Macule: Identification, Types, Causes and When to See a Doctor

Medically Reviewed By Sarika Ramachandran, MD
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A macule is a flat, discolored area of skin that appears different from the surrounding skin. Macules are a common type of skin lesion. A skin lesion is an area of skin that is different in size, shape, color, or texture from the surrounding skin. Macules are very common in children and adults and occur in at least 1 in 20 people.

This article explains what a macule is, how to identify one, and what can cause it. It will also discuss diagnosis and treatment options for macules.

What is a macule?

Young girl checking her skin in a mirror
Image Source/Getty Images

A macule is a flattened skin lesion. It can be significantly lighter than the surrounding skin due to decreased melanin content. This is known as hypopigmentation. A macule may also be darker than the surrounding skin, known as hyperpigmentation.

Macule lesions are often benign, meaning they are not harmful. They may occur as a single lesion or as part of a larger rash. In some cases, prompt diagnosis and treatment can help restore color to the area.

How can you identify a macule?

A macule is a flat area of skin that is usually smooth. It is also characterized by lighter or darker pigmentation compared to the rest of your skin.

Macules can occur anywhere on the body and are usually less than one centimeter in diameter.

A large macule is known as a patch. Examples of patches include freckles, flat moles, and port-wine stains, which are reddish-purple lesions. They can also include some rashes such as those associated with rubella or measles.

What causes a macule?

A variety of conditions can cause macules. These include:

  • vitiligo, a condition in which the skin loses melanocytes, or pigment cells
  • tinea versicolor, a type of fungal infection
  • tuberous sclerosis, a rare disorder that can cause hypopigmentation
  • bacterial or viral infections
  • skin cancers
  • environmental factors, such as exposure to sun, trauma, or chemicals

How do doctors diagnose a macule?

To diagnose a macule, a dermatologist will examine your skin. They may then suggest tests to confirm the diagnosis.

Tests your dermatologist may recommend include:

  • Dermatoscopy: In this exam, a doctor will use a dermatoscope to inspect the macule. A dermatoscope is a handheld lighted magnifying instrument. It can show details of the macule, such as its edges and whether it is smooth or scaly.
  • Wood’s lamp: This emits UVA light to highlight differences in skin pigmentation. Under a Wood’s lamp, hypopigmentation, or skin that has lost its color, appears brighter than normal skin.
  • Skin scraping: With skin scraping, a doctor uses a small tool to remove an area of the skin for testing.
  • Skin biopsy: This involves a needle to remove a small tissue sample. The sample is then examined closely, most likely under a microscope.
  • Electron microscopy: This instrument can create a high-resolution image of the macule. However, it is not commonly available in a dermatologist’s office.

What are the treatments for a macule?

Treatment for a macule depends on the underlying cause. If the cause is benign, treatment may not be necessary. Some people may instead use makeup to cover the macule.

In some cases, getting prompt diagnosis and treatment for a rash or lesion can lessen the appearance of macules. Treatments for skin rashes depend on the diagnosis and can include medications, phototherapy, and surgery.

Medications for hypopigmented macules

The following medications can help treat hypopigmented macules:

  • Topical corticosteroids: These can help restore pigmentation and create a uniform skin color.
  • Vitamin D: Topical vitamin D has been shown to increase melanin production.
  • Topical calcineurin inhibitors: These suppress the immune system to help protect melanin-forming cells. This is the preferred method for treating facial patches.
  • Antifungal medication: Both oral and topical forms can help treat Tinea versicolor, a common fungal infection.
  • Oral isotretinoin: This is a retinoid used to treat a skin condition called progressive macular hypomelanosis (PMH). This condition causes light-colored macules and is common in young adults.

Phototherapy and Surgery

Phototherapy, specifically narrow-band ultraviolet B (NB-UVB) therapy, is considered one of the safest and most effective treatments for macules caused by vitiligo.

Psoralen plus ultraviolet A (PUVA) therapy combines the medication psoralen with UVA light. Psoralen in oral or topical form becomes active when it is exposed to light. This medication may cause side effects. Because of this, this type of phototherapy is not usually not recommended for children and those who are pregnant.

Surgical procedures such as skin grafting can treat localized and inherited patches of hypopigmented skin. Skin grafting involves removing the upper skin layers from one area of the body and attaching them to another. Split-thickness skin grafting removes the epidermis and dermis layers of skin.

Treatments for postinflammatory hyperpigmentation

Postinflammatory hyperpigmentation occurs when a rash heals but leaves the area with darker pigmentation.

The first step to treating postinflammatory hyperpigmentation is addressing the underlying cause of the rash and inflammation. Using sunscreen and other measures is also important to help protect the skin against ultraviolet radiation.

Treatments for postinflammatory hyperpigmentation include:

  • Topical tyrosinase inhibitors: These can help prevent melanin production.
  • Chemical peels: Salicylic, glycolic, or trichloroacetic acid peels can remove epidermal cells that contain excess melanin. These treatments should only be used under the direction of an experienced clinician.
  • Laser therapy: Lasers work by destroying pigmented cells. These include Q-switched ruby lasers, Q-switched Nd:YAG lasers, and ultrashort pulse lasers known as picosecond lasers.

How does a macule affect quality of life?

Macules often do not require treatment as most of the conditions that cause them are benign. 

It is important to diagnose the underlying cause of your macule so you can receive prompt treatment. This can help improve your overall health and quality of life rather than simply treating the superficial condition.

In some cases, hypopigmented and hyperpigmented skin lesions may have a negative psychological impact. This can include stress, anxiety, or depression.

If the appearance of a macule is affecting your mental or social well-being, talk with your doctor. It can also be helpful to talk with a therapist. They can help you find ways to cope with your condition in a supportive environment.

Frequently asked questions

Here are other questions people often ask about macule.

What is the difference between a macule and a papule?

Macules and papules are both skin lesions, but unlike a macule, a papule is not flat. A papule is a solid, raised spot or bump on your skin. Papules and macules can have similar colors or a variety of colors. They can both be lighter or darker than the surrounding skin.

Can a macule be cancerous?

A macule is not necessarily a sign of skin cancer. If you suspect you have a macule or any type of skin lesion, contact a dermatologist.

Tips for preventing skin cancer include:

  • minimizing sun exposure
  • using sunscreen with UVA and UVB protection
  • wearing protective clothing made of ultraviolet protection factor (UPF) material
  • avoiding tanning beds

Summary

A macule is a flat, discolored skin lesion. It is typically harmless but can be a sign of a more serious condition. Early diagnosis can help you get treatments that may return your skin to its original color.

For some people, the appearance of a macule can impact their mental health. If you feel your macule is affecting your quality of life, it may be helpful to contact a therapist for support.

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Medical Reviewer: Sarika Ramachandran, MD
Last Review Date: 2022 Sep 16
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