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Got red butterfly rash on face, brown skin on lips and chin. What it could be?

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Practicing since : 2003
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earlier in the year out of no where I got a red butterfly rash on my face that lasted a night. Im not sure if it has anything to do with the brown spots that started to appear on my face. its started small but now i have brown skins on my lips around my mouth and chin..over both eyebrows and underneath both eyes and is spreading.... at first sight it seems like melasma. but it itches. sometimes its even prickly. it know it sounds strange but it feels like insects creepy crawling underneath the spots. not all the time but a lot during the day. and the marks on my eyebrows seem to be underneath the surface of the top layers of skin.
Posted Wed, 2 Jan 2013 in Skin Hair and Nails
Answered by Dr. Rohit Batra 1 hour later
Thanks for your query.

Rash on face lasting for a while cannot be melasma. Moreover, melasma increases gradually and is not itchy.

Redness on face with itching and scaling can be - Atopic Dermatitis, Contact irritant dermatitis or Rosacea.

A picture of yours would be helpful in coming to a diagnosis. You have a feature to upload the images by yourself on the right side of this query page. Please utilize it so that I can suggest you better.

Rosacea increases with sun exposure, anger or eating chilly food.
Atopic Dermatitis can also involve other body folds like joints of arms and legs.

Contact irritant Dermatitis occurs because of some application - creams etc.

A mild topical steroid is helpful in controlling the symptoms and sun avoidance should be advocated.


Dr.Rohit Batra
Above answer was peer-reviewed by
Follow-up: Got red butterfly rash on face, brown skin on lips and chin. What it could be? 45 minutes later
The rash was was earlier in the year and as i said, may not have anything to do with it..but i wanted to add it just in case it does. the brown marks have appeared and worsened gradually over a 6 month course. there is no scaling. it does not appear to be dry. there is no redness only brown discoloration that is spread and also also appearing as small dots. it itches from time to time and there is a sensation of what i can only describe as something crawling underneath the skin in those areas.
Answered by Dr. Rohit Batra 4 hours later

Thanks for your follow up and photograph.

An itchy lesion is not a melasma and this looks like a post inflammatory hyper-pigmentation.
Melasma is common on cheeks and is not a straight patch as in your case - the coloration is above cheek.
Now if it is not a contact irritant dermatitis- arising out of any cream application it can be allergy to sun, dust, etc.
The treatment options for all remain as topical steroidal cream with avoidance of sun and dust.

A personal visit to a dermatologist is a must as topical steroids are prescription medicines.


Dr.Rohit Batra
Above answer was peer-reviewed by
Follow-up: Got red butterfly rash on face, brown skin on lips and chin. What it could be? 3 hours later
even if its not only in this area? it is spreading to checks and is around my chin etc and above eyebrows. could that still post inflammatory hyper pigmentation? and that could be something that spreads over time like melasma? im concerned because it continues to spread. i get spots here and there. if it was a reaction to something wouldnt it stop at some point? I cant treat the brown spots if new ones keep popping up. would that cream stop it new ones from popping up?
Answered by Dr. Rohit Batra 27 hours later
Dear patient,
Thanks for your follow up query.

An itchy lesion can spread to other areas if it is a result of some inflammatory process and the old ones will keep leaving marks. Topical steroid will not only clear these marks but will also arrest further lesions. Melasma is not a lesion, which starts as a red itchy lesion.

Above answer was peer-reviewed by
Follow-up: Got red butterfly rash on face, brown skin on lips and chin. What it could be? 34 hours later
Never at any point are the lesions red. it stays brown and spreads brown. would that sill classify it as post inflammatory hyper-pigmentation?
Answered by Dr. Rohit Batra 9 hours later
Thanks for your follow up.
One of the features of inflammation is redness. Once the inflammation has subsided it is brown in color. As you pointed that the lesion was red butterfly rash to start with which suggests it was the result of inflammation.

Dr Rohit Batra
Above answer was peer-reviewed by
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