Petechiae

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What are petechiae?

Petechiae are small red or purple dots of blood that develop on the skin or in the mucous membranes, such as in the mouth. Petechiae are a physical finding caused by some other condition. Petechiae occur when superficial blood vessels under the skin break. Petechiae may look like a rash.

The most common cause of petechiae is physical trauma, such as a violent coughing fit, prolonged vomiting, or excessive crying. This kind of trauma can result in facial petechiae, particularly around the eyes. Petechiae can also appear in aging skin. These forms of petechiae are generally harmless and disappear within a few days.

Petechiae can also be a sign of a serious blood disorder called thrombocytopenia. In this disease, blood platelet levels are low, which impairs blood clotting and causes small bleeds into the skin. Petechiae may also be a sign of another platelet-related disorder, idiopathic thrombocytopenic purpura (ITP). ITP is thrombocytopenia with no known cause.

Certain drugs can impair the ability to form blood clots and cause petechiae. These drugs include antiplatelet medications, anticoagulants, aspirin, and corticosteroids. Seek prompt medical care if you are taking these types of medications and get petechiae.

What other symptoms might occur with petechiae?

Petechiae may accompany other symptoms, which vary depending on the underlying disease, disorder, or condition.

Symptoms that may occur along with petechiae

Petechiae may accompany other symptoms including:

  • Collection of clotted blood under the skin (hematoma)
  • Easy bleeding or bruising
  • Excessive bleeding from the gums
  • Joint hemorrhage (hemarthrosis)
  • Unexplained nosebleeds

Serious symptoms that might indicate a life-threatening condition

In some cases, petechiae may be a symptom of a life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Confusion or loss of consciousness for even a brief moment
  • Severe bleeding
  • Severe headache

What does petechiae look like?

Forearm showing capillaritis, pinpoint-like hemorrhages (petechiae)
Large bruise on woman's arm
Getty
Petechiae with bruise on arm

What causes petechiae?

Petechiae occur when small blood vessels under the skin break. The most common cause of petechiae is physical trauma. Petechiae may also spontaneously appear in aging skin.

Petechiae may be a sign of serious blood disorders in which blood fails to clot. The inability to form blood clots and resulting petechiae may also occur with certain medications.

Traumatic petechiae causes

Petechiae may be caused by physical trauma including:

  • Choking
  • Excessive crying
  • Heavy lifting with extreme straining
  • Violent coughing
  • Vomiting including multiple episodes

Drug-related petechiae causes

Petechiae can also be caused by reactions to certain medications. Examples include:

  • Acetaminophen (Tylenol) and naproxen (Aleve, Naprosyn)
  • Chlorothiazide (Chlotride, Diuril)
  • Cimetidine (Tagamet)
  • Heparins including low molecular weight heparin
  • Phenytoin (Di-Phen, Dilantin) and carbamazepine (Carbatrol, Tegretol)
  • Quinine
  • Rifampin (Rifadin, Rimactane), penicillin, and linezolid (Zyvox)

Serious or life-threatening petechiae causes

In some cases, petechiae may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include:

  • Blood clotting factor defect
  • Disseminated intravascular coagulation (a syndrome that results in depletion of blood clotting factors)
  • Exposure to toxic substances or poisoning (rodenticide)
  • Idiopathic thrombocytopenic purpura (thrombocytopenia with no known cause)
  • Serious infections, such as enterovirus infection or meningococcal infection
  • Thrombocytopenia (low blood platelet count; platelets help form clots to stop blood loss)

When should you see a doctor for petechiae?

If you develop petechiae, contact your doctor. Your doctor can help you decide if you should be seen immediately based on your medical history. See a doctor promptly when petechiae:

  • Appear suddenly
  • Are unexplained and have no identifiable cause, such as crying or vomiting
  • Are widespread or spreading quickly

Call 911 or go to your nearest emergency room when petechiae occur along with:

  • Change in consciousness
  • Difficulty breathing
  • Fever, especially in a child
  • Other signs of bleeding
  • Rapid heart rate

Petechiae can be a sign of a life-threatening infection or serious medical condition. Do not delay medical care.

How do doctors diagnose the cause of petechiae?

To diagnose your condition, doctors will need a detailed history about your petechiae. They will also perform a physical exam, looking at your skin from head to toe and possibly marking it. The exam will also check your heart, lungs, abdomen, and ears, nose and throat. Your doctor may do a neurological evaluation as well.

Questions for diagnosing the cause of petechiae

Questions your doctor or licensed healthcare practitioner may ask you related to your petechiae include:

  • When did you first notice the red dots?
  • Where on your body do you have the red dots?
  • Have you had any recent physical trauma, including vomiting or excessive crying?
  • Have you had any other symptoms, including fever, vomiting or cough? When did they begin?
  • Have you been around anyone who has been sick?
  • Have you had any other problems with bleeding, such as bleeding gums or nosebleeds?
  • What medications are you taking?
  • What other medical conditions do you have?
  • Have you had a meningococcal vaccine?

Your doctor will use the results of the exam and your answers to these questions to decide if testing is necessary. Various blood tests are at the core of diagnostic testing for petechiae. Blood tests may include:

  • Blood culture to check for bacteria, especially meningococcal infection
  • Clotting times to see if your blood clots normally or not
  • Complete blood counts (CBC), which will show platelet levels, as well as white blood cell and red blood cell levels
  • Electrolyte and chemistry panels
  • Liver function tests because a healthy liver makes factors involved in blood clotting

A urinalysis to look for protein in the urine can also be helpful in getting to a diagnosis. More testing could be necessary depending on the results of these tests. This may involve invasive procedures, such as a bone marrow biopsy.

What are the treatments for petechiae?

In many cases, petechiae does not require treatment. Temporary causes, such as excessive crying, will resolve on their own. Even petechiae rashes from some infections will resolve with observation alone.

When treatment is necessary, it completely depends on the underlying cause. If doctors suspect a meningococcal infection, they will start IV (intravenous) antibiotics immediately. This requires a hospital admission. Other causes may also involve hospitalization for expert consultation. Otherwise, your doctor may refer you to a specialist, such as a hematologist or oncologist for evaluation and treatment.

If petechiae is the result of a drug reaction, your doctor may stop or change your medication.

Home care for petechiae

There is nothing specific you can do for the petechiae themselves after they develop. The dots (petechiae “rash”) will clear on their own once the underlying cause is no longer there.

If you tend to bruise easily, you can take steps to protect your skin. Protect yourself from injuries that cause bruising and bleeding by avoiding bumping into objects or pulling on the skin. Sun exposure can worsen the changes that occur in aging and thinning skin, so use sunscreen and cover up when you are outside.

If you do bump into something or injure yourself, follow first aid for bruising or bleeding. For bruising, remember RICE—rest, ice, compression and elevation. Icing the area right after you injure it can help minimize bruising. Resting the area, wearing an elastic bandage, and elevating the area will aid healing and reduce swelling.

For minor bleeding, wash the wound and apply gentle pressure with clean gauze. Once the bleeding has stopped, apply antibiotic cream and a clean bandage.

What are the potential complications of petechiae?

Petechiae originating from physical trauma should resolve in a few days. Petechiae related to an underlying blood clotting disorder or other serious condition can be serious, and failure to seek treatment can result in serious complications and permanent damage.

Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including:

  • Chronic poisoning
  • Intracranial hemorrhage (bleeding inside the skull or brain)
  • Severe or uncontrolled bleeding
  • Spread of infection
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Apr 9
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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