Petechiae are tiny, pinpoint red or purple spots on the skin caused by bleeding beneath the surface. These spots, typically less than 2 millimeters in diameter, result from small blood vessels, called capillaries, breaking and leaking blood. Their persistence or reappearance often indicates an underlying issue requiring attention. This article will discuss petechiae, their causes, reasons for persistence, and when to seek medical consultation.
What are Petechiae
Petechiae appear as small, flat spots on the skin, typically red, purple, or brown. They are usually smaller than 2 millimeters. Unlike common rashes, petechiae do not blanch, meaning they retain their color when pressure is applied, which helps distinguish them from other skin conditions. This non-blanching characteristic indicates blood leaking from capillaries into the surrounding skin tissue. While they can appear anywhere on the body, petechiae are frequently observed on the arms, legs, torso, and even inside the mouth or on the eyelids.
Common Causes of Petechiae
Petechiae arise from various factors that lead to the rupture of tiny capillaries, allowing blood to seep into the skin. Some causes are benign, such as physical trauma or straining. For instance, intense coughing, vomiting, or prolonged straining during activities like childbirth or heavy lifting can increase pressure in small blood vessels, leading to petechiae, particularly around the face and upper body. Minor injuries or excessive friction can also cause these spots.
Certain medications are known to induce petechiae as a side effect. These include specific antibiotics, blood thinners like warfarin, anti-inflammatory drugs such as aspirin, certain antidepressants, and some seizure medications.
Petechiae may also signal more serious underlying conditions. These include bacterial and viral infections, such as meningitis, sepsis, endocarditis, or various viral illnesses like measles or dengue fever. Blood disorders are another category, encompassing low platelet count (thrombocytopenia), clotting disorders, and certain cancers like leukemia. Additionally, vasculitis (inflammation of blood vessels) and vitamin deficiencies, particularly vitamin C and K, can contribute to their appearance.
Why Petechiae Persist or Reappear
The persistence or recurrence of petechiae is directly linked to the ongoing nature of their underlying cause. If the condition responsible for the capillary bleeding is not resolved or continues to affect the body, the petechiae will likely remain visible or reappear. For example, if a medication is causing the spots, they will not disappear until the medication is stopped or adjusted. Similarly, petechiae resulting from a chronic health condition, such as an autoimmune disease or a blood disorder, may persist as long as the condition remains active.
In cases of infection, petechiae may continue to emerge until the infection is effectively treated and cleared from the body. The body’s ability to repair damaged capillaries and reabsorb the leaked blood is dependent on addressing the root problem. Therefore, the continued presence of petechiae often indicates an unaddressed issue that is still causing capillary damage or affecting the blood’s clotting ability.
When to Seek Medical Attention
While some instances of petechiae are harmless, their sudden appearance or widespread nature can indicate a serious underlying issue requiring medical evaluation. Consult a healthcare provider if petechiae appear without a clear, benign cause, such as minor trauma or straining. Prompt medical attention is important if petechiae are accompanied by other concerning symptoms. These include fever, widespread or rapidly spreading spots, unusual fatigue, or general unwellness.
Additional symptoms signaling a need for urgent medical consultation include bleeding elsewhere on the body, such as nosebleeds or bleeding gums. Severe headaches, confusion, dizziness, or shortness of breath alongside petechiae also indicate a potentially serious condition. For children, any appearance of petechiae, particularly with a fever, should prompt immediate medical assessment.
Diagnosis and Management
Diagnosing the cause of petechiae typically begins with a thorough physical examination and a detailed medical history. Healthcare professionals will note their size, color, location, and whether they blanch under pressure. Depending on the suspected cause, various diagnostic tests may be ordered. A complete blood count (CBC) is a common initial test to check platelet levels, red and white blood cell counts, which can help identify bleeding disorders or infections.
Coagulation studies, such as prothrombin time (PT) and partial thromboplastin time (PTT), evaluate the blood’s clotting ability. Other tests, like blood cultures, urine tests, or a lumbar puncture, may be performed if an infection like meningitis is suspected. Management of petechiae focuses on treating the underlying condition rather than the spots themselves. For instance, if a bacterial infection is identified, antibiotics will be prescribed. If a medication is the cause, dosage adjustments or a change in medication may be necessary. For chronic conditions, ongoing management of the primary illness is required to prevent further petechiae.