title: Bier spots are an under-recognized cutaneous manifestation of lower extremity lymphedema: a case series and brief review of the literature.
abstract: Bier spots represent a benign vascular mottling characterized by multiple irregular white macules along the extensor surfaces of the arms and legs. They have been reported in a variety of diverse conditions with no consistent disease association. We have identified a novel association between these physiologic anemic macules and lower extremity lymphedema. Eleven patients between 23 and 70 years of age (5 male and 6 female) were diagnosed with Bier spots as evidenced by reversible white macules ranging from 3 to 8 mm in diameter on the extensor portions of the feet, ankles, and calves. The thighs were affected as well in 2 morbidly obese subjects. We suspect that these lesions are not uncommon in lymphedema but are simply under-recognized.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: steven.dean@osumc.edu.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Dean
authors.affiliation: Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Matthew
authors.initials: M
authors.lastname: Zirwas
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D017496:Hypopigmentation / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D035002:Lower Extremity; D008209:Lymphedema / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D012867:Skin / Q000098:blood supply*; D017445:Skin Diseases, Vascular / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D012880:Skin Pigmentation; D014661:Vasoconstriction; D055815:Young Adult