What causes small dots on lips? Related conditions and treatments

You glance in the mirror one day and see something on your lips that you’ve never noticed: small white spots that seem to have just popped up out of nowhere. Or maybe they’ve been there for a while, and you wonder if they will ever go away. They may even be different colors, such as red, yellow, or even blue.

“Dots on the lips can vary in color,” says Pooja R. Shah, MD, FAAD, assistant professor at the Zucker School of Medicine at Hofstra and director of Women’s Skin Health and Wellness at Northwell Health Physician Partners. “They may be painless, or they may be uncomfortable.”

Tiny dots on lips may resolve on their own without treatment, depending on what is causing them. 

What causes small dots on lips?

There are various causes of small dots that appear on the lips, some more common than others.

Cold sores (aka fever blisters)

Although you may have never had symptoms of herpes simplex virus type 1 (HSV-1), the virus that causes cold sores, chances are you’ve had it. According to the National Institute of Dental and Craniofacial Research, 90% of U.S. adults have been infected with HSV-1 at some point. Cold sores are painful sores filled with fluid that form around the lips and are highly contagious. Once infected with HSV-1, you can get cold sores repeatedly.

“If you look closely, you’ll see that a cold sore is actually a group of tiny blisters on a red base,” says Bruce Robinson, MD, FAAD, a board-certified New York City dermatologist and member of the American Academy of Dermatology. Your first sign that a cold sore is starting may be a tingling or burning sensation on your lips.

Cold sore triggers among people infected with HSV-1 differ from person to person, and some people with HSV-1 never experience cold sores. “Cold sores can occur when you are getting a cold or feeling run down,” says Sonya Kenkare, MD, a board-certified dermatologist at Illinois Derm Institute in Hinsdale, Illinois. “When you get sick, your immune system sees it as an insult. The result can be a cold sore.”

In addition to stress and illness, cold sores can be triggered by sun exposure, poor sleep, your menstrual cycle, or even a bump on the lip. “Any traumatic event can cause it,” Dr. Robinson says. “Usually, they occur in the same area of the lip because when you first get one, it travels down a nerve that feeds that area of the lip.”

Cold sores generally clear up on their own within a couple of weeks. If they don’t, Dr. Shah recommends seeing your healthcare provider, who can prescribe a medication that may shorten the severity and duration of your symptoms. “Your doctor may tell you to take Zovirax (acyclovir) or Valtrex (valacyclovir) at the very first sign of a cold sore.” Dr. Shah says that a daily suppressive dose of Valtrex may be prescribed for people who get cold sores more than six times a year.

Abreva (docosanol) is a topical ointment that your doctor may recommend. “It can relieve the pain and discomfort from a cold sore,” says Chad Prather, MD, clinical assistant professor at Louisiana State University Department of Dermatology in New Orleans.

You may be able to reduce your chances of getting a cold sore by protecting yourself against the sun. “Sunburn and exposure to sunlight can sometimes lead to outbreaks, so be sure to use sunscreen,” Dr. Shah advises. Call your doctor if your cold sore lasts longer than a few weeks, you develop a high fever, or you notice eye irritation.

People sometimes confuse cold sores with canker sores. While canker sores form inside the mouth and are not contagious, cold sores form on the outside of the mouth and are highly contagious. 

Venous lake

A venous lake is a small, harmless blue spot on your lips made up of dilated veins. It’s more common in people over 50 and more likely to affect men than women. It is usually on the lower lip but also could be on the upper lip. “People come into my office thinking they have a melanoma, but often it turns out to be a venous lake, which is very treatable,” Dr. Robinson says.

To treat a venous lake, your doctor may inject some medicine directly into the spot. This procedure is called sclerotherapy. It causes the blood vessels to shrink and has a low risk of complications. In one recent study, researchers found that sclerotherapy was the safest and most effective treatment for venous lakes. Sun exposure is a major risk factor for venous lakes, so now you have one more good reason to wear sunscreen, including lip balm that contains sunscreen.

Melanoma and other forms of skin cancer can also develop on the lips. See a healthcare provider to have a new spot on the lips checked out, especially if it is changing or growing.

Fordyce spots

Fordyce spots (Fordyce granules) are enlarged, slightly raised sebaceous glands (oil glands) that may look like white spots on the lips. They appear in hairless areas of your skin, including the edges of your lips and the inside of your cheeks. “Everyone has these oil glands in their lips, and the oil they produce is what leaves a lip print on a glass when you drink something,” Dr. Kenkare explains. 

Typically, Fordyce spots are the size of a dot you’d make with a ballpoint pen. In some people, Fordyce spots can look like little white bumps on the lips. They are slightly more common in men.“While they can be treated by resurfacing, chances are your doctor will just tell you to leave them alone,” Dr. Kenkare says. “They are not harmful and won’t get larger.”

Fordyce spots can be treated cosmetically with a laser treatment, Dr. Prather says. “But there is no harm in them, and they are not a sign of a bigger problem. They’re just oil glands that got a little enlarged.”

Milia

If you see tiny white spots on your lips, you may assume they’re Fordyce spots, but they could also be milia. Both types of white spots look alike but have different causes. Milia are tiny benign cysts that pop up on the lips when keratin, a protein typically found in skin, gets trapped beneath the skin’s surface. The white or yellow spots are small and dome-shaped. They are not usually painful or itchy. 

Milia affects close to half of all newborns, but adults can get these little white spots on their faces and lips as well. Treatment isn’t necessary since it is harmless and goes away on its own within a few weeks. If they persist, see your healthcare provider to make sure the white spots aren’t a symptom of another condition. 

Mucous cysts

“These little fluid-filled sacs can develop on the lips,” Dr. Shah says. Lip-biting or lip-sucking may cause mucous cysts. They also may occur because of a blocked salivary gland. Your doctor may advise a surgical procedure to remove a mucous cyst. This is the best way to ensure that it doesn’t come back.

Contact dermatitis

“This is an allergic reaction that can happen when you use certain lip products,” Dr. Shah says. Symptoms of contact dermatitis include small fluid-filled blisters, itchiness, dry, cracked skin, or a rash.

Once you know what you are allergic to, avoiding that product can help. But sometimes, finding out what you are allergic to can be challenging. See a healthcare provider if the bumps are causing discomfort and they come and go.

Are tiny dots on lips contagious?

Many times, tiny dots on lips are not contagious. Cold sores are very contagious, so don’t kiss anyone while you have symptoms. If you have a cold sore, avoid sharing eating utensils, cups, water bottles, or other items. Avoid kissing while you have symptoms.

Most importantly, see a doctor if the tiny dots on lips persist

Tiny dots on the lips are usually nothing to worry about. They may require treatment if your symptoms worsen or include fever, bleeding, or difficulty eating. Only your healthcare provider can rule out infections or other health conditions. Visit your doctor to determine the best treatment for tiny spots or dots on the lips.