Petechiae are tiny red blood spots or dots on the skin that are flat and do not itch. They appear due to bleeding into the skin. They can appear in clusters and may look like a rash.
Petechiae can be harmless when due to straining or serious when due to underlying medical conditions like systemic infections or leukemia. One should see a doctor to know the underlying cause of petechiae.
Pictures and appearance
Petechiae are pinpoint flat red spots on the skin which are often referred to as blood spots. They can also be seen in the mucous membranes like inside the mouth and eyes. They are usually 1-2 mm in size.
If these are pressed, the red spots do not fade or become pale which happens with rashes.
Blood spots that are larger than 0.2 cm but less than 1 cm are called purpura. Blood spots that are greater than 1 cm are called ecchymoses.
One can see a group of petechiae that can look like a rash. Purpura and petechiae may be seen together.
Location
Petechiae can appear anywhere on the body. The site will also depend on the underlying cause.
In general, they are usually seen on:
- Arms
- Legs
- Trunk
- Buttocks
- Mucosal surfaces like the mouth and eyes
Causes
Petechiae occur when tiny vessels called capillaries leak blood into the skin. Any petechiae with fever requires immediate medical attention.
The main mechanisms behind the appearance of these pinpoint red dots on the skin are:
- Decrease in the number of platelets (platelets are blood cells that are essential for normal clotting of blood).
- Abnormal functioning of platelets.
- Problems with clotting factors.
- Abnormality of the vessels.
Petechiae may appear due to many possible reasons. Below are some of the most common causes of petechiae:
1. Straining
Any straining like weight lifting, forceful coughing, vomiting, or giving birth can lead to the appearance of petechiae. These usually present as red dots on the neck, arms, or shoulders.
2. Injury
Injuries like any trauma, grazing of skin against a rough surface, or sunburn can lead to petechiae.
3. Infections
Infections can lead to petechiae in different ways: abnormal activation of the coagulation pathway which consumes the platelets leading to thrombocytopenia or damage to the blood vessels.
- Meningococcemia: This is a widespread infection caused by the bacteria – Neisseria meningitidis. The symptoms include petechiae, fever, chills, malaise, myalgias, headaches, nausea, and vomiting.
- Rocky Mountain spotted fever (RMSF): It is a bacterial infection caused by Rickettsia rickettsii. It can occur by the bite of an infected tick. It can present with fever, headaches, myalgias, malaise, pain in the legs, and petechiae.
- Endocarditis: It is an infection of the heart lining (especially the valves). It is usually caused by bacteria. The symptoms include petechiae, splinter hemorrhages (hemorrhage under a nail), fever, malaise, fatigue, and shortness of breath.
- Infectious mononucleosis: It is a viral infection caused by the Epstein-Barr virus. It can present with fever, petechiae, fatigue, enlarged lymph nodes, headache, and swollen tonsils.
- Viral hemorrhagic fevers like dengue, Lassa fever, yellow fever, or Ebola, can affect the blood vessels and can interfere with blood clotting. It can present with petechiae, fever, fatigue, bleeding, body pains, nausea/vomiting, and diarrhea.
- Other infections: CMV, scarlet fever, parvovirus B19, and Hantavirus, are some of the other infections which can cause petechiae.
4. Medications
Certain medications may affect the platelets or clotting factors which are required for normal clotting of blood. In addition, some medications may interact with other medications or can activate the immune system.
The following medications may cause petechiae in some people:
- NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen.
- Antibiotics like penicillin.
- Anticoagulants like warfarin and heparin.
- Anti-seizure medications like carbamazepine.
- Antimalarial medications like quinine.
- Sedatives.
- Drugs for irregular heart rate.
5. Vitamin C deficiency
Vitamin C is a water-soluble vitamin and deficiency of this vitamin can lead to scurvy. It can make the small blood vessels fragile and prone to damage by minimal trauma.
The symptoms of scurvy include petechiae, bleeding gums, easy bruising, fatigue, and aches.
6. Vitamin K deficiency
Vitamin K is required for the production of clotting factors and a few proteins that are required for proper blood clotting.
A deficiency of vitamin K can lead to easy bruising, mucosal bleeding (like nose bleeding, blood in urine or stools), or petechiae.
7. Vasculitis
Vasculitis is the inflammation of blood vessels. Inflammation can reduce the lumen of vessels, reducing the blood supply. It may occur due to an autoimmune process where our own cells attack the cells of the blood vessels.
It can be of various different types. The symptoms may include fever, fatigue, muscle pain, petechiae, vision problems, nerve involvement, and blood in the urine.
8. Thrombocytopenia
Thrombocytopenia is the reduction in the number of platelets. This can be due to a decrease in platelet production, increased destruction, or dilution of platelets.
It can occur due to many reasons – drugs that suppress bone marrow like some chemotherapy drugs, infections, enlarged spleen, autoimmune disorders, immune thrombocytopenic purpura (ITP), hemolytic uremic syndrome (HUS), and disseminated intravascular coagulopathy (DIC).
9. Platelet dysfunction
Many disorders like liver cirrhosis, multiple myeloma, systemic lupus erythematosus, uremia and some types of blood disorders can lead to defective function of platelets. So, the blood clotting is affected leading to petechiae.
10. Congenital disorders
This includes a group of disorders in which the platelets or other components of blood may be defective or reduced in quantity leading to abnormal bleeding. These include:
- Glanzmann disease
- Bernard-Soulier syndrome
- Wiskott-Aldrich syndrome
11. Leukemia
Petechiae may rarely appear due to leukemia. Leukemia is a broad term used for various cancers of blood and blood-forming tissues. The symptoms may vary depending on the type of leukemia.
Some of the symptoms include easy bruising or bleeding, bleeding from the nose or gums, fatigue, night sweats, fever, chills, weight loss, enlarged lymph nodes, and frequent infections.
Diagnostic tests
Your doctor will first examine your skin lesions to see if they are petechiae. Petechiae are pinpoint flat red or purple spots or dots that do not go away if pressed, meaning they are non-blanching.
Your doctor may also ask you about other symptoms like bleeding from the gums or nose, blood in urine or stool, your vaccination status, medical history, current medications, recent exposure, or injury.
Diagnostic tests may be done to find the cause of petechiae. These may include:
- CBC (complete blood count)1 which can tell if the blood cells are in adequate quantity.
- Coagulation tests to know about clotting factors.
- Microbiological cultures if an infection is suspected.
- Imaging like X-ray or CT scan.
- Urine test.
- Liver and renal profiles.
Additional tests may be ordered depending on the results of the initial tests.
Do petechiae go away?
If petechiae appear after a minor injury or straining like coughing or vomiting, they usually disappear on their own in a few days (usually 2-4 days).
Petechiae which occur due to underlying medical conditions usually disappear when the condition is treated. The time it takes to go away will depend on the medical condition.
Treatment
The treatment of petechiae depends on the underlying medical condition. Your doctor will determine the cause after a physical examination and diagnostic testing.
The treatment options may include:
- If the petechiae appear after a minor injury, they may fade on their own and may not need additional treatment.
- If caused by medication, your doctor may stop your medication and recommend some other medication.
- If petechiae are accompanied by fever, there is a possibility of infectious disease. In such a case antibiotics or antivirals may be given. If a person is very sick, hospitalization may be necessary.
- Petechiae due to leukemia requires chemotherapy, immunotherapy, bone marrow transplant, or other treatment methods.
- Platelet transfusion may be given if the number of platelets is too low.
- Vitamin C or K supplementation if there is any deficiency.
- Medications to suppress the immune system like azathioprine or cyclophosphamide.
- Corticosteroids to reduce inflammation.
Can you treat these at home?
Petechiae can occur due to a variety of reasons and some of these can be serious. So, it’s important to see a doctor to know what is causing the petechiae.
If petechiae appears after a minor injury, a cold compress, fluid, and rest may be helpful.
When to call a doctor
Petechiae is not a medical condition but a sign of many other medical conditions some of which require immediate medical attention. If you have petechiae or pinpoint red dots on your skin, you should see a doctor to know what is causing them.
In addition, see your doctor immediately if:
- Petechiae are spreading quickly.
- You have a fever.
- You have trouble breathing.
- You are confused or dizzy.
- Petechiae appeared following a tick bite.
Prevention
You cannot always prevent petechiae, however, there are some general measures one can follow that can decrease the chances of getting them.
- Eat healthy food to avoid vitamin deficiencies.
- Practice good hand hygiene.
- Get all your (or your child’s) vaccines as per the immunization schedule.
- Clean the common surfaces like door knobs, handles, or countertops.
- Do not use anyone else’s personal belongings.
- Do not share your utensils with others.
- Avoid direct contact with anyone who is sick.
- Use masks and wash your hands thoroughly if you are caring for someone who is sick.
- Use insect repellents or wear full-length shirts and pants when you go outdoors (especially in areas with grass and woods) to avoid insect bites.
- Protect your skin from the sun by using sunscreen or protective clothing.
Key points
Petechiae are tiny red blood spots or dots on the skin which are not itchy. They are flat and less than 2 mm in size. They can appear due to various conditions like infections, trauma, medications, blood or clotting disorders, and rarely due to leukemia.
Petechiae requires a thorough clinical examination and in some cases, additional testing to find the underlying cause.
Some cases may resolve on their own or with medications while some are fatal and may require hospitalization and intensive treatment.
References
- McGrath A, Barrett MJ. Petechiae. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- Vayne C, Guéry EA, Rollin J, Baglo T, Petermann R, Gruel Y. Pathophysiology and Diagnosis of Drug-Induced Immune Thrombocytopenia. J Clin Med. 2020 Jul 13;9(7):2212. doi: 10.3390/jcm9072212. PMID: 32668640; PMCID: PMC7408966.
- Kuter D. Overview of Platelet Disorders. 2022. Merck Manual.
- Noris P, Pecci A. Hereditary thrombocytopenias: a growing list of disorders. Hematology Am Soc Hematol Educ Program. 2017 Dec 8;2017(1):385-399. doi: 10.1182/asheducation-2017.1.385. PMID: 29222283; PMCID: PMC6142591.
- Leung AK, Chan KW. Evaluating the child with purpura. Am Fam Physician. 2001 Aug 1;64(3):419-28. Erratum in: Am Fam Physician 2002 May 1;65(9):1751. PMID: 11515831.
Disclaimer: This blog post is for information purposes only and does not replace medical advice.