What Are Petechiae?

Petechiae are small red dots on the skin; they can occur in people of any age, but they are particularly common in children. in fact, the sudden appearance of petechiae is a very common reason that kids are seen in the emergency room. Petechiae appear as a rash, comprised of very small (pinpoint) red spots that affect the skin and mucous membranes. They are commonly found on the arms, legs, stomach, and buttocks.

The size of the spots is an important feature of the rash; the spots must be less than 2 millimeters (0.078 inches) to be considered petechiae. The spots are not raised like hives, and they don’t itch. The spots may or may not be palpable (able to be felt) depending on the underlying cause.

The rash-like red dots which occur in petechiae are not a condition, but rather, a symptom of something else, such as a viral or bacterial infection, a trauma, or other causes. Petechiae could even be a symptom of an allergic reaction. Petechiae occurs as a result of bleeding—from small blood vessels called capillaries that break) under the skin—which causes the spots to be a brownish-purple in color.

The spots could appear in one area of the body (due to some sort of trauma), or they could be widespread (such as those which occur as a result of a bleeding disorder). Petechiae is sometimes a symptom of a serious disorder, one that could potentially require emergency medical attention.

Symptoms

The symptoms of petechiae include:

• Reddish-brown, flat spots that often show up suddenly
• Spots that are commonly found on the extremities (arms and legs) stomach and buttocks
• Spots that can appear in other areas of the body, including inside the mouth and eyelids
• Spots that often appear in a cluster and look like a rash
• Spots that do not itch
• Spots that are non-blanching (note non-blanching rashes are those that do not disappear after brief pressure is applied to them.

After they initially appear, areas affected by petechiae may spread out and begin to blend together to form larger patches. This could indicate that a bleeding disorder is present. If fever accompanies petechiae, it could indicate a serious infection. Petechiae is a common rash seen in pediatric emergency departments; this type of non-blanching rash can be of great concern.

Causes

Healthcare providers must perform a thorough exam to evaluate the underlying cause of petechiae. There are many potential underlying causes of petechiae; some of the most common causes include fungal, viral or bacterial infections such as those that cause:

• The flu
• Strep throat
• Scarlet fever
• Sepsis (an infection in the bloodstream)
• Infectious mononucleosis (an infectious viral disease characterized by swelling of the lymph glands)
• Rocky Mountain spotted fever (caused by a tick bite)
• Endocarditis (an infection of the lining of the heart)
• Invasive meningococcal disease (IMD), caused by Neisseria meningitidis (a major cause of septicemia and meningitis)
• Viral hemorrhagic fevers (VHFs) (such as Ebola )

Sudden strain can result in the small blood vessels called capillaries to burst and leak into the skin; this appears as red dots that comprise petechiae. Causes of strain that could result in petechiae may include:

• Forceful and prolonged coughing or vomiting
• Giving birth (from pushing)
• Lifting heavy weight

Other causative factors of petechiae include:

• A collagen disorder (such as the Ehlers–Danlos syndromes [EDS]. The EDS is a group of connective tissue diseases of the skin, ligaments, blood vessels, joints and internal organs).
• Sunburn
• Skin abrasions
• Trauma
• Injuries
• Specific autoimmune disorders such as systemic lupus erythematosus (SLE)
• Vasculitis (inflammation of the blood vessels)
• Other Inflammatory conditions
• A low platelet (blood clotting) level
• Some medical treatments (such as cancer treatments like radiation and chemotherapy).
• Specific vitamin deficiencies (such as scurvy, a condition resulting from lack of adequate vitamin C, as well as vitamin K deficiency)
• Chronic (long-term) liver disease

Side Effects of Medications

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

• Antibiotics
• Anticoagulants (blood thinners)
• Antidepressants
• 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
• Phenytoin (an anti-seizure drug)
• Quinine (a drug for malaria)

Diagnosis

Diagnosing the underlying cause of petechiae involves a thorough physical and history examination. The healthcare provider will gather information such as:

• When the rash was first noticed (time and day)
• Other symptoms (cough, fever, vomiting, contact with infected people and more)
• How fast the rash spread (rapidly spreading rash [along with fever] is more concerning)
• Any recent bleeding (such as nose bleeds)
• Recent injuries
• Any patterns of petechiae with bruising
• Vaccination status
• Medical history
• More

An in-depth patient history is vital to establish any pattern of symptoms that could alert the healthcare provider of the possibility of serious illness. Diagnostic tests that may be ordered when a child is seen for petechiae may include:

• A completed 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 and more).
• 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 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.

Note, if a healthy child with petechiae is evaluated, and the cause is found to be an innocuous cause of the rash (such as an injury without complications), the child should be further observed (some sources say for at least four hours, but it may be longer, particularly if test results take longer than four hours) to ensure other symptoms/complications to not arise.

Treatment

Treatment for petechiae depends on the underlying cause. Many times, there is no treatment required, such as when the child is well after the observation period with no signs of infection, normal lab test results, and no spreading of the rash. In this instance, the 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 IMD) 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.

A Word From Verywell

Petechiae require prompt medical intervention to screen for medical emergencies. A medical consultation will also rule out serious conditions that may require emergency medical intervention. But this does not mean that parents should panic and assume the worst. Although petechiae may be cause for serious concern (particularly when children have the rash along with a fever), according to Perth Children’s Hospital less than 10% of children with petechiae and fever will be diagnosed with meningitis. The most important thing to keep in mind is that acting quickly to seek professional medical advice can help to improve the prognosis (outcome) of any serious medical complications if they do occur.