Macules are small, flat, discolored areas of skin. They can be hypopigmented, lighter than the skin, or hyperpigmented, darker than the skin. Macules do not change the texture, thickness or feel of the skin; when you run your finger across them, they will not feel any different than other parts of your skin. Most macules are harmless; however, in some cases they indicate skin cancer.
Macules are usually less than 1 centimeter wide. A small, flat birthmark is a macule. So is an age spot. They are most commonly seen on babies, young children, and older adults. As with birthmarks, they are often present at birth; however, they can grow, or the number of macules can increase over time. They can appear without any trauma to the skin. Some, such as age spots, appear as a result of UV exposure during late adulthood. Macules are most commonly found on the back, chest, arms, or face but can appear anywhere on the body.
There are a few skin conditions that might cause macules:
Vitiligo — a skin condition that causes the loss of pigment. When discolored skin is larger than 1 centimeter, it is called a patch. Vitiligo usually results in patches of skin that are lighter than surrounding skin. It usually occurs on both sides of the body and affects not only the skin but also the hair, eyes, or inside the mouth.
Rosacea — a skin condition that usually begins with a tendency to blush easily but can develop into redness, swelling, and acne-like breakouts on the face. The skin can thicken and feel bumpy. It can sometimes cause small areas of permanent discoloration.
Skin cancer — Although macules don’t indicate skin cancer and most are harmless, they are often found on people who have skin cancer. When you notice a new macule, you should have it checked by your dermatologist.
When to see a doctor
You should contact your doctor if:
- A macule becomes inflamed or itchy
- You notice a new macule
Treatment for macules depends on the cause. Birthmarks don’t usually require any treatment; however, if the appearance is bothersome, skin-lightening techniques might help.
When macules are caused by vitiligo, immunosuppressant medications or light therapy can help to prevent further growth of the macule or to prevent additional macules from forming. In severe cases or when daily functioning is impaired because of embarrassment, your doctor might suggest skin grafts or depigmenting your skin to match the macule. However, this is often a last-resort treatment. Some people use specialized makeup to cover up hypopigmented patches.
Macules that are hyperpigmented, or darker than the skin, might respond to skin-lightening treatments, such as creams or laser treatments. These work best when the hyperpigment is in the top layer of the skin only. When it is deeper, these treatments usually don’t work.
When macules are caused by skin cancer, your doctor will discuss the different treatment options available, such as chemotherapy, radiation, excision, or a combination of treatments based on the type and severity of your cancer. Remember, most macules are harmless, but it is impossible to tell by looking whether it is cancerous or not. It is best to talk with your dermatologist.