Lupus Rash vs Rosacea: How to Tell the Difference

Medically reviewed by Dr. Ola Tarabzuni

Key Takeaways

  • Rosacea and lupus rash are distinct skin conditions that can result in facial redness but have different underlying causes and symptoms.
  • Rosacea is a chronic skin inflammation disorder characterized by persistent redness, visible blood vessels, and sometimes papules and pustules resembling acne.
  • Lupus rash, or malar rash, is a characteristic symptom of systemic lupus erythematosus (SLE), an autoimmune disease. It appears as a butterfly-shaped rash across the cheeks and nose.
  • Rosacea is not an autoimmune disease, whereas lupus rash is associated with an autoimmune response where the immune system mistakenly attacks healthy tissues.
  • Differentiating between rosacea and lupus rash requires a comprehensive evaluation by healthcare professionals, including consideration of medical history, physical examination, additional diagnostic tests, and the presence of associated symptoms. Proper diagnosis is crucial for determining the appropriate course of treatment.


The struggle with facial Skin conditions can sometimes be confusing, significantly when their symptoms overlap. “Lupus rash vs rosacea” are two frequent skin disorders that can result in redness and affect the face. Although the look of lupus rash and rosacea may be somewhat similar, it is essential to recognize the difference between rosacea and lupus rash and their distinctive characteristics for a proper diagnosis and course of treatment.

Let’s explore, shedding light on the distinct symptoms, underlying causes, and their impact on the skin. This blog discusses the depths of these enigmatic conditions and equips you with the knowledge to differentiate between rosacea and lupus. Let’s unravel the mystery and provide insights for an accurate diagnosis.

What is Rosacea?

Rosacea, often called the “blushing curse,” is a chronic skin disorder that manifests primarily on the face. It has a knack for turning a simple blush into a full-blown crimson spectacle.

Imagine, if you will, a gentle rosy hue spreading across your cheeks, as if you were naturally blushing. But in the case of rosacea, this blush tends to linger longer than expected, becoming a constant companion on your facial canvas. 

Rosacea is known for its distinct symptoms beyond the mere blush. Scientifically speaking, rosacea is a chronic inflammatory skin disorder that primarily affects the facial skin. It is characterized by persistent redness, visible blood vessels (telangiectasia), and often papules and pustules (resembling acne) on the affected areas.

What is Lupus?

Systemic lupus erythematosus (SLE), another name for lupus, is a chronic autoimmune condition that can impact various body organs and systems. In lupus, the immune system unintentionally damages and inflames healthy tissues. Although the precise etiology of lupus is unknown, several genetic, hormonal, and environmental factors are thought to play a role in the disease’s onset. Common symptoms include fatigue, joint pain, skin rashes (such as the characteristic butterfly rash), fever, and organ involvement (such as kidneys, heart, or lungs). Lupus is a complex and unpredictable condition, and its management typically involves a multidisciplinary approach, including medication, lifestyle changes, and regular medical monitoring.

How do I know if I have rosacea or lupus? Ask an Online Doctor

Lupus rash vs rosacea 

Lupus rash and rosacea vie for attention with distinct symptoms in skin conditions. To shed light on their differences, we present a handy table that unveils the contrasting characteristics of these two intriguing adversaries. It discusses Rosacea vs Malar rash Lupus,  location, redness, texture, sensitivity, and more, to unravel the unique signatures of lupus rash and rosacea.

SymptomLupus RashRosacea
LocationLupus rash occurs on the face, scalp, neck, and other body partsRosacea primarily affects the central face (cheeks, nose, forehead)
RednessRed or purplish discoloration in lupus. Persistent redness, often described as a blush in rosacea
TextureRaised, scaly, or crusty patches are present in lupus.Smooth skin with visible blood vessels (telangiectasia) is seen in rosacea.
SensitivitySensitivity to sunlight (photosensitivity) increases in Lupus.Rosacea may worsen with exposure to sunlight or triggers
Rash patternLupus facial flushing may appear as a butterfly-shaped rash across the cheeks and nose. Does not follow a specific pattern or shape
Bumps/PustulesIt may be present, but typically not a primary featureMay have pimple-like bumps or acne-like lesions
ItchingCan be presentGenerally does not cause itching
SwellingCan cause swelling or edema in affected areasSwelling may occur, especially in severe cases
Eye involvementIt may affect the eyes, causing dryness, pain, and sensitivity to lightTypically does not directly involve the eyes
Systemic symptomsFatigue, joint pain, fever, and other systemic symptomsPrimarily limited to the skin, with rare systemic involvement

Experiencing a malar rash? Consult to find out the cause.

Rosacea vs Lupus rash causes

The causes of rosacea and lupus rash differ significantly.

Rosacea’s origins remain elusive but are believed to result from genetic factors, environmental triggers, and immune system abnormalities. Factors like sunlight, extreme temperatures, certain foods, alcohol, and stress may contribute to rosacea flare-ups.

On the other hand, lupus rash is associated with an autoimmune response, where the immune system mistakenly attacks healthy tissues. While the exact cause of lupus is not known, genetic, hormonal, and environmental factors are believed to be involved. Understanding these causes is crucial for diagnosis and management.

What causes Rosacea?

Rosacea is not an autoimmune condition. The precise etiology of rosacea is still unknown; research indicates that several genetic, environmental, and immune system factors may play a role in its occurrence. The immune system with the innate immune response is thought to be involved in rosacea-related inflammatory processes.

  • Abnormal Blood Vessels: Several theories have been proposed regarding the underlying mechanisms of rosacea. One hypothesis suggests that abnormalities in the blood vessels of the facial skin contribute to the persistent redness and flushing observed in rosacea. These blood vessels may become enlarged and dilated, leading to increased blood flow and characteristic redness.
  • Demodex Mites: Another theory involves the role of microbes, particularly certain bacteria called Demodex mites, that naturally inhabit the skin. It is thought that an overabundance of these mites or an abnormal immune response to them may trigger inflammation and contribute to the development of rosacea.
  • Skin barrier dysfunction: Furthermore, abnormalities in the skin’s barrier function and increased sensitivity have been observed in individuals with rosacea.

This may make the skin more susceptible to external triggers, such as sunlight, extreme temperatures, certain foods, alcohol, and emotional stress, which can provoke or exacerbate rosacea symptoms.

Read More: What Happens If I Drink Alcohol When Taking Metronidazole

What causes Lupus?

Lupus is a complex autoimmune disease whose exact cause is not fully understood. However, several factors are believed to contribute to its development:

  • Genetics: Genetic predisposition plays a role in the development of lupus. Individuals with a family history of lupus or other autoimmune diseases are more likely to be susceptible to the condition.
  • Environmental Triggers: Certain environmental factors can trigger or exacerbate lupus symptoms in susceptible individuals. These triggers may include exposure to ultraviolet (UV) light from the sun or artificial sources, certain medications (such as hydralazine and procainamide), infections, hormones, stress, and smoking.
  • Hormonal Factors: Hormonal imbalances, particularly in females, are associated with lupus. The disease occurs more frequently in women of childbearing age, suggesting a connection with hormones such as estrogen.
  • Dysregulated Immune System: Lupus develops when the immune system unintentionally targets its tissues and organs. Although the precise causes of this dysregulation are not understood, a combination of genetic, hormonal, and environmental variables is at play.
What triggers skin lupus? Speak with Online Doctor

Consult a doctor now if you notice a persistent blush-like rash on your face.

How do I know if I have a lupus rash or rosacea? 

Distinguishing between lupus rash and rosacea can be challenging, as they share similar features. However, healthcare professionals use several factors to differentiate between the two conditions. Here are some differences in their diagnosis:

Medical History and Symptoms

  • A detailed medical history and thorough discussion of your symptoms will be conducted. Symptoms specific to lupus, such as joint pain, fatigue, and organ involvement, may indicate a higher likelihood of lupus rash.
  • Rosacea primarily focuses on the facial area, while lupus rash can occur on the face, scalp, neck, and other body parts.

Physical Examination

  • A dermatologist or rheumatologist will examine the affected areas and assess the characteristics of the rash.
  • The butterfly-shaped rash across the cheeks and nose is a hallmark feature of lupus rash, though it may not always be present.
  • Rosacea is characterized by persistent redness, visible blood vessels, and sometimes pimple-like bumps.

Additional Diagnostic Tests for Rosacea and Lupus

  • Blood tests can help detect certain antibodies and assess overall immune function. Specific lupus-related antibodies, such as anti-nuclear antibodies (ANA), may be present in lupus but are not typically found in Rosacea.
  • Skin biopsy: A small sample of affected skin may be taken and examined under a microscope to differentiate between lupus rash and Rosacea.
  • Additional tests: In some cases, further tests may be ordered to evaluate organ involvement or rule out other conditions.

Triggers and Response

  • Rosacea symptoms often worsen with triggers like sunlight, temperature changes, certain foods, alcohol, and emotional stress.
  • Lupus rash may not have specific triggers and can be more persistent, regardless of external factors.

Systemic Symptoms

  • Lupus is a systemic autoimmune disease affecting multiple body organs and systems. Experiencing symptoms beyond the skin, such as joint pain, fever, fatigue, or organ involvement, may suggest a higher likelihood of lupus.

Pattern and Distribution Rosacea vs Malar Rash (Lupus)

  • Rosacea does not typically follow a specific pattern and can affect various areas of the face, including the cheeks, nose, forehead, and chin.
  • Lupus rash, particularly the butterfly-shaped rash, tends to have a distinctive distribution across the cheeks and bridge of the nose.

Response to Medications

  • Treatment approaches can also provide diagnostic clues. For example, certain medications commonly used for Rosacea, such as topical or oral antibiotics, may improve rosacea symptoms but not significantly impact lupus rash.

Duration and Persistence of Lupus and Rosacea

  • Lupus rash tends to be more chronic and persistent, with flare-ups that may occur over time.
  • On the other hand, Rosacea can have a more consistent and prolonged presence, often with gradual worsening over time.

Associated Symptoms:

  • Lupus is often associated with various systemic symptoms, such as fatigue, muscle pain, hair loss, sensitivity to sunlight, and mouth ulcers.
  • While Rosacea can cause discomfort and sometimes affect the eyes, it generally does not have the same systemic involvement as lupus.

Response to Treatment Lupus vs Rosacea

  • Lupus rash may require systemic treatments like corticosteroids, immunosuppressants, or other medications to manage the underlying autoimmune process.
  • Rosacea is typically treated with topical medications, oral antibiotics, or other interventions to manage its symptoms.

Family History Rosacea vs Lupus

  • A family history of autoimmune diseases, including lupus, may increase the likelihood of lupus rash.
  • On the other hand, Rosacea is not typically associated with a family history of autoimmune conditions.
What are the first warning signs of lupus? Consult an Online Doctor

Criterias to Diagnose Rosacea and Lupus

To make a diagnosis of rosacea, one diagnostic criteria or two major criteria must be present. For lupus, at least four of the criteria must be present for a diagnosis to be made.

Diagnostic Criteria for RosaceaDiagnostic Criteria for Lupus
Fixed erythema on the central thirdMalar rash
of the face (not butterfly rash)Discoid rash
Phymatous changesPhotosensitivity
Major Criteria Oral ulcers
Papules and/or pustulesSerositis
TelangiectasiasRenal disorder
Ocular symptomsNeurological disorder
Secondary CriteriaHematologic disorder
Burning and/or stingingImmunologic disorder
EdemaAntinuclear antibody
Ocular symptoms

What is the difference between rosacea vs lupus treatments

The treatment approaches for rosacea and lupus differ due to the distinct nature of these conditions. Here are the key differences in their treatments:

Rosacea Treatment:

Multiple rosacea subtypes can require treatment accordingly.

Topical Medications

Topical creams or gels containing antibiotics (such as metronidazole or azelaic acid) or other anti-inflammatory agents are commonly prescribed to reduce redness and inflammation associated with rosacea.

Oral Medications

Sometimes, oral antibiotics (such as tetracycline or doxycycline) may be prescribed to control more severe or persistent rosacea symptoms.

Laser or Light Therapies

Procedures like laser therapy or intense pulsed light (IPL) can target visible blood vessels and reduce redness in certain types of rosacea.

Trigger Management

Identifying and avoiding triggers (e.g., sunlight, extreme temperatures, certain foods) that worsen rosacea symptoms can help manage flare-ups.

Skincare Routine

Implementing a gentle skincare routine, including mild cleansers and moisturizers, and avoiding harsh or irritating products, can help maintain skin health.


Electrosurgical techniques can be used to remove or reduce thickened tissue, such as in cases of rhinophyma. High-frequency electrical energy removes excess tissue and reshapes the affected area precisely.


It involves the controlled removal of the top layers of skin using a rotating device with a rough surface. It can help with skin texture and decrease the visibility of scars or irregularities caused by rosacea.

Topical or Oral Medications for Ocular Rosacea

Regular eyelid cleansing using warm compresses and gentle cleansers can help manage symptoms of ocular rosacea, such as dryness, irritation, and inflammation. These can help alleviate dryness and provide relief for visual signs. Prescription medications, such as cyclosporine eye drops, may be recommended in severe cases. Depending on the severity and specific symptoms, medicines like antibiotics, corticosteroids, or immunosuppressants may be prescribed to manage ocular inflammation and reduce symptoms.

Where does lupus rash first appear? See an Online Doctor

Lupus Treatment:


 Lupus treatment often involves medications to control the underlying autoimmune response and manage specific symptoms. These may include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antimalarials, immunosuppressants, or biologic agents.

Sun Protection

Since lupus rashes can worsen with sun exposure, individuals should practice strict sun protection measures, including using broad-spectrum sunscreen, wearing protective clothing, and seeking shade.

Management of Systemic Symptoms

Depending on the specific symptoms and organ involvement, additional treatments or medications may be prescribed to address issues like joint pain, fatigue, kidney problems, or other lupus-related complications.

Regular Monitoring 

Regular follow-up with healthcare professionals is essential to monitor disease activity, adjust medications, and address emerging concerns.

It’s worth noting that treatment plans for rosacea and lupus are highly individualized, tailored to each person’s unique needs and the severity of their condition. It is essential to consult with healthcare professionals, such as dermatologists or rheumatologists, who specialize in these conditions for accurate diagnosis, treatment recommendations, and ongoing management.


Is rosacea an autoimmune disease?

No, Rosacea is not an autoimmune disease. It is considered a chronic skin condition though its cause is still poorly understood.

Can lupus rash be mistaken for rosacea?

Yes, Due to similarities in appearance, lupus rash can be mistaken for rosacea. The butterfly-shaped rash observed in lupus might resemble the persistent redness of rosacea. Both disorders can induce facial redness. Healthcare experts employ certain characteristics and diagnostic standards to distinguish between the two, such as additional symptoms, medical history, physical examination, and maybe more diagnostic tests.

Your Doctors Online uses high-quality and trustworthy sources to ensure content accuracy and reliability. We rely on peer-reviewed studies, academic research institutions and medical associations to provide up-to-date and evidence-based information to the users.

  • Afiouni R, Helou J, Matar S, Tomb R. Severe Granulomatous Rosacea with Cutaneous Lupus Erythematosus. J Clin Aesthet Dermatol. 2021 Feb;14(2):22-24. Epub 2021 Feb 1. PMID: 34221223; PMCID: PMC8211343.
  • American Academy of Dermatology Association. HOW TO PREVENT ROSACEA FLARE-UPS
  • Lupus Foundation of America. Lupus facts and statistics
  • AAFP. Rosacea: Diagnosis and Treatment
  • Naji Rad S, Vashisht P. Malar Rash. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:
  • Rainer BM, Kang S, Chien AL. Rosacea: Epidemiology, pathogenesis, and treatment. Dermatoendocrinol. 2017 Oct 4;9(1):e1361574. doi: 10.1080/19381980.2017.1361574. PMID: 29484096; PMCID: PMC5821167.
  • Centers for Disease Control and Prevention. Lupus
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases. Rosacea: Diagnosis, Treatment, and Steps to Take

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