Petechiae are tiny red or purple spots that can appear on the skin, often resembling a rash. These small discolorations typically do not cause pain or discomfort. While their appearance can sometimes be concerning, understanding their nature helps clarify why they usually remain painless. The presence of petechiae indicates a minor bleed under the skin.
What Are Petechiae?
Petechiae are small, flat spots on the skin, typically 1 to 3 millimeters in diameter. They can appear as red, purple, or brown pinpricks, often in clusters. A distinguishing feature is that they do not blanch or fade when pressed, unlike many typical rashes. This helps differentiate them from other skin conditions.
These small spots form when tiny blood vessels, called capillaries, break open and leak blood into the skin. Capillaries are the smallest blood vessels. The pooling of blood from these broken capillaries creates the visible spots.
Why They Usually Don’t Hurt
Because they are simply extravasated blood and not an inflammatory process or an injury to nerve endings, petechiae typically do not activate pain receptors directly. The sensation of pain is usually associated with nerve stimulation, which is not a direct result of the blood pooling that forms petechiae.
Any pain experienced when petechiae are present is generally related to the underlying condition that caused them, rather than the spots themselves. For instance, a painful infection that leads to petechiae might cause discomfort, but the skin spots themselves remain painless. This distinction highlights that petechiae are a symptom, not a condition that intrinsically generates pain.
Common Reasons for Their Appearance
Petechiae can arise from various causes, including physical stresses, certain medications, or infections. Physical straining is a frequent, harmless cause, often appearing after forceful activities such as severe coughing, vomiting, crying, or heavy lifting. These actions increase pressure within small blood vessels, leading to their rupture and the formation of petechiae around the face, neck, or chest. Minor trauma or vigorous exercise can also induce these spots.
Certain medications can also lead to petechiae as a side effect. These include blood thinners, some antibiotics, antidepressants, and nonsteroidal anti-inflammatory drugs (NSAIDs). When these spots appear due to medication, they typically resolve once the drug is stopped.
Petechiae can also result from various infections, both viral and bacterial. Viral infections like mononucleosis, enterovirus, cytomegalovirus, or influenza can cause them. Bacterial infections such as strep throat, scarlet fever, meningitis, or Rocky Mountain spotted fever are also associated with petechiae.
When to Consult a Doctor
While petechiae are often harmless, their presence can sometimes signal a more serious underlying condition, making medical evaluation important. Consult a healthcare professional if petechiae appear suddenly without a clear, benign cause, or if they are widespread and rapidly spreading. Such an occurrence warrants attention to identify the origin.
Medical attention is particularly important if petechiae are accompanied by other symptoms, as these can indicate a more significant issue. These symptoms might include fever, unexplained bruising, or bleeding from other areas like the gums or nose. Shortness of breath, confusion, or changes in consciousness alongside petechiae also necessitate prompt medical consultation. In infants and young children, petechiae, especially with a fever, should always prompt immediate medical assessment due to the potential for serious infections.