An autoimmune rash occurs when the immune system attacks the skin or surrounding tissue as part of a broader autoimmune condition. These rashes vary widely in appearance, from the characteristic butterfly rash (malar rash) across the cheeks and nose in lupus, to the scaly plaques of psoriasis, to the heliotrope rash of dermatomyositis, and they are often one of the earliest and most visible signs that something systemic is happening.

Understanding the type of autoimmune rash you're dealing with matters because it can point toward a specific underlying condition, guide appropriate treatment, and help you know when to seek further evaluation. This article covers the most common autoimmune rashes, the conditions they're associated with, what causes them, and how they're managed from both a conventional and functional medicine perspective.

Read on to learn what causes autoimmune diseases, which autoimmune diseases feature a rash as a common symptom, how autoimmune rashes are managed and treated when to see a doctor, and more.

What is an autoimmune rash?

Our immune systems are designed to monitor for threats, such as an injury, insect bites, viral or bacterial infections, and more. In response, the immune system jumps into action to help fight off illness or repair an injury.

However, the immune system can malfunction and think that a threat is present when it isn’t. In response, it attacks cells, tissues, and organs. When this occurs, an autoimmune disorder may be present. Researchers know about more than 80 autoimmune disorders.

The skin is your largest and heaviest organ. It contains three layers, and for the average adult, its surface includes about 15 to 20 feet. The skin functions as a barrier between the rest of your body and the outside world and encounters toxins, pathogens, and other stressors. The skin is an active immune organ that includes a network of immune cells. For these reasons, autoimmune disorders often affect the skin.

“It can be said that the skin is the window to internal health,” says Amy Huang, MD, a board-certified dermatologist with Medical Offices of Manhattan and a contributor to LabFinder. Many times, autoimmune-associated rashes are the first signs of internal inflammation.”

“The immune system’s attack on the skin leads to inflammation,” Dr. Kopelman adds, “and that’s why a rash is a common symptom.”

Common autoimmune diseases that cause rashes

Several autoimmune diseases can cause rashes. However, just because you have a rash does not mean you have one of these conditions. Sometimes rashes are just temporary reactions to the immune system doing its job correctly. If a rash doesn’t resolve, or it comes and goes, then something else may be going on.

1. Lupus

Systemic lupus erythematosus is an autoimmune disease that involves multiple systems of the body. A common symptom is a malar rash. “Lupus can give you that recognizable ‘butterfly’ rash on your face,” says Raj Dasgupta, MD, the chief medical advisor for Fortune Recommends Health.

The rash, which may itch or burn, can appear as a flat or raised red or purple area across the nose bridge and cheeks and sometimes other parts of the face.

2. Psoriasis and psoriatic arthritis

Psoriasis is an autoimmune condition that affects the skin. It presents as plaques with silvery scales. The plaques result from a dysregulation in keratinocyte (a skin cell) turnover.

A related condition, psoriatic arthritis (PsA) shows up in nearly one-third of people who have psoriasis. PsA attacks the joints with inflammation, leading to pain. Sometimes the skin over the joints presents with itchy plaques.

3. Eczema

Eczema, also called atopic dermatitis, is another autoimmune condition affecting the skin. Eczema has many different types, according to the National Eczema Association. However, it often presents as dry and intensely itchy skin that can easily become infected from scratching.

4. Rheumatoid arthritis

Rheumatoid arthritis (RA) is a systemic autoimmune condition in which inflammation damages joints, leading to joint pain, stiffness, and other symptoms. In rare cases, people with RA develop rheumatoid vasculitis from inflammation in the arteries. The rash involves itchy and painful spots or patches on the skin.

5. Sjögren’s syndrome

Sjögren’s syndrome is an autoimmune disorder that affects your mucus membranes and moistures-secreting glands. It most often presents with dry eyes and dry mouth. However, a rash or dry skin is also a common symptom. The rash may appear as raised welts, purple or red spots, or as dry and itchy patches.

6. Vasculitis

Vasculitis is an autoimmune disorder that leads to blood vessel inflammation that causes the walls to thicken. This restricts the amount of blood that can flow through, leading to organ and tissue damage. Vasculitis can present red spots on the skin that indicate bleeding is going on beneath the skin. It can also cause open sores or lumps.

Vasculitis can also be a symptom of other autoimmune diseases, such as lupus, RA, and scleroderma.

7. Dermatomyositis

Dermatomyositis is a rare autoimmune condition that leads to muscle inflammation. One symptom is a rash. The rash may present on the face, shoulders, upper back, hands, eyelids, and more.

8. Scleroderma

Scleroderma, also called systemic sclerosis, is an autoimmune disease that affects connective tissues. It causes a buildup of collagen that leads to thickening or hardening of the skin. The thickened skin may have a different appearance than the surrounding skin, and it may look like a rash with small reddish spots.

Butterfly Rash (Malar Rash): The Classic Autoimmune Skin Sign

The butterfly rash, also called a malar rash, is one of the most recognizable autoimmune skin presentations. It appears as a red or pinkish rash that spreads across both cheeks and the bridge of the nose in a shape that resembles a butterfly with open wings. The rash typically spares the nasolabial folds (the lines that run from the nose to the corners of the mouth), which helps distinguish it from other facial rashes like rosacea or seborrheic dermatitis.

What causes a butterfly rash?

The butterfly rash is most closely associated with systemic lupus erythematosus (SLE). It appears in approximately 30-60% of people with lupus and is considered one of the diagnostic criteria for the condition. The rash occurs because lupus triggers immune complex deposition in the skin, leading to inflammation. Sun exposure frequently triggers or worsens the malar rash, UV light can cause a lupus flare and bring the rash to the surface even if it wasn't visible before.

Other autoimmune and inflammatory conditions can produce a similar facial rash pattern, including rosacea (which can mimic a butterfly rash but has a different mechanism), dermatomyositis (which may present with a heliotrope rash around the eyes rather than cheeks), and, rarely, other connective tissue diseases.

What does a butterfly rash feel like?

The rash may be flat or slightly raised, and can be warm to the touch. Some people describe it as feeling similar to a sunburn, tender, slightly itchy, or sensitive to touch. It may come and go, often worsening after sun exposure or during a lupus flare, and fading during periods of remission.

When to see a doctor about a butterfly rash

A butterfly rash or malar rash that persists, recurs, or appears alongside other symptoms, fatigue, joint pain, hair loss, fever, or sensitivity to sunlight, warrants evaluation by a physician or rheumatologist. Lupus is a systemic condition with potential effects on the kidneys, heart, and other organs, and early diagnosis and monitoring significantly improve outcomes.

Causes of autoimmune rash

The underlying autoimmune condition is the cause of the autoimmune rash. “The immune system itself is at the core of these conditions,” Dr. Kopelman says, “and any disruption or overactivity can lead to skin reactions.”

However, genetics, environmental factors, and hormone imbalances, Dr. Huang adds, can predispose you to these inflammatory conditions. Here are some of the common causes of autoimmune disorders.

Genetics may put you at an increased risk for developing an autoimmune disorder, but likely your genes aren’t the only cause. Epigenetic factors, such as our lifestyle behaviors and environmental exposures, can change how our genes work. If you have a family history of RA, for example, that doesn’t mean you will automatically develop RA. However, you may be exposed to environmental pollution or another factor that ultimately triggers the autoimmune disorder.

Managing Autoimmune rash

Even if you have an autoimmune disease where rash is a symptom, you may not always have a corresponding rash. A rash may show up during a flare and then disappear if you’re in a period of remission, which is when you’re feeling relatively good and having minimal symptoms of your autoimmune disease. Your flare triggers will depend on your autoimmune disease and factors unique to you.

“As someone who regularly treats patients with autoimmune skin conditions, I can’t stress enough how vital it is to identify what exacerbates the condition, whether it’s sun exposure, stress, certain foods, or even medications,” Dr. Kopelman says. “By recognizing and avoiding these triggers, patients can better control their disease activity and prevent painful flare-ups. It significantly improves both their skin and overall quality of life.”

Keeping a symptom diary can help you determine your triggers. Your clinician can work with you to help lessen your exposure to triggers and develop a care plan for flare prevention and treatment.

Symptoms of autoimmune rashes

The symptoms of autoimmune rash vary, depending on the type of autoimmune disorder.

Potential rash symptoms

• Blistering
• Burning
• Cracking
• Discoloration
• Dryness
• Flaking
• Flushing or redness
• Hives (urticaria)
• Itching
• Raised bumps
• Scaling
• Skin thickening

Diagnosing autoimmune rashes

Your clinician can diagnose an autoimmune disorder and corresponding rash by conducting or ordering various tests and examinations.

Physical examination

“When you see a doctor for a rash,” Dr. Dasgupta says, “they’ll likely start with a physical exam and ask about your medical history.” Sometimes a rash is identifiable by its texture and how it looks or an examination can give your clinician some ideas as to which tests may be most beneficial for further investigation. Blood tests and biopsies may follow.

Blood tests

Blood tests can look for certain immune system markers or antibodies associated with specific autoimmune conditions.

Blood test examples

• Antinuclear antibody (ANA) tests
• Autoantibody tests
• Complete blood count with white blood cell differential (CBC with WBC differential)
• Comprehensive metabolic panel
• Complement levels
• C-reactive protein (CRP)
• Erythrocyte sedimentation rate (ESR)
• Extractable Nuclear Antigen (ENA) panel

Biopsies

In some cases, you may need a skin biopsy. Biopsies involve taking a tiny sample of the affected skin that an experienced lab technician can then analyze for any concerns.

How to treat autoimmune rash

The treatment for your autoimmune rash will depend on your underlying autoimmune disease, your existing medications, your unique symptoms, and even your unique preferences.

Treatment of the underlying medical condition

The first step to treating an autoimmune rash is ensuring that your autoimmune disease is well-controlled. If you’re experiencing a rash, you may be experiencing a disease flare-up. A flare might require different treatment than when you’re in remission. Based on your unique circumstances, your doctor may prescribe medications or lifestyle changes.

Topical creams

Topical creams for an autoimmune rash may serve a few different purposes. Some creams include corticosteroids to reduce inflammation and irritation. Some creams can help support and protect the skin barrier from moisture loss, which may also help ease irritation.

Oral or injectable medications

Several oral or injectable medications can help alleviate the symptoms of an autoimmune rash.

Anti-inflammatory medications. Non-steroidal anti-inflammatory medications help reduce inflammation and calm the immune system response.

Biologics. Biologics are made from living cells or organisms. Monoclonal antibodies are a type of biologic commonly used to treat autoimmune disorders. These medications are a clone of an antibody, and they bind to one antigen. Therefore they can modify immune-system activity.

Corticosteroids. Corticosteroids are synthetic versions of steroid hormones the body produces. They work by suppressing the immune system and inflammation.

JAK Inhibitors. Janus kinase (JAK) inhibitors block the JAK-STAT signaling pathway to reduce the body’s production of proteins that cause inflammation.

TNF inhibitors. Tumor necrosis factor (TNF) inhibitors block TNF-alpha, an inflammation-causing protein.

Lifestyle changes

Lifestyle changes are also an important part of managing an autoimmune condition and related rash. Your clinician might suggest the following.

• Changing your diet
• Changing your personal care products
• Changing your exposure to chemicals or toxins
• Getting more physical activity
• Improving sleep
• Managing stress
• Reducing exposure to flare triggers
• And more

Complications of autoimmune rashes

If you have a rash that doesn’t resolve within a few days or returns, don’t ignore the symptom, Dr. Huang says. A rash could be a symptom of an underlying autoimmune disorder. “Autoimmune and inflammatory conditions can be serious and can lead to internal organ damage,” she explains. They can also put you at risk for infection from a compromised skin barrier.

Seeking medical attention

“If you notice a rash that just won’t go away, gets worse, or isn’t improving with basic treatments, it’s a good idea to talk to a doctor,” Dr. Dasgupta says. “You should definitely reach out if the rash is paired with other symptoms like fever, joint pain, or fatigue. If it’s causing a lot of discomfort or getting in the way of your daily life, don’t hesitate to get it checked out.”

Frequently Asked Questions About Autoimmune Rashes

How do I know if my rash is autoimmune?

Your clinician can conduct an examination, ask you about your medical history, and order blood tests or skin biopsies if needed.

What are the 5 common symptoms of an autoimmune disorder?

The most common symptoms of an autoimmune disorder include fatigue, joint pain and stiffness, muscle aches or weakness, skin rashes or dryness, and swelling or pain in one or more parts of the body.

How to get rid of an autoimmune rash?

If you are experiencing symptoms of an autoimmune rash, talk to your doctor who can prescribe an appropriate treatment regimen.

Can autoimmune rash be cured?

An autoimmune rash is a result of an underlying autoimmune condition. Autoimmune diseases typically don’t have cures, but many have effective treatments for managing the disease and therefore the associated rash. In some cases, your autoimmune disease may go into remission when treated in the early stages with a multi-pronged approach.

What does an autoimmune rash look like?

Autoimmune rashes vary considerably depending on the underlying condition. The butterfly (malar) rash of lupus appears as a red, flat or raised rash spanning both cheeks and the nose bridge. Psoriasis typically produces thick, scaly, silver-white plaques on the elbows, knees, or scalp. Dermatomyositis causes a heliotrope rash (purplish discoloration around the eyes) and Gottron's papules on the knuckles. Scleroderma can cause skin thickening and tightening. Vitiligo produces patches of depigmented skin. Each rash pattern is associated with specific autoimmune conditions and can serve as a diagnostic clue.

What autoimmune diseases cause rashes?

Many autoimmune conditions have skin manifestations. The most common include lupus (butterfly/malar rash, discoid lesions), psoriasis (scaly plaques), dermatomyositis (heliotrope rash, Gottron's papules), scleroderma (skin thickening), pemphigus vulgaris (blistering), lichen planus (purple, itchy papules), and vitiligo (pigmentation loss). Some less common conditions like Sjogren's syndrome and mixed connective tissue disease can also produce skin findings. If you have a persistent or recurring rash alongside systemic symptoms, evaluation by a dermatologist or rheumatologist is recommended.

Can an autoimmune rash go away on its own?

Some autoimmune rashes improve during periods of disease remission, particularly in relapsing-remitting conditions like lupus. However, autoimmune rashes are generally a sign of ongoing immune system activity and tend to recur without treatment of the underlying condition. Symptom-free periods don't mean the underlying condition has resolved. Managing the root autoimmune condition, through medication, lifestyle modifications, and appropriate monitoring, is usually necessary to prevent rash recurrence and protect against systemic complications.

How is an autoimmune rash treated?

Treatment depends on the underlying condition and rash severity. Topical corticosteroids are commonly used for immediate flare management. For lupus-related rashes, antimalarial medications (particularly hydroxychloroquine) are a cornerstone of treatment and have been shown to reduce both rash frequency and systemic flares. Immunosuppressive medications may be used for more severe disease. Sun protection is essential for lupus and other photosensitive autoimmune rashes, broad-spectrum SPF 50+ sunscreen and UV-protective clothing can significantly reduce flare frequency. From a functional medicine perspective, identifying and addressing inflammatory triggers (diet, environmental exposures, gut health, stress) can complement conventional treatment.

Is a butterfly rash always lupus?

Not necessarily, but a butterfly rash is one of the classic diagnostic criteria for lupus and should always be evaluated in that context. Rosacea can produce a similar facial flushing pattern that mimics a malar rash, but it typically involves visible blood vessels, acne-like bumps, and a different trigger profile (heat, alcohol, spicy food). Seborrheic dermatitis affects the nasolabial folds, which the classic lupus butterfly rash spares. If you have a persistent red rash across both cheeks and the nose bridge, particularly if accompanied by fatigue, joint pain, or photosensitivity, a rheumatological evaluation including an ANA blood test is the appropriate next step.

Takeaway

A rash can sometimes be a symptom of an autoimmune disorder. If so, you’ll need a treatment plan that addresses your underlying condition for the long term rather than just treating the rash.

Parsley Health doctors and clinicians can help you get to the root cause of your symptoms. Reach out for a free consultation.