Red spots on the skin that are not itchy can be due to various conditions such as petechiae, infantile hemangioma, keratosis pilaris, acne, cherry angiomas, pyogenic granuloma, granuloma annulare, lupus, Lyme disease, hand foot and mouth disease, erythema nodosum, syphilis, leprosy, or skin cancer.
These non-itchy spots can present as flat red spots or raised red bumps. While some might be harmless and resolve over time, others may require treatment.
Below you will find 14 possible causes of non-itchy red spots on the skin, along with pictures and treatment options.
If you want to know about both itchy and non-itchy red spots and bumps, refer to this article (it includes 38 skin conditions that can cause them).
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1. Petechiae and purpura
Flat, red spots on the skin that are not itchy can be due to blood spots, which include petechiae or purpura (though some types of purpura can be raised). These spots occur due to bleeding from small blood vessels into the skin.
Petechiae present as non-itchy red dots on the skin that are less than 2 mm in size, while purpura, which are larger than 2 mm, appear as non-itchy red splotches on the skin.
Both can appear in clusters and may look like rashes. However, unlike rashes, these spots do not fade or become pale when you press on them.
Causes
Purpura and petechiae can occur due to various reasons.
Thrombocytopenic purpura or petechiae involves disorders that lead to the destruction of platelets. Platelets are cells present in our blood that help in the clotting of blood.
Deficiency of these may result in blood spots. It can be due to unknown reasons, autoimmunity, drugs, infections, and other diseases.
Coagulation disorders: These can affect the coagulation factors essential for proper clotting of blood. It includes disseminated intravascular coagulation or side effects of drugs like heparin and warfarin.
Disorders affecting the blood vessels: These include weaker blood vessels, as in aged skin, inflammation of vessels (vasculitis), and injury to blood vessels.
Several other causes can lead to purpura or petechiae.
Treatment
Treatment will depend on the underlying cause.
These may include
- Steroids
- Vitamin K
- Antivirals
- Antibiotics
- Immunosuppressants
- Chemotherapy, radiation, or bone marrow transplant
Blood spots due to minor injury may not need treatment.
2. Birthmark – Infantile hemangioma
Infantile hemangiomas are the result of the collection of extra blood vessels in the skin.
Symptoms
It can be of two types:
- Superficial when it is present just underneath the skin. This appears as a red bump and is also called strawberry hemangioma.
- Deep is found deeper in the skin and can be bluish or skin-colored.
This can appear at birth or shortly after birth. It can go through three phases:
- The growth phase, where it grows quickly.
- Plateau phase with no change.
- Involution in which it shrinks in size.
Cause
The exact cause is not known.
Treatment
Most of these go away and do not need treatment. If they are large or cause any discomfort, they can be treated with the following:
- Beta-blockers
- Steroids
- Ligation of blood vessels
- Laser
- Surgical removal
3. Keratosis pilaris
Keratosis pilaris, also referred to as ‘chicken skin’, can lead to tiny, non-itchy red spots on the skin.
Symptoms
This usually affects children and adolescents and clears by the age of 20-30s. They are usually seen on the upper arms, cheeks, thighs, or buttocks.
They appear as rough small red spots on the skin and may feel like sandpaper. They can worsen in the dry or winter season.
They usually don’t hurt or itch.
Causes
This occurs due to blockage of the hair follicle with keratin (a protein that is part of our hair and outer layer of skin). It can result in inflammation leading to red bumps. Why this occurs is not completely clear.
It may be associated with atopic dermatitis or genetics.
Treatment
It usually clears on its own with age. However, the appearance may be improved with several ingredients.
- These may include urea and alpha hydroxy acids like lactic acid which can get rid of the dead skin cells.
- Retinoids can help in promoting cell turnover and removing dead skin cells making the surface less bumpy and soft.
- Chemical peels and microdermabrasion may also be helpful.
4. Acne vulgaris
Acne vulgaris (the common acne) can lead to different kinds of lesions, some of which can appear as red spots.
Causes
Acne usually affects teenagers, although it can affect all ages. It is commonly seen in areas rich in oil glands, like the face, upper back, chest, or shoulders.
It occurs due to blockage of the hair follicles with sebum and dead skin cells. It can result in inflammation and the proliferation of bacteria.
Symptoms
Acne is of two types – non-inflammatory and inflammatory.
Non-inflammatory acne lesions can appear as closed comedones or blackheads.
Inflammatory acne can appear as red bumps. They can be in the form of papules, pustules, nodules, or cysts. All these can appear as red bumps. Nodules and cysts are usually painful.
Typically, acne is not itchy. However, some individuals may experience itching, often due to dry skin rather than the acne itself. It’s also worth noting that some acne medications can dry out or irritate the skin, which may lead to itching.
Treatment
Treatment will depend on the severity of the acne.
- Mild or moderate acne can benefit from topicals like salicylic acid, benzoyl peroxide, retinoids like adapalene, and tretinoin, or topical antibiotics.
- Severe acne may need oral antibiotics or oral retinoid (Accutane) in addition to topicals.
5. Cherry angioma
Cherry angiomas are benign lesions that consist of proliferating small blood vessels (capillaries). They usually appear after the age of 30-40.
Symptoms
Cherry angiomas appear as small (1- 5 mm) non-itchy red spots on the skin, although they can be bigger in size. They are usually bright red in color. They are often raised but can also be flat.
They can appear anywhere on the body but are commonly seen on the chest, back, and arms. They usually don’t hurt or itch but can bleed due to trauma.
Causes
The exact cause behind it is not clear. However, the following factors may play a role:
- Genetics
- Aging
- Hormones (as in pregnancy)
- Side effects of a medication
Treatment
These do not require treatment. However, if they bleed or for cosmetic reasons, they can be removed in a doctor’s office. The following procedures may be done:
- Cryotherapy
- Electrosurgery
- Laser
6. Pyogenic granuloma
Pyogenic granuloma is a benign proliferation of capillaries, a type of blood vessel. The name is a misnomer as this is not infectious.
Symptoms
This can be seen in all ages; however, they are common in children, young adults, and pregnant females.
They can appear on the skin and mucous membranes. The common sites are:
- Face
- Fingers
- Oral cavity – gums, lips, tongue
They appear as red or reddish-brown bumps or nodules a few mm in size. The size may increase over time.
The surface is smooth initially, but it can become irregular and crusty as it matures. The mature lesion may have white scales around the base of the bump.
They do not itch but can bleed easily.
Causes
The exact reason is not known. They are often associated with:
- Trauma
- Hormonal changes (pregnancy, OCPs)
- Drugs
Treatment
- The first step is to address any associated factors.
- Complete surgical excision is the preferred method of treatment.
- Other treatment methods include:
- Freezing
- Laser
- Curettage
- Intralesional steroid injection
- Topicals like imiquimod cream, alitretinoin gel or timolol. The results may vary with these topicals, and they may not be effective.
7. Granuloma annulare (Localized type)
Round red patches on the skin that are not itchy can be due to granuloma annulare.
Symptoms
There are various types of granuloma annulare and the symptoms can vary depending on the type.
Localized type is the most common type (75% of cases) and affects children or young adults. It leads to ring-shaped bumps on the hands, wrists, feet, and ankles.
The surface is smooth, and the center of the bump may be slightly depressed. These rings are usually red, but they can also be purplish or skin-colored. This type is usually not itchy.
There are a few other uncommon types, like the generalized type, which is seen in adults.
Causes
The exact cause is not clear. However, it can be triggered by several factors:
- Injury
- Infection
- Drugs
- Sun exposure
- Insect bites
It is found more commonly in females. It is also seen more often in people with diabetes, thyroid disease, or HIV.
Treatment
The spots usually clear on their own and do not require treatment. However, treating them can help in clearing them fast. They can reoccur.
The common treatments are:
- Topical steroids
- Topical calcineurin inhibitors
- Steroid injection
- Freezing
- Laser
- Oral medications like steroids, antimalarials, antibiotics, etc.
8. Hand, foot and mouth disease
Hand, foot, and mouth disease is a viral infection commonly seen in young children.
Symptoms
Hand, foot, and mouth disease leads to a skin rash on the hands and feet. The red spots of this rash may eventually form blisters. This rash is usually not itchy. Sores and blisters are also seen in the mouth.
The rash may be preceded by a fever. Other symptoms may include a sore throat, feeling sick, and loss of appetite.
Cause
It is most commonly caused by a type of enterovirus called coxsackievirus A16. It is contagious and can spread in daycares or schools.
Treatment
The rash does not require specific treatment and usually clears up in about a week. Over-the-counter medications like Tylenol may help manage symptoms.
9. Lyme disease
Lyme disease is a bacterial infection caused by Borrelia bacteria. It is transmitted through the bite of an infected tick, with symptoms usually appearing between 3 to 30 days post-bite.
In half of the cases, flu-like symptoms such as headaches, fever, chills, joint pain, or enlarged lymph nodes may be seen.
Approximately 70% of patients develop a skin rash, also known as erythema migrans, which is usually not itchy.
This rash is characterized by a red circle on the skin with a ‘bull’s eye’ appearance. It has a red center surrounded by a pale area and then an outer red ring. The red central spot marks the area of the tick bite.
If Lyme disease is not treated, it can affect several other body parts including the central nervous system, heart, eyes, and more. Late-stage symptoms may include nerve pain, numbness, headaches, dizziness, facial paralysis, vision loss, chest pain, abnormal heart rate, and arthritis.
Treatment
It’s best to start treatment for Lyme disease early to prevent complications. It is usually treated with antibiotics like amoxicillin and doxycycline.
10. Cutaneous lupus
Cutaneous lupus refers to a group of disorders that affect the skin and has three main types: acute, subacute, and chronic. The acute type is often itchy, whereas the subacute and chronic forms are usually not itchy.
The three types are characterized by the following features:
- Acute cutaneous lupus: This presents as a red rash, mainly on the cheeks and nose, in a butterfly pattern.
- Subacute cutaneous lupus: This type presents with raised red circular spots that have a scaly surface. These spots are commonly seen on sun-exposed areas like the upper arms or trunk.
- Chronic cutaneous lupus: The most common type of chronic form is discoid lupus, which presents with round, red, scaly patches or plaques that can lead to scarring and hair loss. This often affects the scalp, ears, cheeks, nose, and lips.
Cause
Lupus is associated with factors such as genetics, environment, and the immune system. It is most commonly seen in females aged between 20 to 50 years.
Treatment
Lupus is usually treated with topical steroids, oral steroids, antimalarials, or immunomodulators. Also, one should protect the skin from sun and use a broad-spectrum sunscreen.
11. Erythema nodosum
Erythema nodosum presents with painful red bumps on the anterior aspect of the shins. These occur due to inflammation of subcutaneous fat.
Symptoms
It can appear in all ages and sexes.
It presents with painful red nodules, which can be a few cm in size (can be 10 cm or more). They are usually round or oval and have ill-defined borders.
They are deep red in color, and as they heal, they can become purplish or bruise-like in appearance. They may take a few weeks to resolve. They usually do not leave any scars.
These are often accompanied by fever, joint pain, or enlarged lymph nodes.
Causes
In around 55% of cases, the cause is unknown.
In other cases, it may be associated with infections like streptococcal, drugs, pregnancy, inflammatory conditions like sarcoidosis, inflammatory bowel disease, or occasionally cancers.
Treatment
The treatment will depend on the underlying cause, which should be addressed.
The other treatments may include:
- NSAIDs for pain
- Oral potassium iodide
- Systemic steroids
12. Syphilis
Syphilis is a sexually transmitted disease. It can lead to a non-itchy rash on the skin.
Causes
Syphilis is caused by a bacteria called Treponema pallidum. It is transmitted sexually by direct contact with the lesions. A pregnant female can transfer it to the baby.
Symptoms
After the initial infection, the first stage, known as primary syphilis, presents with a painless, firm, round sore called a chancre, typically appearing on the genitalia. It usually heals within a few weeks, and one might not even notice it.
The second stage, known as secondary syphilis, occurs between 3-8 weeks later and is characterized by red or reddish-brown bumps appearing on the body. These bumps may have rough surfaces and are usually seen on the chest, back, palms, and soles.
Other symptoms like fever, weakness, headache, and enlarged lymph nodes may accompany it.
Treatment
One should refrain from any sexual activity while having active lesions to prevent the spread of disease to others.
It is treated with antibiotic penicillin. If treated early, serious long-term complications can be avoided.
13. Hansen disease (Leprosy)
Hansen’s disease, also known as leprosy, can cause red bumps on the skin. In addition, it can affect the eyes, nerves, and mucous membranes.
It is uncommon, and as per the CDC, per year, about 150 people in the United States and 250,000 around the world get this infection.
Symptoms
Leprosy can lead to numbness, enlarged nerves, or affect the eyes.
The skin can present with the following symptoms:
- Red or hypopigmented patches or bumps on the skin.
- Loss of sensation.
- Loss of eyebrows and eyelashes.
- Painless sores on hands or feet
If the disease is not treated, it can advance, permanently damaging parts of the skin, eyes (loss of vision), and nerves (paralysis).
Causes
It is caused by a bacteria called Mycobacterium leprae. It is slow growing, so finding the source of infection may be hard.
According to the CDC, it is transmitted by prolonged close contact with someone with untreated leprosy.
It is NOT transmitted by:
- Casual contact like handshaking, sitting next to each other, etc.
- Sexual contact.
- Pregnant mother to the baby.
Treatment
Leprosy is treated with multiple antibiotics. The common ones are dapsone, rifampicin and clofazimine.
14. Skin cancer
Skin cancer is of three main types:
- Squamous cell carcinoma
- Basal cell carcinoma
- Melanoma
Itching is not a common symptom of skin cancer.
Causes
Squamous cell carcinoma and basal cell carcinoma occur as a result of DNA damage due to UV rays. The cause of melanoma is not clear, but genetics and sun exposure may play a part.
Symptoms
All these cancers can present in various ways. Some of these are:
- Squamous cell carcinoma can appear as a firm red bump that does not heal or ulcerate.
- Basal cell cancer can present with a red bump or spot. It can also appear skin-colored or pigmented.
- Amelanotic melanoma can appear as a red, pink, or skin-colored bump.
Any bump that appears suddenly, grows rapidly, has irregular edges, or fails to heal should be examined by a healthcare provider to rule out the possibility of cancer.
Treatment
Treatment depends on the type of cancer. The treatment may include surgical excision, chemotherapy, or radiotherapy.
When to see a doctor
While some of the non-itchy red skin spots mentioned above are harmless, others can lead to serious complications. Timely treatment can help prevent these outcomes.
One should see a doctor if:
- The red spots cover a large area of the body.
- There is a visible discharge like pus.
- The red spots are accompanied by systemic symptoms like fever, weakness, and swollen lymph nodes.
- The spots do not heal.
- You are not sure what is causing them.
Key points
Non-itchy red spots on the skin can occur due to a variety of conditions, such as petechiae or purpura, pimples, keratosis pilaris, granuloma annulare, lupus, syphilis, leprosy, among others.
Certain conditions such as Lyme disease, lupus, syphilis, leprosy, and skin cancer require timely treatment. For others, like petechiae or erythema nodosum, it’s crucial to identify and address the underlying cause.
If you’re uncertain about the cause of the red spots on your skin, it’s best to consult a doctor.
Read more:
Itchy Bumps on Skin: Causes, Pictures, Treatment
White Bumps on Face: 8 Causes (Not only Milia) and Treatments
References
- Schmieder SJ, Harper CD, Schmieder GJ. Granuloma Annulare. [Updated 2022 Apr 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- Schwartz RA, Nervi SJ. Erythema nodosum: a sign of systemic disease. Am Fam Physician. 2007 Mar 1;75(5):695-700. PMID: 17375516.
- Qadeer HA, Singal A, Patel BC. Cherry Hemangioma. [Updated 2022 Oct 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- Sarwal P, Lapumnuaypol K. Pyogenic Granuloma. [Updated 2022 Sep 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- Syphilis – CDC Detailed Fact Sheet. CDC.
- Hansen’s disease (Leprosy). CDC.
- Pennycook KB, McCready TA. Keratosis Pilaris. 2022 Jun 27. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. PMID: 31536314.
Disclaimer: This blog post is for information purposes only and does not replace medical advice.