Overview of butterfly erythema
Butterfly erythema (erythema butterfly) refers to the symmetrical facial erythema on both cheeks of patients with systemic lupus erythematosus (SLE), connected by the bridge of the nose, with light red or bright red color, like a butterfly overlaying it, which is a kind of lesion with high specificity in SLE. Butterfly-shaped erythema is a kind of edematous erythema, higher than the skin, the edge is either clear or blurred, at first bright red or purplish red, and later it can change to dark red, the surface is mostly smooth, and in severe cases, it can be accompanied by blisters, crusts, and then scales, follicular keratinous plugs, and dilated capillaries appear. After the disappearance of erythema, generally do not leave traces, there can be brown butterfly-shaped erythema pigmentation. Skin atrophy is less common and should be differentiated from pregnancy spots and freckles. Treatment mainly focuses on relieving symptoms and controlling the progress of the disease.
Causes
1. Discoid lupus erythematosus
Discoid lupus erythematosus is a kind of localized lupus erythematosus, which is characterized by erythema on one or both sides of the face, with localized reddening and protrusion and central atrophy. The rash can be seen on the scalp, ears, chest, and any skin exposed to the sun, followed by vasodilatation, pemphigus, hypopigmentation or hyperpigmentation, accompanied by redness of the conjunctiva, capillary dilatation of the nail folds, and oral lesions.
2. Polymorphic sun rash
The early stage of erythema pteronyssinus is red, vesicular, with multiple small papules, which is induced by ultraviolet irradiation a few hours or days later, and the rash appears on the cheeks as well as at the knit of the nose, the hands, the arms and other parts of the body, accompanied by itching.
3. Rose rash
The beginning of the manifestation is limited to the lower part of the nose, including the jaw, cheeks and forehead, for the raised non-scarring intermittent erythema, and then the rash gradually increased, the severity of the rash varies, often accompanied by capillary dilatation, the progression of the rash for the oily, accompanied by herpes, papules, nodules, as well as facial capillary dilatation. Severe Banburi rash in men. The rash is mostly seen in the elderly.
4. Seborrheic dermatitis
The disease is characterized by oily, scarred, yellowish macules and papules of various sizes on the face and bridge of the nose, as well as on the top of the head, the jaw, the arch of the eyebrow, and the forehead, nasolabial folds, and trunk, accompanied by itching, erythema, conjunctivitis, severe acne, and oily skin. Severe seborrheic dermatitis is most often seen in acquired immunodeficiency syndrome.
5. Systemic lupus erythematosus
40% of SLE patients have erythema pteronyssinus. In acute SLE, the rash is short-lived and gradually involves the forehead, jaw, peri-auricular area and other exposed areas, often accompanied by mucous membrane damage, as well as erythema of the palms and fingers, capillary dilatation of the nails and the base of the eyelids, purpura, petechiae, ecchymosis and hematomas. It may be accompanied by painful stiffness and deformity of the joints and ulnar deviation of the fingers and proximal metacarpophalangeal joints, as well as facial and periocular edema, dyspnea, low-grade fever, malaise, nausea, vomiting, weight loss, enlarged lymph nodes, photosensitivity, and hepatomegaly.
Examination
Examine the rash for macules, papules, herpes, and scarring, edema, hypopigmentation or hyperpigmentation, mouth ulcers, and inflammatory lesions. Immunologic tests, blood tests, and biopsies are performed, as well as urinalysis if necessary.
Differential diagnosis
1. Systemic manifestations of lupus nephritis
Intermittent fever; erythema of the zygomatic region, also known as butterfly erythema because of its butterfly-like shape.
2. Erythema nodosum (EN)
Erythema nodosum (EN) is a kind of reactive inflammatory disease involving dermal blood vessels and lipid membrane tissues, and the skin of the anterior tibial region of the lower leg is often red or purplish-red with nodular changes.
3. Erythema multiforme
Erythema multiforme is an acute self-limiting inflammatory skin disease, often accompanied by mucosal damage, the rash is polymorphic, typical damage is target-shaped or iris-like damage. It can be caused by a variety of reasons, which can be related to infection with bacteria, virus (especially herpes simplex virus), enzyme bacteria, protozoa, and also can be caused by certain drugs, such as sulfonamides, barbiturates, salicylates and biological products, and some patients are related to cold.
Principles of treatment
1. General treatment
Acute active period should be bed rest. Those in chronic stage or whose condition has been stabilized can participate in work appropriately, and mental and psychological treatment is very important. Patients should be followed up regularly to avoid triggering factors and stimuli, and avoid direct exposure of the skin to sunlight. Women in their childbearing years should be strictly contraceptive.
2. Drug treatment
According to the different causes of the disease, corresponding treatment should be adopted, such as lupus erythematosus, which can be treated with glucocorticoid and immunosuppressant.