Petechiae

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What are petechiae?

Petechiae are small red or purple dots of blood that appear on the skin or in the mucus membranes. The mouth is one mucus membrane where petechiae may occur. Petechiae occur when superficial blood vessels under the skin break. Petechiae may look like a rash.

The most common cause of petechiae is through 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 may also appear in aging skin. These forms of petechiae are generally harmless and disappear within a few days.

Petechiae may also be a sign of a serious blood disorder called thrombocytopenia. In this disease, blood platelet levels are decreased and blood clotting is impaired. Petechiae may also be a sign of another platelet-related disorder called idiopathic thrombocytopenic purpura, which is thrombocytopenia with no known cause.

The impairment in ability to form blood clots and the resulting petechiae may also occur because of certain medications you may be taking. These drugs include antiplatelet medications, anticoagulants, aspirin, and steroids.

Sudden and unexplained bleeding under the skin may be a medical emergency. Seek immediate medical care (call 911) if you, or someone you are with, have any symptoms including high fever (higher than 101 degrees Fahrenheit), confusion or loss of consciousness for even a brief moment, or severe headache.

Seek prompt medical care if you are taking these types of medications and experience 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)
  • Heavy bleeding during menstrual periods (menorrhagia)
  • 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
    • High fever (higher than 101 degrees Fahrenheit)
    • Severe bleeding
    • Severe headache

    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 the resulting petechiae may also occur because of certain medications.

    Traumatic causes of petechiae

    Petechiae may be caused by physical trauma including:

    • Choking

    • Excessive crying

    • Heavy lifting with extreme straining

    • Violent coughing

    • Vomiting including multiple episodes

      Drug-related causes of petechiae

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

      • Acetaminophen (Tylenol) and naproxen (Aleve, Naprosyn)

      • Carbamazepine (Carbatrol, Tegretol)

      • Chlorothiazide (Chlotride, Diuril)

      • Cimetidine (Tagamet)

      • Heparins such as low molecular weight heparin

      • Phenytoin (Di-Phen, Dilantin)

      • Rifampin (Rifadin, Rimactane) and linezolid (Zyvox)

      Serious or life-threatening causes of petechiae

      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)

      • Von Willebrand's disease (hereditary bleeding disorder)

      Questions for diagnosing the cause of petechiae

      To diagnose your condition, your doctor or licensed health care practitioner will ask you several questions related to your petechiae including:

      • When did you first notice the red dots or purple bruising?

      • Have you had any recent physical trauma?

      • What medications are you taking?

      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: 2018 Dec 26
      1. Bleeding into the skin. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/003235.htm.
      2. What is immune thrombocytopenia? National Heart, Lung, and Blood Institute Diseases and Conditions Index. http://www.nhlbi.nih.gov/health/dci/Diseases/Itp/ITP_WhatIs.html.
      3. Idiopathic thrombocytopenic purpura (ITP). PubMed Health, a service of the NLM from the NIH. http://www.nlm.nih.gov/medlineplus/ency/article/000535.htm.
      4. Kahan S, Miller R, Smith EG (Eds.). In A Page Signs & Symptoms, 2d ed. Philadelphia: Lippincott, Williams & Williams, 2009.
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