skin condition that mainly affects the face. While it can cause eye irritation in some cases (ocular rosacea), it doesn’t typically involve the internal organs or systemic symptoms like lupus does.
Severity:
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Lupus rash: Lupus can be severe and potentially life-threatening if not managed properly. It can affect organs beyond the skin, such as the kidneys, heart, and lungs.
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Rosacea: While rosacea is a chronic condition, it’s not life-threatening. It mainly affects the skin, and with proper treatment, symptoms can usually be managed effectively.
Let’s compare - Lupus Rash vs. Rosacea
How are lupus rash and rosacea treated?
Both lupus rash and rosacea require medical attention and management, but their treatments differ significantly due to the distinct causes and nature of each condition.
Treatment for lupus rash
Since lupus is an autoimmune disease, lupus rash is treated as part of the broader management of lupus. The treatment goal is to control the immune system’s overactivity, manage symptoms, and prevent flare-ups. Here are common treatment options for lupus rash:
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Topical steroids: Topical corticosteroids are often prescribed to reduce inflammation and control the butterfly rash and other skin lesions. They are used for short periods to minimise side effects.
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Antimalarial drugs: Drugs like hydroxychloroquine (Plaquenil) are commonly used to treat lupus and control skin rashes. They help to reduce skin inflammation and prevent flare-ups by modifying the immune response.
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Immunosuppressive medications: For more severe cases, immunosuppressive medications like methotrexate or azathioprine may be used to suppress the immune system and reduce inflammation in the skin and other organs.
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Sun protection: As lupus rash can worsen with sun exposure, it’s crucial to use broad-spectrum sunscreen (SPF 30 or higher) and protective clothing. People with lupus are also advised to avoid direct sunlight, particularly during peak hours, to prevent flare-ups.
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Systemic treatment: If the lupus rash is part of a broader flare-up affecting other organs (like the kidneys or heart), doctors may prescribe systemic steroids (like prednisone) to control inflammation throughout the body.
Treatment for rosacea
Unlike lupus, rosacea is a chronic skin condition, and its treatment focuses mainly on managing and reducing symptoms. The goal is to control flare-ups, reduce redness, and prevent the condition from worsening. Here are common treatment options for rosacea:
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Topical medications: Topical treatments such as metronidazole cream or azelaic acid are often prescribed to reduce inflammation and control redness. These medications are effective at managing papulopustular rosacea (which causes pimples and pustules).
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Oral antibiotics: For more severe rosacea, oral antibiotics like doxycycline or tetracycline are commonly used. These antibiotics have anti-inflammatory effects and help reduce the redness and swelling associated with rosacea.
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Laser and light therapy: Laser treatments (such as pulse-dye laser) and intense pulsed light (IPL) therapy can help reduce the appearance of visible blood vessels (telangiectasia) and the overall redness of the skin.
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Skin care routine: Gentle skincare is essential for managing rosacea. It's recommended to use mild, fragrance-free cleansers, moisturisers, and sunscreens. Avoiding products that can irritate the skin, such as alcohol-based toners or harsh scrubs, is also important. Check out Allay Organics, our top recommendation for rosacea skincare.
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Avoiding triggers: Identifying and avoiding common triggers is a key part of managing rosacea. These triggers may include spicy foods, alcohol, hot beverages, extreme temperatures, and stress. Keeping a diary of triggers can help rosacea sufferers manage their flare-ups.
Key takeaways: When in doubt, consult a healthcare professional
By understanding these key differences, you can better identify the cause of your skin issues and find the right treatment. While lupus rash is often tied to an autoimmune disease requiring more comprehensive care, rosacea is a manageable skin condition that can be controlled with medications, lifestyle changes, and skincare adjustments.
If you're dealing with persistent redness, irritation, or unusual skin changes, don’t hesitate to reach out to a medical professional. Lupus can affect other areas of the body and requires careful diagnosis and treatment, while rosacea is something that’s best tackled early with the right treatment.
With the right care and a bit of patience, both lupus rash and rosacea can be managed, allowing you to feel comfortable in your skin again.
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