Finding small, white dots on your lips can be surprising. While these spots frequently cause alarm, they are often a common, harmless anatomical variation or a minor, non-contagious skin issue. White lesions appearing on the vermilion border (the colored part of the lip) or the inner mouth can occasionally signal an underlying condition requiring medical attention. This article explores the most frequent reasons for white spots on the lips, ranging from benign causes to conditions requiring professional diagnosis.
The Most Common Cause: Fordyce Spots
The most frequent explanation for white or yellowish dots on the lips is Fordyce spots, also called Fordyce granules. These are visible sebaceous glands (oil-producing glands) naturally present in the skin. On the lips, they are considered “ectopic” because they appear where hair follicles are absent, unlike most sebaceous glands on the body.
Fordyce spots appear as tiny, pale, or skin-colored bumps, typically measuring between one and three millimeters in diameter. They can occur individually or in clusters, often becoming more noticeable when the surrounding skin is stretched. These spots are present in a large percentage of the adult population, with estimates suggesting that between 70% and 80% of adults have them.
They are benign and painless, and are not transmissible through contact. While thought to be present from birth, they often become prominent following puberty due to hormonal changes that cause the oil glands to enlarge. Because they represent a natural structural feature, Fordyce spots do not require medical treatment.
Other Non-Infectious Causes
Not all harmless white spots are Fordyce granules; another common non-infectious cause is Milia. These are tiny, dome-shaped cysts that appear white or yellow, formed by trapped keratin (a protein found in skin, hair, and nails). Unlike Fordyce spots, which originate from oil glands, Milia result from skin cells becoming trapped beneath the surface.
Milia are not painful or itchy and may appear on the face, including the lips, especially near the vermilion border. They are commonly seen in newborns but can also occur in adults, often resulting from skin damage, sun exposure, or the use of heavy lip products. These cysts are harmless and frequently resolve spontaneously without intervention. Less common white spots include minor scar tissue from previous injury or post-inflammatory hypopigmentation (loss of skin color following a healed rash).
Infectious and Inflammatory Conditions
Some white dots can be signs of infectious or inflammatory conditions that need medical attention. One such condition is oral candidiasis, commonly known as thrush, a fungal infection caused by an overgrowth of Candida albicans. Thrush typically presents as creamy white lesions or patches, rather than small dots, on the inner cheeks, tongue, and sometimes the lips, and can cause pain or a burning sensation.
Small, fluid-filled white blisters on the lip border may indicate the early stages of a cold sore, caused by the Herpes Simplex Virus (HSV). These lesions are highly contagious and are usually accompanied by a characteristic tingling, burning, or itching sensation before they blister and crust over. Another possibility is oral lichen planus, a chronic condition that manifests as white, lacy patterns, plaques, or papules on the lips and inside the mouth. These infectious and inflammatory causes are differentiated from benign spots by the presence of pain, redness, inflammation, or a quick change in appearance.
When to Seek Medical Advice and Treatment Options
A medical consultation is prudent if the white dots on your lips exhibit certain red flags. Seek professional advice if the spots are painful, begin to bleed, grow rapidly, or persist for more than two to three weeks without change. Accompanying symptoms such as fever, swollen lymph nodes, difficulty swallowing, or a persistent sore throat also warrant immediate evaluation.
For conditions like Fordyce spots and Milia, treatment is unnecessary because they are benign and pose no health risk. If the spots are a cosmetic concern, a dermatologist may offer procedures such as carbon dioxide laser treatment, micro-punch surgery, or cryotherapy to reduce their visibility. Infectious causes require specific medical interventions. Oral thrush is treated with antifungal medications, while cold sores caused by HSV are managed with antiviral drugs to shorten the outbreak. The approach to treatment depends entirely on accurately diagnosing the underlying cause of the white spots.