This article was published in Annals of Vascular Surgery, 11 July 2014 (10.1016/j.avsg.2014.07.005), Steven M. Dean, Matthew Zirwas, Bier Spots are an Under Recognized Cutaneous Manifestation of Lower Extremity Lymphedema: A Case Series and Brief Review of the Literature, Copyright Elsevier, 2014.
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 (five male and six 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 two morbidly obese subjects. We suspect that these lesions are not uncommon in lymphedema but are simply under recognized.