Bier Spots on Hands & Legs Symptoms, Causes, Treatment

Bier spots are a type of benign vascular abnormality that appear on the skin as small, white spots accompanied by a pale ring of erythema (redness). They tend to appear more frequently on the trunk, the arms, and the legs. They are easier to see while an arm or leg is restrained by a tourniquet and less noticeable when raised. 

In most cases, a reason cannot be identified for the spots, however, it is believed that they are caused by an increased pressure that causes small veins to constrict (a condition known as "venous hypertension") (idiopathic). 

Bier spots often affect healthy adults and can develop during pregnancy. In other cases, however, they represent symptoms of a systemic illness, such as cryoglobulinemia, polycythemia, scleroderma, lymphedema, etc. They typically resolve on their own and, other than counseling, do not need to be treated in any way.

Bier Spots Symptoms

The following is a list of possible signs and symptoms of Bier Spots:

The presence of a large number of little macules (discolored flat spots on the skin with clearly defined boundaries) on skin that are irregularly spaced and noticeably lighter in color than the skin around them.

These can be seen anywhere on the body, especially the limbs and the trunk (chest and back). Most of the time, the skin between the spots is the same color as the rest of the patient's skin. This fluctuates according to the season, the amount of sun exposure, and the dilation of blood vessels after exercise.

When the examiner presses down on the affected area of the skin with a modest amount of force using both hands, the superficial blood vessels become momentarily emptied. When the pressure is released, most vessels return to their normal filling levels. The Bier Spots are still as pale as they were before. It is uncommon to notice symptoms like pain, discomfort, irritability, or others of this nature. On the other hand, if any linked conditions are present, the signs and symptoms of those disorders may be observed.

Bier Spots Causes

Bier spots were first identified by Bier in 1898. People between the ages of 20 and 40 are more likely to exhibit symptoms, and females are more likely to be affected than males. Medically, the lesions manifest themselves as temporary, little white macules with accompanying blanching redness when the patient is upright. However, these lesions vanish once the limbs are raised above the level of the patient's body. These macules are thought to be the tiny cutaneous vessels' physiological response to venous hypertension. Another potential mechanism is vaso-constriction of tiny arteries, which results in tissue hypoxia. Bier spots often have a physiological explanation, but they can occasionally be the first indication of systemic illnesses such as lymphoma, mixed cryoglobulinemia, and scleroderma renal crisis.

Bier Spots Treatment

The condition is asymptomatic so medical intervention is unnecessary. Macules have a chronic nature, despite the fact that their appearance can be intermittent depending on how the limbs are positioned. Bier spots are typically benign and idiopathic, but diagnosis is still necessary because they might mimic other disorders that are treatable in response to indications of related systemic diseases.