Lupus Rash in Pictures: How to Recognize and Treat It

Lupus is an autoimmune condition that can affect the skin, joints, and internal organs. It can be hard to diagnose because its symptoms are often mistaken for other diseases. Lupus can range from mild, with symptoms limited to the skin, to severe, affecting many different parts of the body and organs. 

Skin rashes are common in all types of lupus. In fact, lupus rash affects 70% to 80% of people with lupus. And in 20% of cases, a rash is the first noticeable sign of lupus. So it helps to know what to look for.

What does a lupus rash look like?

The lupus rash is most common on the face and other sun-exposed skin, like the arms. Depending on where it is on your body, and your underlying skin tone, a lupus rash can look different for different people. Here are some examples. 

Butterfly rash

A butterfly rash on the cheeks, nose, and chin in darker skin.

A butterfly face rash on the cheeks, nose, and upper lip in lighter skin.

The butterfly rash is a telltale sign of lupus. It’s a flat or raised rash that develops in a butterfly shape over the cheeks and the nose. In lighter skin, the rash is red or pink, and it can be mistaken for blushing or a sunburn. In darker skin tones, the rash can look dark red, dark brown, or a darker shade than surrounding skin. 

A butterfly rash usually doesn’t have any symptoms, but some people describe it as a little painful or itchy. In more severe cases, it can even feel hot. A butterfly rash doesn’t leave scars or discoloration when it goes away. 

Sun-sensitive lupus rash on arms, legs, or chest

Close-up of a lupus rash on the arm.

Close-up of a lupus rash on the neck.

People with lupus get rashes that flare in areas of skin exposed to the sun. In addition to the face, sun-sensitive rashes can affect:

• Chest

• Upper back

• Arms

• Neck 

This type of lupus rash is usually scaly. In lighter skin, it looks red or pink. In darker skin tones, it looks purple or brown. In some cases, it forms ring shapes on the skin.

The rash doesn’t come on immediately after sun exposure. It can take a few days to a few weeks to appear. For some people, the rash can be quite itchy. This type of rash doesn’t scar the skin when it heals, but it can leave patches of lighter or darker skin, which get better with time. 

Discoid lupus rash

Close-up of a person’s scalp with discoid lupus rash.

Close-up of a discoid lupus rash on the arm.

Discoid lupus also appears in sun-exposed areas. It’s most common on the face and scalp, but it can affect other parts of the body, too. The rash consists of thick, coin-shaped patches of scarred skin that can be red or dark. Discoid lupus also typically causes hair loss in the affected skin, because skin scarring plugs and destroys the hair follicles. 

Some people feel mild itching or pain with these rashes. Discoid lupus can leave permanent scars, skin discoloration, and lasting hair loss. 

EXPERT PICKS: WHAT TO READ NEXT

• Sun sensitivity and lupus: If you have lupus, learn how unprotected sun exposure may be making your rash and other symptoms worse.   

• More than skin deep: Read how one woman’s mysterious lifelong symptoms ended up in a lupus diagnosis.  

• Living with lupus as a Black woman: See one woman’s mission to educate other women of color about lupus and kidney failure.

What causes lupus rash?

Lupus is a condition that can cause inflammation in any part of the body. It’s an autoimmune condition, meaning your immune system mistakenly reacts against your own body, including your skin. Experts don’t know why this happens, but it’s likely a combination of genetics and environment. 

Lupus can affect anyone, but it’s much more common in women, especially women ages 15 to 44. Lupus also affects people from certain ethnic backgrounds more than others. For example, you have a higher risk of having lupus if you are:

• Black 

• Hispanic and Latino 

• Asian 

• Indigenous 

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Lupus rash symptoms

The symptoms of lupus rashes depend on the individual, the type of rash, and where the rash is on the body. Many people don’t have any symptoms. Some describe a mild itch or soreness. Sometimes the butterfly rash can feel warm and tender, like a sunburn. If a lupus rash has any symptoms, they usually improve with treatment. 

One common symptom of lupus rashes is hair loss. Some people develop coarse, dry hair around the hairline that breaks easily leaving short hairs known as “lupus hair.” This usually grows back after lupus treatment. Other people with discoid lupus (see above) can develop hair loss that’s usually permanent.    

Lupus is more than just skin deep. It can affect many other organs, too. In addition to skin rashes and hair loss, some early lupus symptoms include:  

• Fatigue (feeling tired)

• Joint pain

• Skin sensitivity to sunlight

• Muscle soreness

• Fevers

How to tell if it’s a lupus rash or something else

People commonly mistake lupus rashes for a sunburn or other common skin conditions. A dermatologist can usually tell them apart. But sometimes it can be hard. A skin biopsy can help figure it out in these cases. Here are some conditions that are not skin lupus, but may look similar to it: 

• Rosacea: Like a lupus rash, rosacea can also cause red patches across the nose and cheeks. Rosacea is more likely if you have acne-like spots and eye symptoms, like dryness or burning.  

• Sunburn: Like sunburn, skin lupus gets worse in the sun. But sunburns are usually flat and red, and affect all sun-exposed skin. 

• Acne: Both acne and lupus commonly affect the face. But if you see pimples, blackheads, or cysts, then it’s probably acne. 

• Seborrheic dermatitis: This can cause a scaly, red rash around the nose. But, unlike lupus, seborrheic dermatitis often involves the skin crease between the nose and cheek (the nasolabial fold) as well. 

Treatments for lupus rash

The treatment you’ll get for lupus depends on whether your lupus just affects your skin, or other organs, too. For milder cases in the skin only, the first-choice treatment is a prescription topical cream or ointment. If you have discoid lupus, you might need steroid injections into the spots. Systemic lupus usually requires medications to calm the inflammation or lower the immune system.

Best creams for a lupus rash

The best cream for a lupus rash is usually a prescription topical steroid. This is because they work well, have been used the longest, and are widely available. Choosing the right one depends on which area of the body you’re treating: 

• Face: You’ll want to use a lighter option like hydrocortisone 2.5% since the skin on the face is thinner and more sensitive. 

• Arms and legs: You can use medium-strength steroids like mometasone furoate 0.1% cream or triamcinolone acetonide 0.1% cream.

• Scalp, hands, or feet: Stronger steroids like clobetasol work best because the skin in these areas is thicker. 

Other prescription creams that can be used for lupus are calcineurin inhibitors, like pimecrolimus cream and tacrolimus ointment. These don’t have as many long-term side effects as steroids, but there also isn’t as much research behind them. 

Other medications to treat skin lupus

If you have extensive skin rashes, you may need one or more of these medications: 

• Antimalarial medications, like hydroxychloroquine and chloroquine, work 50% to 90% of the time. 

• Steroid pills are an option for short-term relief. While they work well and quickly, you can’t use them in the long term because of the side effects. 

• Other medications that lower the immune system, like methotrexate (Rheumatrex) and mycophenolate mofetil (Cellcept), are a longer-term option in severe cases. 

• For people who also have lupus that affects the kidneys (lupus nephritis), there’s an FDA-approved biologic called Benlysta (belimumab). 

Avoid the sun 

Lastly — but perhaps most importantly — minimize your sun exposure. Exposure to sunlight can cause symptoms of lupus flares, both in the skin and in your organs. But the reaction doesn’t necessarily happen right away. It can be delayed anywhere from 3 days to 3 weeks. Because of this, sun protection with a broad-spectrum sunscreen and sun-protective clothing needs to be part of everyday life. 

Natural remedies to treat a lupus rash

The best thing you can do for a lupus rash is to avoid the sun and other things in your environment that trigger your lupus. 

There’s not enough good evidence to support natural remedies for skin lupus. But here are some supplements that show promise:

• Vitamin D

• Omega-3 fatty acids/fish oil

• N-acetylcysteine

• Turmeric

But be careful — some natural supplements (like alfalfa sprouts, echinacea, and melatonin) may actually worsen lupus symptoms. They can also interact with prescription medications. It’s always best to check with your healthcare team before trying new supplements. 

Why trust our experts?

Written by:

Maryann Mikhail, MD

Maryann Mikhail, MD, is a board-certified dermatologist and medical writer based in South Florida. She is the founder of Waverly DermSpa in Fort Lauderdale and holds a voluntary faculty position at the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at the University of Miami MIller School of Medicine.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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