BACKGROUND: Malar rash is one of the three cutaneous diagnostic criteria of 
systemic lupus erythematosus (SLE). Although its clinical recognition is often 
straightforward, the differential diagnosis with erythematotelangiectatic 
rosacea may sometimes be challenging.
OBJECTIVE: To describe dermoscopic features of SLE malar rash and investigate 
the accuracy of dermoscopy for the differential diagnosis with 
erythematotelangiectatic rosacea.
METHODS: A representative dermoscopic image of target areas was evaluated for 
the presence of specific features. Fisher's test was used to compare their 
prevalence between the two cohorts, and accuracy parameters (specificity, 
sensitivity, and positive and negative predictive values) were evaluated.
RESULTS: Twenty-eight patients were included in the analysis, of which 13 had 
SLE malar rash and 15 erythematotelangiectatic rosacea. The main dermoscopic 
features of malar rash were reddish/salmon-coloured follicular dots surrounded 
by white halos ('inverse strawberry' pattern), being present in 53.9% of the 
cases, while network-like vessels (vascular polygons) turned out to be the main 
feature of erythematotelangiectatic rosacea, with a prevalence of 93.3%. The 
comparative analysis showed that the 'inverse strawberry' pattern was 
significantly more common in SLE malar rash, with a specificity of 86.7%, while 
vascular polygons were significantly more frequent in rosacea, with a 
specificity of 92.3%.
CONCLUSION: Dermoscopy may be a useful support to distinguish SLE malar rash and 
erythematotelangiectatic rosacea by showing peculiar features.