Petechiae
Petechiae are small red, purple, or brown spots that appear on the skin when tiny blood vessels, called capillaries, break and bleed under the surface. These spots can show up from something simple, like a hard cough or straining, but they may also signal more serious health problems. Infections, certain medications, vitamin deficiencies, or conditions affecting platelets can also cause petechiae.
Anyone who notices new or spreading petechiae should pay attention, especially if there are other symptoms like fever or unexplained bruising. Recognizing what causes petechiae helps people know when to seek medical advice.
Definition of Symptom
Petechiae are tiny, pinpoint spots that appear on the skin or inside the mouth. These spots are usually red, purple, or brown. They form when small blood vessels, called capillaries, break and leak blood under the skin.
These spots often look like a rash, but they are not raised or itchy. Unlike some rashes, petechiae do not change color when pressed. They may appear anywhere on the body, including inside the mouth or on the eyelids.
Main Features of Petechiae
| Feature | Description |
|---|---|
| Size | Very small (pinpoint), less than 2 mm |
| Color | Red, purple, or brown |
| Raised? | No, they are flat |
| Itchy? | Usually not itchy |
| Location | Skin and mucous membranes |
Petechiae show bleeding under the skin. They are different from ecchymosis, which are larger, bruise-like patches. Common symptoms include grouped or scattered small spots that may appear suddenly or slowly, depending on the cause. Because leaking blood from capillaries causes petechiae, they may point to problems with blood vessels or clotting.
Possible Causes/Diseases Condition
Many things can cause petechiae. Some causes are harmless, while others need urgent medical attention.
Blood Disorders
Low platelet levels can cause petechiae. In immune thrombocytopenic purpura (ITP), the immune system attacks platelets. Other platelet problems, like Bernard-Soulier syndrome or platelet dysfunction, also raise the risk.
Leukemia and other cancers that affect the blood can cause petechiae by damaging blood cells. Disseminated intravascular coagulation (DIC) is a severe disorder where blood clots and bleeding happen at the same time.
Infections
Several infections can cause petechiae, such as:
- Meningococcal disease and meningococcemia
- Cytomegalovirus infections
- Viral hemorrhagic fevers
- Scarlet fever
- Strep throat
- COVID-19
- Mononucleosis
- Endocarditis (a heart infection)
Serious infections may also cause other symptoms like fever or rash.
Vitamin and Nutritional Deficiencies
Low vitamin C (scurvy) or vitamin K deficiency can weaken blood vessels, making petechiae more likely.
Autoimmune and Inflammatory Diseases
Diseases like lupus and vasculitis can cause blood vessel inflammation or immune attacks on platelets. Ehlers-Danlos syndrome, a connective tissue disorder, may also cause abnormal bleeding.
Other Causes
Straining from heavy coughing, vomiting, or childbirth can burst tiny blood vessels. Medicines, such as blood thinners, might also cause petechiae.
| Condition/Factor | Category |
|---|---|
| Thrombocytopenia, ITP | Platelet Disorders |
| Leukemia, DIC | Blood Disorders |
| Scurvy, Vitamin K Deficiency | Nutrition Deficit |
| SLE, Vasculitis | Autoimmune |
| Meningococcal, Viral Fevers | Infections |
| Medications, Straining | Other Causes |
Other Non-Disease Causes
Petechiae do not always result from illness. Many non-disease causes can lead to these small red or purple spots under the skin. Physical factors such as trauma or injury can cause petechiae. Even mild events, like scratching, rubbing the skin, or wearing tight clothing, can apply pressure and break small blood vessels.
Prolonged straining is another common cause. Activities such as intense coughing, vomiting, crying, lifting heavy weights, or childbirth can lead to petechiae, especially around the face and eyes. Straining increases pressure, which pushes blood out of tiny vessels. A variety of medications can also trigger petechiae. Some examples include:
| Medication | Common Use |
|---|---|
| Phenytoin | Seizure control |
| Penicillin | Treating infections |
| Quinine | Muscle cramps/malaria |
| Corticosteroids | Inflammation relief |
These medicines may affect blood vessels or interfere with how blood clots. Allergic reactions, including those to new drugs, may also cause petechiae. The skin can show small spots as part of a mild allergic response. Non-accidental injury, especially in children or elders, is another important non-disease cause. Unexplained petechiae in these groups should be taken seriously.
How It Causes the Symptom
When tiny blood vessels, called capillaries, break and bleed under the skin, petechiae form. This bleeding causes small red, purple, or brown spots. Common underlying causes include:
- Infections: Viral and bacterial infections, such as meningitis or strep throat, can damage blood vessels and lead to petechiae.
- Medications: Certain drugs, like blood thinners or chemotherapy, may reduce the body’s ability to clot, causing bleeding and petechiae.
- Straining: Intense coughing, vomiting, or weight lifting can create physical strain that breaks small capillaries, especially in the face or neck.
- Medical Conditions: Blood disorders such as leukemia or low platelet levels are linked to a higher risk of petechiae.
| Cause Category | Examples |
|---|---|
| Infections | Virus (e.g., mono) |
| Bacteria (e.g., strep) | |
| Medications | Blood thinners, chemo |
| Straining | Coughing, vomiting |
| Blood disorders | Leukemia, ITP |
If the blood cannot clot properly, even small injuries or natural wear in blood vessels can cause spotting. Conditions like vasculitis, where blood vessel inflammation leads to leaking, can also cause petechiae. Other triggers include allergic reactions, autoimmune diseases, or trauma. Petechiae do not itch or raise. They usually stay flat because the blood is trapped underneath the skin.
Possible Complications
Petechiae can lead to problems if not addressed early, especially if an underlying condition causes them. Some causes, such as infections or blood disorders, may become serious if untreated.
A major concern is the risk of severe bleeding. When low platelet counts cause petechiae, blood may not clot normally, which raises the risk for nosebleeds, gum bleeding, or even internal bleeding.
Certain diseases linked to petechiae, like vasculitis or leukemia, can also damage organs. For example, inflammation in blood vessels may reduce blood flow to organs, possibly causing kidney or liver problems.
List of Possible Complications
- Severe Bleeding
- Organ Damage (like kidney or liver issues)
- Nerve Injury
- Chronic Fatigue (caused by anemia or chronic disease)
- Serious Infections if the immune system is weak
People with untreated infections causing petechiae, such as meningococcal infections, can develop sepsis. This is a medical emergency that requires quick treatment.
If autoimmune diseases or blood cancers cause petechiae, people may need long-term care. These conditions can strain the body and lead to issues like frequent infections or poor wound healing. In rare cases, untreated conditions may lead to life-threatening complications like multi-organ failure or shock.
When to Seek Medical Attention
Pay attention to new or changing petechiae. Some situations require urgent care. Seek medical attention right away if petechiae appear suddenly or spread quickly, especially if you also have symptoms like fever, trouble breathing, or heavy bleeding. Common warning signs to watch out for include:
- Rapid appearance or spreading of spots
- Fever
- Difficulty breathing
- Bleeding from nose, gums, or other sites
- Feeling very weak or dizzy
If petechiae cover the body or you don’t know the cause, visit a health care professional soon. Sometimes these spots signal a serious infection or a blood problem. If children develop new petechiae that don’t fade with gentle pressure, especially with a fever, get them checked right away.
