Bier spots are a benign vascular anomaly characterized by white spots on the skin surrounded by a pale halo of erythema (redness). They are more common on the arms, the legs and the trunk. They are better observed when a tourniquet is placed around the affected arm or leg, and become less obvious when raising it.[1][2] The spots are thought to be due to raised pressure constricting small veins (venous hypertension) and in most cases no cause is found (idiopathic).[1] Bier spots usually affect healthy people, and may appear during pregnancy. But sometimes, they are part of a systemic disease such as cryoglobulinaemia, polycythaemia, scleroderma, aortic hypoplasia and coarctation, alopecia areata, Peutz-Jeghers syndrome, lichen planus, rapid heartbeat (tachycardia), lymphedema and excessive sweating of the hands (palmar hyperhidrosis).[1][2] They are usually, self-limiting and except for counseling, require no treatment.[2][3]
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