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Physicians are aware of the distinctive malar flush or "butterfly" eruption which characterizes systemic lupus erythematosus (SLE) (Fig 1). The other butterfly eruptions illustrated in this section are associated with unrelated dermatologic conditions of no great medical concern. Needless anxiety for either patient or physician may be avoided if the lesions are examined for the characteristic morphologic signs.
Seborrheic dermatitis of the malar areas may appear as a symmetrical erythema involving the butterfly area. The lesion is granular to the touch and is covered by a greasy scale (Fig 2) unlike the erythema, edema, and telangiectasia of SLE. Erythema and scaling of the scalp, eyebrows, and retroauricular areas as well as marginal blepharitis are also usually found.
Acne rosacea of the malar areas presents a more difficult diagnostic problem (Fig 3) since telangiectasia is a constant feature which with the erythema may easily be confused with SLE. Unlike SLE acneiform
Halprin KM. The "Butterfly" Eruption. JAMA. 1966;197(6):417. doi:10.1001/jama.1966.03110060091024
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