Is it possible to have lupus and not have butterfly rash?

Absolutely: Many presentations of sle are very different. A malar rash is only one of many presenting clinical problems. Only 30 percent of sle pts coming to a rheumatogist have the rash. I suspect it is higher for dermatologists.

Yes: Though the butterfly rash on the cheeks is common, it is not always present. Some patients may never have an evident malar rash (the technical name). Interestingly, the name of the disease, which is latin for "wolf, " is based on the fanciful idea that the rash makes faces look wolf-like.