Welcome to our family. You are doing the right thing in trying to learn as much as you can about what is going on with you so that you can be your own health advocate. Often times, we find that we know much more than our doctors and we have to educate them in order to get proper care. One of the primary reasons that this site exists is to help one another in becoming educated and in learning how to manage our symptoms and maintain a reasonably normal life.
You asked about the Lupus Rash vs Rosacea. The Lupus malar rash is a redness or rash that may appear in a butterfly configuration across the nose and cheeks (the butterfly configuration is not mandatory for a malar rash). It can appear on one or both sides of the face and it is usually flat. In rosacea, the rash does not have the butterfly configuration.
The lupus butterfly rash is characterized by a butterfly-shaped red rash that extends over the bridge of the nose and the cheeks. The rash may be flat or raised. The malar rash often appears or gets worse after sun exposure (photosensitivity) or stress that causes an increase in the circulation to the skin. Sometimes the lupus butterfly rash appears on other parts of the body as well, usually on the trunk, arms or legs. The malar rash normally is not painful, although it may itch and cause a burning sensation. Sometimes the malar rash appears when the disease flares up (an active state of lupus). The malar rash may be the first sign of lupus, the sign that lupus is entering an active phase, or it may actually cause the disease to attack other tissues in the body.
The lupus butterfly rash can be as mild as a slight blush-like rash to a severe, scaly rash. The butterfly rash can last for a short period of time or it may last for many months. The reason the malar rash is shaped like a butterfly is because it follows the angle that the UV rays land on the skin. The malar rash is caused by a malfunctioning immune system, which causes the body to attack healthy tissues in the skin (such as Lupus).
Rosacea is clinically defined as a chronic skin disease that causes redness and swelling, primarily on the face. Rosacea usually varies in severity, and manifests in episodes of flushing and inflammation of the affected areas.The common rosacea symptoms include:
Flushing - frequent blushing or flushing is sometimes the first sign of this disease. This facial redness may come and go and is not in a butterfly configuration.
Persistent Redness – this is the most common rosacea symptom. It is like having a blush or sunburn that will not go away. This may be more noticeable when smiling, frowning, or squinting. Using cleansers, cosmetics, or moisturizers may increase the irritation and redness. It is this redness that causes the confusion and causes some patients to ask if rosacea is a symptom of lupus.
Bumps and Pimples - Bumps or pimples on the skin, either small and solid (papules) or pus-filled (pustules). This may resemble acne without blackheads. Rosacea may sometimes burn or sting, this is commonly referred to as acne rosacea.
Visible Blood Vessels - Red lines (telangiectasia) in the face caused by enlarged blood vessels.
From your description, it may be that your rash is not rosacea and could possibly be malar. However, a doctor (preferably a rheumatologist) will have to make the final determination. Your history and your symptoms are so familiar to those of us who suffer from an auto-immune disorder. It is very possible to have a negative ANA and still have an auto-immune disorder (and vice-versa). Getting a diagnosis can be a lengthy and frustrating process, especially if you are dealing with medical professionals who know little about auto-immune disorders. I hope that you are able to find a competent rheumatologist who believes you and who is sincerely interested in helping you. In the meantime, we are here to help you as much as we can and in any way that we can.
I wish you the very best.
Peace and Blessings
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