What are the other Names for this Condition? (Also known as/Synonyms)

• Angiospastic Macules
• Exaggerated Physiologic Speckled Mottling of Skin
• Physiologic Anemic Macules

What is Bier Spots? (Definition/Background Information)

• Bier Spots may be described as a rare abnormality of the blood vessels (veins) resulting in several small flat and lightly-pigmented spots on the trunk and limbs. It is a benign condition that is mostly observed in healthy young men
• The cause of the condition is generally unknown, but Bier Spots have been associated with a host of conditions including scleroderma, cryoglobulinemia, lichen planus, and Peutz-Jeghers syndrome. Bier Spots have been observed in pregnant women too
• In a majority of cases, no treatment may be necessary for Bier Spots; however, treating the underlying/associated condition, if any noted, is important. Bier Spots are usually known to resolve spontaneously, and the prognosis is usually good

Who gets Bier Spots? (Age and Sex Distribution)

• The presentation of Bier Spots may occur at any age, although most cases are reported in young adults
• Both males and females may be affected; a male preference is noted
• Individuals of all racial and ethnic groups may be affected; however, the condition is very uncommon

What are the Risk Factors for Bier Spots? (Predisposing Factors)

The risk factors for Bier Spots may potentially include any of the following conditions:

• Alopecia areata 
• Aortic hypoplasia and coarctation
• Cryoglobulinemia
• Lichen planus
• Lymphedema 
• Palmar hyperhidrosis
• Peutz-Jeghers syndrome
• Polycythemia
• Scleroderma
• Tachycardia
• Bier Spots may appear during pregnancy, in some women

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Bier Spots? (Etiology)

• In a majority of cases, the cause of occurrence of Bier Spots is not well-understood (idiopathic)
• Medical experts believe that increased blood pressure may constrict the small blood vessels (veins) at the location of these skin spots resulting in the condition

What are the Signs and Symptoms of Bier Spots?

The signs and symptoms of Bier Spots may include:

• Presence of numerous small macules (flat discolored skin spots with defined borders) on skin that are irregularly spaced, and notably paler than the surrounding skin
• These are observed on the limbs (arms and legs) and trunk (chest and back)
• The intermediate spaces between the macules are usually normal skin hue for the patient. This varies with season, based on tanning, or with the dilatation of vessels after exercise.
• When moderate pressure is applied to the affected skin, with both hands of the examiner, the superficial blood vessels are briefly emptied. This leaves the area with a uniform color. When released, most vessels fill back normally. The Bier Spots remain as pale as before this maneuver

Pain, discomfort, irritation, or other such symptoms are not generally observed. However, the signs and symptoms of any associated conditions, if present, may be noted.

How is Bier Spots Diagnosed?

Bier Spots may be misdiagnosed as other skin conditions such as pityriasis versicolor or nevus anemicus. A diagnosis of the condition may be made based on the following information:

• Physical examination of the individual and medical history evaluation
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy, if necessary: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
• Diagnostic tests to check for an underlying disorder or condition if present

A differential diagnosis may be necessary to eliminate other conditions that present similar signs and symptoms. This may include:

• Achromic nevus
• Naevus anemicus
• Pityriasis versicolor
• Post-inflammatory hypopigmentation
• Vitiligo

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Bier Spots?

The complications of Bier Spots may include:

• Cosmetic concerns
• Emotional stress
• Complications that may arise from any underlying disorders/conditions

Overall, Bier Spots are most frequently a benign transient finding.

How is Bier Spots Treated?

• If there is an underlying disorder/condition causing Bier Spots, then adequate treatment of the causative condition is essential
• Otherwise, generally, there is no treatment necessary for Bier Spots and the condition is known to be self-resolving

How can Bier Spots be Prevented?

• The exact cause for Bier Spots is not known, and therefore, no guidelines or methods are available for its prevention
• However, in some cases, undertaking appropriate treatment of the underlying condition (if any) causing Bier Spots, may help prevent the same

What is the Prognosis of Bier Spots? (Outcomes/Resolutions)

• The prognosis of Bier Spots is good, since it is considered a benign condition that mostly resolves in the absence of any treatment
• However, if Bier Spots are associated with a pre-existing condition, the outcomes may be determined by the severity of the associated condition

Additional and Relevant Useful Information for Bier Spots:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/