Skin Health More Skin Conditions What Are Petechiae? Rash-Like Spots on the Skin and Mucous Membranes By Sherry Christiansen Sherry Christiansen is a medical writer with a healthcare background. She has worked in the hospital setting and collaborated on Alzheimer's research. Learn about our editorial process Sherry Christiansen Medically reviewed by Medically reviewed by Casey Gallagher, MD on June 21, 2020 Casey Gallagher, MD, is board-certified in dermatology. He is a clinical professor at the University of Colorado in Denver, and co-founder and practicing dermatologist at the Boulder Valley Center for Dermatology in Colorado. His research has been published in the New England Journal of Medicine. Learn about our Medical Review Board Casey Gallagher, MD on June 21, 2020 Print Table of Contents View All Table of Contents Symptoms Causes Diagnosis Treatment 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. Verywell / Nusha Ashjaee Symptoms The symptoms of petechiae include: Reddish-brown, flat spots that often show up suddenlySpots that are commonly found on the extremities (arms and legs) stomach and buttocksSpots that can appear in other areas of the body, including inside the mouth and eyelidsSpots that often appear in a cluster and look like a rashSpots that do not itchSpots 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. When to Call the Doctor Often, petechiae are caused by something minor, but it’s important to consult with the pediatrician or healthcare provider anytime petechiae is noted in a child. Emergency medical treatment should be sought out immediately with any of these symptoms that occur along with petechiae:A fever over 100.4 F or higherIf petechiae get larger or spread to other body partsLong streaks that appear under the nailsA child that has a sudden change in emotion (such as crying without being able to be consoled)A child that gets very sleepyA child that has trouble breathing 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 fluStrep throatScarlet feverSepsis (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 vomitingGiving 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).SunburnSkin abrasionsTraumaInjuriesSpecific autoimmune disorders such as systemic lupus erythematosus (SLE)Vasculitis (inflammation of the blood vessels)Other Inflammatory conditionsA low platelet (blood clotting) levelSome 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: AntibioticsAnticoagulants (blood thinners)AntidepressantsAntiepileptics (medications for seizures)NSAIDS (non-steroidal anti-inflammatory drugs such as Ibuprofen)SedativesAntiarrhythmics (medication for an irregular heart rate) Common medications that are known to cause petechiae include: PenicillinPhenytoin (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 injuriesAny patterns of petechiae with bruisingVaccination statusMedical historyMore 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 testsA chest X-rayTests to check for vitamin deficienciesUrinalysis (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. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Fairview Patient Education Petichiae (child). Updated 2020 Santistevan, J. What’s that rash? An approach to dangerous rashes based on morphology. EM Docs. Updated July 1, 2016 Thomas AE, Baird SF, Anderson J. Purpuric and petechial rashes in adults and children: initial assessment. BMJ. 2016;352:i1285. doi:10.1136/bmj.i1285 Ranganathan D, John GT. Therapeutic plasma exchange in renal disorders. Indian J Nephrol. 2019;29(3):151-159. doi:10.4103/ijn.IJN_420_17 The Royal Children's Hospital Melbourne. Clinical practice guideline: Fever and petechiae—purpura. MedlinePlus. Drug-induced thrombocytopenia. Updated May 22, 2019. University Hospital of South Manchester NHS. Non blancing (petechial rash)—information for parents. Updated May, 2017 Perth Children’s Hospital. Petechiae. Updated May 2018