6 surprising reasons why white spots appear on your lips

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6 surprising reasons why white spots appear on your lips
Vitiligo is a chronic autoimmune condition that causes white spots on the body—particularly the face.FG Trade/Getty Images
  • White spots on your lips can be a sign of milla — harmless bumps that will resolve in a few weeks.
  • The herpes simplex virus can cause white spots on the mouth that turn into blisters or sores.
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White spots on the lips are common and they can vary in size and shape. Some are asymptomatic and will go away on their own, while others can cause pain or burning and may require treatment.

In most cases, they are natural and harmless, such as fordyce spots, but some may be painful, irritated, and long-lasting, which could be a sign of something more serious, like cancer.

Either way, it's important to determine the cause so you know whether or not treatment is necessary and if your health is at risk.

Here are six reasons for white spots on your lips and how to treat them.

1. Milia

Milia are small, hard, white bumps which are filled with trapped keratin beneath the surface of your skin, says Susan Massick, MD, dermatologist and associate professor in the Division of Dermatology at The Ohio State University Wexner Medical Center.

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Medical term: Keratin is a type of protein that helps make up your skin cells.

The bumps are usually very small, typically less than three millimeters wide, and are dome-shaped and smooth.

Milla can spontaneously occur and they are normal, harmless, and common, Massick says.

Treatment: Since milia aren't harmful and often resolve on their own within a few weeks to a few months, treatment isn't always necessary, says Massick.

However, if you are bothered by the appearance of the milia or if it won't go away, Massick says your dermatologist can:

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  • Make a tiny incision in order to extract it.
  • Treat it with an electric needle.
  • Prescribe topical retinoids if you have multiple milia and it's a recurring issue.

2. Fordyce spots

Fordyce spots are slightly enlarged sebaceous glands (oil glands) on the lips, says Jason Miller, MD, board-certified dermatologist at Schweiger Dermatology Group.

The spots are very tiny, slightly raised, around one to three millimeters in size, and often appear in clusters or patches. They can range from white to yellowish, and it may be easier to see them when you stretch out your skin.

Fordyce spots are typically asymptomatic. They are harmless, but some people may be bothered by their appearance, says Miller.

Treatment: Treatment isn't necessary unless it's a cosmetic concern. In this case, Miller says treatment involves cauterization or lasers to reduce the appearance of the spots.

3. Herpes simplex virus (HSV)

Herpes simplex virus causes white spots on the lips that turn into cold sores. These sores appear in three stages:

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  1. You may feel a tingling or burning sensation before these spots crop up, signaling that an outbreak is on its way.
  2. White spots appear, typically somewhere on the edge of the lips
  3. These white spots blister, scab, and crust over — resulting in a cold sore.

After your first cold sore outbreak, HSV will typically recur in the same location if you're exposed to cold sore triggers like stress, viral infections, fevers, or hormonal changes.

Treatment: The most common treatment is oral antiviral medications, says Massick. These may be taken to shorten the course of your outbreak. You can also try at-home treatments such as:

  • Docosanol (Abreva), an over-the-counter topical cold sore treatment
  • Prescription antiviral medication
  • Numbing gels such as benzocaine or lidocaine to reduce burning and itching
  • Over-the-counter pain relievers such as acetaminophen or ibuprofen
  • Avoiding acidic, spicy, or salty foods
  • Applying cold, wet compresses

HSV is highly contagious, especially when blisters are present, so when you have a cold sore you should avoid kissing or other close skin-to-skin contact, as well as sharing items like utensils.

4. Oral thrush (Candidiasis)

Oral thrush, or candidiasis, is a fungal infection due to an overgrowth of yeast. This condition most commonly results in white bumps and patches inside the mouth or on the tongue, but occasionally it can present on the lips or corners of the mouth, as well, Massick says.

You may also experience additional symptoms such as:

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  • Redness
  • Cottony feeling inside the mouth
  • Pain when you eat or swallow
  • Decreased sense of taste

Treatment: Prescription antifungal medications are necessary to clear up the infection. In milder cases, treatment is usually a topical antifungal medicine, but in more persistent infections, especially in people who are immunocompromised, oral systemic antifungal medications may be necessary, says Massick.

5. Vitiligo

Vitiligo is a chronic autoimmune condition that results in the loss of pigment in the skin, leaving behind smooth, white spots or patches, says Miller. The condition can begin at any age, but it will most commonly pop up between the ages of 10 and 30.

These spots vary greatly in size. They can be as small as five millimeters, which are called macules, or they can be larger, widening out over time.

They happen when the immune system attacks and destroys melanocytes, which are cells responsible for skin pigment production. While this phenomenon can occur anywhere on the body, it commonly occurs on the face, including the lips, Miller says.

Treatment: There isn't a cure for the condition but you can try treatments to restore pigment. Miller says the most common treatments are topical anti-inflammatory medications (corticosteroids) and light/laser therapies. Other types of vitiligo treatments include:

  • Topical immunomodulators (which suppress the immune response locally)
  • Topical vitamin D analogs (which modulate the body's inflammatory and immune responses locally)
  • Skin graft surgery
  • Micropigmentation with tattooing

6. Skin cancer

The most serious potential cause for white spots on the lips is cancer. The most common type of cancer found on the lips is squamous cell carcinoma, says Miller. This cancer accounts for up to 30% of all oral cancers.

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"Persistent white or red scaly patches that do not resolve on the lips could be a sign of early skin cancer, particularly in patients with history of extensive sun exposure, sunburns and smoking," says Massick. These patches may be flat or raised.

If your white spots are persistent and don't improve or resolve, Massick says some red flags are if the spots:

  • Are painful
  • Bleed easily
  • Are growing
  • Are accompanied by oral or throat pain

These are signs that you should seek medical evaluation.

Treatment: First, there must be a biopsy of the lesion to confirm if the spot is cancerous, says Miller. If it is, treatment options include:

  • Surgical removal
  • Chemotherapy
  • Radiation therapy
  • Immunotherapy
  • Targeted drug therapy

Insider's takeaway

The causes of white spots on your lips can vary greatly from something temporary and harmless like milia to something more serious and dangerous, such as cancer.

If you're concerned about the appearance of the white spots on your lips, or if you're experiencing any discomfort, see your dermatologist so you can get a proper diagnosis and decide on the best course of treatment, if necessary.

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