What's Causing Pinprick Red Dots on Your Skin?

Pinpoint red dots on the skin can be caused by simple problems like heat rash, contact dermatitis, or scraping your skin against a rough surface. A cluster of pinprick red dots that are flat against the skin and do not itch can be a condition known as petechiae.

Petechiae happens when tiny blood vessels under the surface of this skin (capillaries) suddenly break open, causing a group of tiny red, brown, or purple dots to form.

Petechiae is not a condition by itself; rather, it’s a symptom of another health problem. For example bacterial meningitis, blood-clotting disorders, sepsis, and leukemia. Straining for a long time and certain medications can also cause skin capillaries to spontaneously burst.

This article looks at some common and uncommon causes of red dots on the skin, including how to tell if you have petechiae and when to see a provider.

Is It Petechiae?

Petechiae are red or purple dots on the skin that happen when blood vessels break under the skin's surface, creating what is called a petechial rash.A petechial rash is caused by internal bleeding and is often a sign of a serious medical condition. 

Petechiae dots are usually less than 2 millimeters in diameter. The spots do not disappear when you put pressure on them (non-blanching).

There are several disorders of the cardiovascular or circulatory systems that can cause a petechial rash, including:

• Meningitis
• Liver disease
• Cancer
• Viral infection
• Blood or clotting disorder

These are serious medical conditions that need treatment as soon as possible. You should call your healthcare provider immediately if you or your child have a pinprick rash that is not itchy. 

Common Causes Red Dots on the Skin 

Pinprick red dots are not always petechiae. The spots red spots can be caused by many different health conditions. Some of these conditions affect the skin while others affect the entire body.

One of the most common reasons you’ll see red dots on your skin is from an injury or irritation. For example, bumping your arm or leg, getting heat rash, or having contact dermatitis.

Some causes of red dots on your skin are more serious. For example, infections of all kinds can cause pinprick red dots on the skin, including:

• Scarlet fever. As its name implies, this illness caused by a strep infection leads to a bright red rash on the skin that can look like dots or bumps. 
• Cytomegalovirus (CMV). The rash from this viral infection typically looks more purple than red, but it can also cause red dots on the skin.
• Rocky Mountain Spotted Fever. This infection comes from ticks. While red dots on the skin are not usually one of the first signs of the illness, they can develop about a week after a person starts having symptoms. Usually, this means the infection is more severe.
• Endocarditis. This infection occurs in the lining of the heart. Some people with the infection develop red dots which can appear on the skin or in their eyes or mouth. 
• COVID-19. It’s not very common, but some people have developed red dots on their skin while they had COVID.

Certain health problems can also lead to red spots on the skin, especially if these conditions are related to your blood. For example:

• Anemia. Having low red blood cells (anemia) or problems with blood clotting can make it more likely you’ll get red dots on your skin. Aplastic anemia can cause petechiae.
• Vitamin deficiencies. Not having enough vitamin K in your body can also make red spots on your skin more likely to pop up, as this vitamin helps your blood clot. Petechiae can also show up if you don't have enough vitamin C in your diet (scurvy).
• Chronic medical conditions. Other chronic medical conditions that can have red dots on the skin as a sign or symptom include lupus, liver disease, and diseases that affect collagen (e.g., Ehlers-Danlos syndromes).
• Allergies. Some allergic reactions can cause rashes that look like red dots on the skin.
• Medications. You may get pinprick red dots on your skin as a side effect of some medications that thin your blood (like warfarin and aspirin). 
• Rare diseases. Rare genetic conditions that make people bleed more easily, like Wiskott-Aldrich syndrome, can also cause red dots on the skin.

Serious Causes of Red Dots on the Skin 

There are also some less common but potentially very serious causes of red dots on the skin. 

While they’re less likely to happen, it’s important to be aware of these possible causes because they can be deadly if they’re not diagnosed and treated quickly. 

Bacterial Meningitis

Meningitis is the infection of the membranes that surround the brain and spinal cord (meninges).

One symptom of meningococcal meningitis is a headache that’s accompanied by a petechial rash. This is called a meningitis rash.

The meningitis rash is a petechial rash. At first, you might notice petechiae on the arms or other areas of the body. These spots can be blanching if you try the clear glass test. However, as the rash becomes more pronounced, it will become non-blanching. 

The meningitis rash can progress from petechial to a purpuric rash, which looks more like bruising than pinpricks. 

The rash is common, but it does not always occur. That said, meningitis is a serious disease that progresses quickly. If you have a petechial rash—especially if it is paired with other meningitis symptoms like headache or stiff neck—seek immediate medical attention. 

Sepsis

A petechial rash is a common symptom of a bacterial blood poisoning (sepsis or septicemia) that can turn deadly quickly.

As with meningitis, a sepsis rash can start with a pinprick appearance before progressing to look more bruise-like.

Other symptoms of sepsis include:

• Fever
• Sweating
• Rapid heart rate and breathing rate
• Lethargy
• Changes to alertness or consciousness

Some people are at a higher risk for sepsis, including:

• People with recent infections of the lungs, skin, intestine, or urinary tract
• People with chronic health conditions such as diabetes
• Babies younger than 1-year-old
• Adults over the age of 65 years old

Sepsis can lead to septic shock, which can be deadly. If you have petechiae or any other symptoms of sepsis, don't wait to get medical attention.

Summary

Skin rashes that cause red dots on the skin are often harmless and more irritating than dangerous. However, a rash that looks like pinprick red dots on your skin that does not itch can be a sign of a serious, even deadly, health problem.

If you or your child have this type of rash, get medical care right away. A provider can figure out if a potentially dangerous infection is s causing the rash and start the right treatment.