What causes white spots on the lips?

White spots on the lips can arise from a variety of causes, ranging from benign and self-limiting conditions to those requiring medical evaluation. Common etiologies include oral candidiasis (a fungal infection caused by *Candida albicans*), which often presents as creamy-white, curd-like plaques that may be scraped off, sometimes leaving an erythematous or bleeding base. Lichen planus—a chronic inflammatory mucocutaneous disorder—can manifest as reticulated, white, lacy streaks (Wickham striae) or plaques, frequently accompanied by burning or sensitivity. Vitiligo, an autoimmune depigmenting condition, may cause well-demarcated, milky-white patches due to loss of melanocytes, typically without scaling or discomfort. Other possibilities include leukoplakia (a potentially premalignant white patch that cannot be rubbed off and is often associated with tobacco use or chronic irritation),Fordyce granules (ectopic sebaceous glands appearing as small, painless, yellowish-white papules), and post-inflammatory hypopigmentation following trauma or eczema. Less commonly, white spots may reflect early signs of squamous cell carcinoma—especially in individuals with risk factors such as prolonged sun exposure, immunosuppression, or a history of actinic cheilitis. A thorough clinical assessment—including history of duration, symptoms (e.g., pain, itching, bleeding), risk factors, and physical examination—is essential. Biopsy may be indicated for persistent, non-resolving, or atypical lesions to exclude dysplasia or malignancy.