Fig. 11.4. A Butterfly rash in systemic lupus erythematosus. A well-demarcated, symmetrical erythema of the malar areas and the back of the nose that has progressed to the forehead and perioral skin. Note the sparing of the nasolabial folds. B Seborrheic dermatitis: note the yellowish color and involvement of the nasolabial folds
Fig. 11.4. A Butterfly rash in systemic lupus erythematosus. A well-demarcated, symmetrical erythema of the malar areas and the back of the nose that has progressed to the forehead and perioral skin. Note the sparing of the nasolabial folds. B Seborrheic dermatitis: note the yellowish color and involvement of the nasolabial folds demarcated symmetrical erythemas (and edema) of the malar areas that are connected over the bridge of the nose and thus result in a butterfly-like shape. The forehead and chin may be affected, and the nasolabial folds are characteristically spared (Fig. 11.4A). If the malar rash persists for some time, scales and mild atrophy may develop.
Dermatomyositis may show an analogous erythema of the face ("heliotropic erythema") that maybe difficult to distinguish (an encompassing term,"erysipelas per-stans," has therefore been coined by the old dermatologists). Typically, the heliotropic erythema is more pronounced in the upper portions of the face (forehead and eyelids), is more edematous, is of a more violaceous color, and not well demarcated. Differential diagnosis may be complicated by muscle weakness and elevated serum muscle enzyme levels, which may be seen in both entities.
Erysipelas of the face is a classic differential diagnosis of the butterfly rash. The main distinguishing marks are its acute onset, asymmetrical distribution pattern, more intensive inflammatory character, regional lymphadenitis, and systemic signs.
Drug-induced phototoxic reactions may be indistinguishable from the butterfly rash of SLE, but they are accompanied by analogous lesions of other exposed body sites in most instances. A history of potentially photosensitizing drugs must be taken (tetracyclines, nonsteroidal anti-inflammatory drugs, amiodarone, phenothiazines, diuretics, sulfonamides, and psoralens).
Seborrheic dermatitis (Fig. 11.4B), rosacea, and perioral dermatitis are trivial dermatoses that are not always easy to distinguish from facial lesions of SLE; this is less true for the butterfly rash than for cases of advanced SLE. In these, indistinct erythema and erythematous papules of the face may develop (more often with female patients who more generously apply various ointments on their facial lesions). Distinguishing criteria are the absence of prominent telangiectasias and pustules; absence of inflammatory papules in the perioral regions; absence of seborrhea of the scalp and face; and absence of the yellowish color of seborrheic dermatitis.
DLE lesions may be arranged in the butterfly area, mimicking a chronic butterfly rash.
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Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.