Bier spots: causes, symptoms, diagnosis, and treatment

Bier spots, also known as Marshall-White syndrome, or physiologic anemic macules, are a vascular anomaly mostly on the distal extremities.


The exact pathophysiological mechanisms are unclear. However, Bier spots have been thought to be a vascular anomaly caused by vasoconstriction of small vessels. In addition, several diseases have been believed to be associated with Bier spots, including scleroderma renal crisis, cryoglobulinemia, Peutz-Jeghers syndrome, alopecia areata, and hypoplasia of the aorta.

Signs and Symptoms

Pale spots occur on the dorsal hands, palms, and feet, with a diameter of 2 - 4 millimeters. When the upper limbs droop for a while, pale spots on the forearms are more obvious, whereas the symptoms subside quickly after lifting the upper limbs or rubbing. The disease can also occur on the trunk and mucous membranes.


On the basis of typical clinical presentations, the disease can be diagnosed.


There is no impact in daily life, so no treatment is required. Oryzanol and medications promoting blood circulation can be considered.