Petechiae

Petechiae are very small (pinpoint) red dots on the skin that form a skin rash due to an infection, allergic reaction, or other cause. These spots are especially common in children and may be found on the arms, legs, stomach, and buttocks.They also affect mucous membranes, such as in the mouth.

A petechiae rash doesn't itch. The small spots (less than 2 millimeters each) don't have raised bumps, as is common with hives, though you may be able to feel them depending on the underlying cause.Causes of petechiae include strep throat, mononucleosis, and endocarditis, an infection of the lining of the heart.

This article explains petechiae and its possible causes, some of which are serious health issues. It explains how the skin rash and underlying cause are diagnosed and treated, and will help you to know when it may be important to contact your healthcare provider.

Symptoms of Petechiae

Petechiae are the result of bleeding from small blood vessels called capillaries under the skin. These breaks cause the spots to be red or brownish-purple in color. Characteristics of petechiae include:

• Flat
• Often show up suddenly
• Found on the extremities (arms and legs), stomach, and buttocks, or inside the mouth and eyelids
• Often appear in a cluster and look like a rash
• Do not itch
• Are non-blanching, meaning they do not disappear after brief pressure is applied to them

After petechiae first appear, they may spread out and begin to blend together to form larger patches. This could indicate that a bleeding disorder is present.

Causes of Petechiae

Petechiae may appear for many possible reasons. Healthcare providers must perform a thorough exam to evaluate and diagnose the underlying cause of petechiae.

Some of the most common causes of petechiae include:

• Fungal, viral or bacterial infections. These range from strep throat and the common flu to Rocky Mountain spotted fever, which is caused by a tick bite, or invasive meningococcal disease leading to meningitis and sepsis (an infection in the bloodstream).
• Chronic conditions and their treatments. They include the skin disorder Ehlers–Danlos syndrome [EDS], liver disease, autoimmune disorders like systemic lupus erythematosus (SLE), and cancer treatments like radiation and chemotherapy.
• Lifestyle and environmental factors. Sunburns, skin abrasions or injuries, specific vitamin deficiencies (including vitamins C and K), and even heavy lifting can lead to petechiae.
  

What Medications Can Cause Petechiae?

Some medications that list petechiae as a possible side effect include:

• Antibiotics
• Anticoagulants (blood thinners) like Coumadin (warfarin)
• Certain antidepressants, notably selective serotonin reuptake inhibitors (SSRIs)
• Antiepileptics (medications for seizures)
• NSAIDs (non-steroidal anti-inflammatory drugs, such as Ibuprofen)
• Sedatives
• Antiarrhythmics (medication for an irregular heart rate)

Common medications that are known to cause petechiae include penicillin, the anti-seizure drug Dilantin (phenytoin), and quinine, a drug used to treat malaria.

How to Treat Petechiae

Treatment for petechiae depends on the underlying cause. Your healthcare provider will determine the cause through a thorough history and physical examination to understand when and how the skin rash started. They also may order diagnostic tests, such as blood samples, to find the cause.

Many times, no treatment is required, such as when a child is well after an observation period with no signs of infection, normal lab test results, and no spreading of the rash. In this instance, a healthcare provider will usually discharge the child to go home.

But when scattered petechiae are noted with a fever, it could be the sign of a very serious infection (such as meningitis) requiring intravenous antibiotic therapy and possibly hospitalization. Several other conditions that cause petechiae (such as a bleeding disorder) will require prompt diagnosis and medical attention as well.

Are There Tests to Diagnose the Cause of Petechiae?

Your healthcare provider will ask about other symptoms, like a cough or fever, as well as recent medical history, such as a nose bleed or injury. They're likely to order tests that may include:

• A complete blood count (to ensure that the platelet level is normal and to check for an increase in white blood cells, which could indicate an infection is present)
• Blood cultures, if infection is suspected
• A lumbar puncture (a small sample of fluid taken from the spine to test for meningitis)
• Blood coagulation profile (to check for normal clotting factors)
• Liver function tests
• A chest X-ray
• Tests to check for vitamin deficiencies
• Urinalysis (to check the urine for bacteria (which may indicate a urinary tract infection) or to check for potential kidney problems

More tests may be ordered after the initial exam and lab tests help to narrow down the possible diagnosis.

When to See a Healthcare Provider

Petechiae can be a sign of a serious condition, especially with other symptoms like a fever. If the skin rash is unexplained, you should contact your healthcare provider for their assessment.

Keep in mind that petechiae can appear with chronic conditions or as a symptom of a serious and previously undiagnosed condition, such as kidney disease or leukemia (a blood cancer).In these cases, seeing a healthcare provider for early diagnosis and treatment may lead to improved outcomes.

Summary

Petechiae are small, pinpoint red dots that form a skin rash but don't itch. They are a symptom of another underlying condition. There are many causes of petechiae, from a simple skin abrasion to a serious diagnosis like meningitis or leukemia. Even certain medications you take may lead to petechiae.

Because there are so many possible causes, the petechiae need to be evaluated in the context of other symptoms, such as a fever that may suggest infection or a spreading rash associated with a bleeding disorder. Your healthcare provider may order tests to help diagnose and treat the condition that's causing the petechiae.

Treatment will depend on the cause. In some cases, a child's rash may simply require observation and comfort measures. In others, petechiae may be the sign of a potentially life-threatening condition that requires hospitalization and/or extensive care.

A Word From Verywell

Petechiae require prompt medical intervention to screen for medical emergencies, but don't assume the worst. For example, Perth Children’s Hospital reports that less than 10% of children with petechiae and fever are diagnosed with meningitis. Do keep in mind that acting quickly to seek professional medical advice can help to improve the prognosis (outcome) of any serious medical complications if they do occur.