Bier spots, also called physiologic anemic macules, are small white irregular spots on the skin usually seen on arms and legs of young adults that are thought to be due to vascular anomaly. In few cases they may also be seen on the trunk making the diagnosis more confusing. They are usually harmless and require no treatment.

Bier spots are usually seen in individuals between 20-40 years and are more common in women than men. They are characterized by numerous irregular white spots (macules) with red erythematous surrounding that blanch on pressure. These white macules often disappear when affected limb is raised. These spots are thought to arise due to physiologic response of small blood vessels of the skin to venous hypertension and constriction of small blood vessels leading to tissue hypoxia. So, there is dilation of vessels in red area and constriction of vessels in pale areas.

Although Bier spots are considered as harmless physiologic response, they sometimes may represent systemic disease like scleroderma renal crisis, lymphoma and mixed cryoglobulinemia. So never underestimated the disease, always seek professional help before confirming the disease. Your doctor may order some tests to confirm that they are not due to some underlying systemic disease. When your doctor confirm they are totally harmless, it can be ignored or treated for cosmetic reason. If it was due to underlying disease, treating the cause will resolve the spots. Sometimes, they are also associated with pregnancy in women.

Other possibilities that may mimic Bier spots
  • Vitiligo
  • Post-inflammatory hypopigmentation
  • Pityriasis versicolor
  • Pityriasis alba
  • Nevus anemicus
Treatment options for Bier spots

In normal physiologic cases no treatment is required because the lesion is harmless, asymptomatic and resolve spontaneously. If it was due to underlying systemic illness, treating the cause will resolve the lesions. As early intervention can increase the chances of positive outcomes, always seek professional help as early as possible, don’t try to diagnose your-self just by looking few images online.