Bier spots

Abstract: A 34-year-old man presented with a 6-month history of hypopigmented macules that were interspersed with blanching erythematous macules on the trunk, upper extremities, and lower extremities. Bier spots are small, hypopigmented macules that are usually found on the arms and legs of young adults. The intervening skin may seem erythematous but blanches with pressure so that the hypopigmented macules disappear. This is a benign vascular anomaly.

Abstract: Bier anaemic spots, cyanosis with urticaria-like eruption syndrome is a recently described benign vasomotor dermatosis that mainly affects the lower limbs. Histopathology shows multiple dilated dermal vessels with scattered eosinophils. We report a case on the trunk and upper limbs.

Abstract: Unilateral nevoid telangiectasia (UNT) [1] is characterized by unilateral cutaneous vasodilation. Contrariwise, Bier spots are small hypopigmented macules secondary to cutaneous vasoconstriction [2]. We report a rare case in which UNT was superimposed on Bier spots, producing changes reminiscent of the phenomenon of vascular twin spotting. A 23-year-old woman had unilateral telangiectasis and peripheral hypochromatic macules in a metameric distribution on her right arm for six years. There was no pruritus or other sensory abnormalities. Her medical history was noncontributory. No clinical signs suggested a hyperestrogenemic condition. Physical examination revealed multiple pin-sized wiry and spider-like telangiectases unilaterally distributed on her right arm (Figure 1a). They started on the back of the hand and extended up the extensor surface of the arm to her shoulder. Closer inspection also revealed numerous asymptomatic pale macules measuring 0.5 to 2 mm. Most of the Bier spots were paired with dilated vessels but some 25 % were free-standing. The rest of her skin and mucosa were uninvolved. The pale lesions became hardly visible 15–30 seconds after she elevated her hand above her head, leaving the telangiectases unchanged (Figure 1b, c). When she lowered her arms, the macules became more prominent. Shave biopsy of a telangiectasis with surrounding achromic halo shown an intact epidermis. Vascular dilation was an inconsistent finding with mild perivascular infiltration of mononuclear cells. There was no sign of vascular proliferation (Figure 1d). Giemsa stain showed a normal number of mast cells. Immunohistochemical staining showed normal expressions of estrogen receptor. Routine laboratory studies, liver function tests, antibodies to hepatitis A, B and C, levels of estrogen, progesterone, testosterone and dehydroepiandrosterone were all within normal limits. A diagnose of vascular twin spotting was made. No treatment was introduced because the lesions were asymptomatic. UNT is characterized by fine, threadlike telangiectases, developing in a unilateral, Unilateral nevoid telangiectasia superimposed on the Bier spots: another demonstration of vascular twin spotting

Abstract: Anemic-appearing macules of the extremities that fluctuate with temperature and position have been referred to as Bier spots. After review of the literature and innumerable clinical presentations, we propose that the best description and better nomenclature is physiologic anemic macules. We present the case of a 27-year-old woman with physiologic anemic macules and review the history of this condition.