Malar erythema – the butterfly rash – is the prototypical SLE picture and, not surprisingly, constitutes one of the ACR classification criteria. This type of skin lesions develops in areas with thermoregulatory vessels, i.e. those that turn reddish upon overheating. Thus, the erythema prominently affects the nose and the cheeks, but leaves out the nasolabial folds. It commonly starts with small, symmetrical erythematous macules or papules that then become confluent. The erythematous area is usually palpably indurated. Sometimes, fine scales are found on the lesions [7].

Generalised ACLE often involves the UV-exposed aspects of toes and fingers, characteristically sparing the knuckles and thus resulting in a negative picture as compared to the Gottron papules of dermatomyositis. This subtype can also involve large portions of the integument and occasionally mimic toxic epidermal necrolysis in its most acute forms. Even if less acute, the rash can be pruritic. In addition to the skin changes, ACLE is often accompanied by superficial mucosal ulcers, which constitute yet another ACR criterion. These ulcers typically afflict the hard palate, but may be found anywhere in the oral cavity as well as the nose.