A 37-year-old woman was referred for assessment of asymptomatic, white spots on her forehead that were noticed at the 28th week of her first pregnancy, and persisted after delivery. She denied any personal or family history of vascular and other diseases; She had given birth 7 months earlier after an uneventful pregnancy with no complications thereafter.

Examination revealed normal skin in upstanding position, mottling of the skin over the forehead appeared when she leaned over, showing hypopigmented macules with diffuse borders over a blanching erythematous base after 5–10s of forward-leaning (Fig. 1A and B), the lesions disappeared within 5s of elevating her head; there was no association with pain, hyperhidrosis or cyanosis, and there were no other similar lesions in any other body site, the rest of the clinical exam was normal. Laboratory findings, including complete blood count, C-reactive protein and antinuclear antibodies (ANA), were also within normal ranges (Fig. 1).

Figure 1

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Although most frequently found on the upper extremities, clinical findings suggested physiologic anemic macules or Bier's spots; given the benign course of the entity the patient was left with no treatment, progressively the patient has had less blanching but the spots have persisted within two years of follow-up.