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| Fig. 22.1 Acute cutaneous lupus erythematosus. Note the classic malar erythema ('butterfly rash'). |
ACLE presents as an acute malar or more generalized photodistributed eruption. The malar erythema has been described as a “butterfly rash,” since the pattern across the cheeks resembles the wings of a butterfly (Fig. 22-1). Nearly all patients presenting with ACLE will have systemic lupus erythematosus (SLE), often in an acute flare. ACLE is usually transient, improving when the SLE improves, and generally does not result in scarring of the skin. A common diagnostic pitfall is the confusion of rosacea with the malar rash of ACLE. Rosacea is common; it is photo-exacerbated. Nonspecific joint symptoms are common, and 5% of the normal population will have a positive antinuclear antibody (ANA) test, often leading to a misdiagnosis of ACLE. Remember, a patient with ACLE is most often in an acute flare and will be “sick,” whereas a rosacea patient will have a chronic history and no systemic symptoms beyond their baseline “aches and pains.”
