Causes, Pictures, and When To Worry

Petechiae are tiny red, purple, or brown spots on your skin, inside of your mouth, or on your eyelids. These sports develop when capillaries, small blood vessels, break and leak blood into your skin.

Petechiae can sometimes occur due to harmless causes, such as prolonged straining, heavy coughing, or vomiting. These can cause increased pressure on your blood vessels, which can lead to capillary rupture. However, petechiae can also be a sign of a more serious health condition.

Treatment depends on what is causing the petechiae. It can range from simple rest and hydration for minor cases to antibiotics, corticosteroids, or other targeted therapies for more serious causes. Seek immediate medical attention if your petechiae appear suddenly, spread quickly, or occur with other symptoms such as fever, difficulty breathing, or excessive bleeding.

Petechiae are a symptom rather than a disease. Here’s a summary of petechiae features:

• It can occur in clusters, resembling a rash.
• There is no discomfort or itching.
• The spots are flat, not raised or bumpy.
• The spots are found on the skin, inside the mouth, or on the eyelids.
• These marks can be red, purple, or brown.
• The spots are tiny, less than 2 millimeters in diameter (similar to the tip of a pen).
• Unlike rashes, petechiae do not blanch (change color when you apply pressure).

If you have red spots and experience confusion, fever, or rapidly spreading spots get immediate medical attention. Feeling dizzy, fainting, having trouble breathing, or developing severe pain also warrants a trip to a healthcare provider.

Petechiae occur when tiny blood vessels (capillaries) break, leaking blood under your skin. Blood vessels are tubes that carry blood and oxygen around your body. Capillaries are the smallest, connecting larger arteries and veins.

Petechiae can happen due to problems with blood clotting (proteins that make a blood clot to seal a wound). Injuries, straining, low platelets (cells that form a plug to stop the bleeding after injury), platelet dysfunction, and weak or swollen blood vessels can also cause petechiae.

Certain health conditions and medications can cause petechiae. Underlying causes include:

• Allergic reactions
• Autoimmune disorders like lupus or Henoch-Schonlein purpura (HSP)
• Bacterial infections such as meningitis or strep throat
• Bleeding disorders like von Willebrand disease
• Congenital syndromes, including Wiscott-Aldrich 
• Connective tissue disorders like Ehlers-Danlos syndrome
• Disseminated intravascular coagulation (DIC) (abnormal blood clotting)
• Genetic conditions like Fanconi anemia (blood cell production problem)
• Leukemia (blood and bone marrow cancer)
• Liver or spleen problems (organs that produce clotting factors and filter blood)
• Skin trauma (injury, insect bites, sunburn)
• Strain from childbirth, coughing, lifting, pooting, or vomiting
• Thrombocytopenia (low platelet count)
• Tickborne illness like Rocky Mountain Spotted Fever
• Vasculitis (blood vessel swelling)
• Viral infections like enterovirus, cytomegalovirus, herpes, or hepatitis C
• Vitamin C deficiency
• Vitamin K deficiency

Blood-thinning medications, including anticoagulants and antiplatelets, can also cause petechiae. Anticoagulants stop blood clots from forming or growing bigger. Antiplatelet drugs prevent blood cells from sticking together, lowering your chance of heart attack or stroke. 

Anticoagulant examples include Coumadin (warfarin), Heparin, Eliquis (apixaban), and Xarelto (rivaroxaban). Examples of antiplatelets include aspirin, Plavix (clopidogrel), and Brilinta (ticagrelor). Other examples of medications and supplements that can contribute to petechiae include:

• Antiarrhythmics (treat irregular heartbeat) like Cardioquin (quinidine)
• Antibiotics such as penicillin or Zithromax, Z-pac (azithromycin)
• Antimalarials like Qualaquin (quinine)
• Anti-seizure medications such as Dilantin (phenytoin) or valproic acid
• Blood pressure medications like Apresoline (hydralazine)
• Chemotherapy (cancer treatment) like Cytarabine (cytosine arabinoside)
• Diuretics (water pills), including Lasix (furosemide)
• Heartburn or reflux medications, such as Zantac (ranitidine)
• Herbal remedies like Ginko Biloba (interferes with platelets)
• Nonsteroidal anti-inflammatory drugs (NSAIDs), including Motrin, Advil (ibuprofen) and Aleve (naproxen)

Risk Factors

Risk factors for petechiae include:

• Age (newborns or older adults)
• Alcohol or tobacco use
• Autoimmune, congenital, or genetic disorders
• Family history of bleeding disorders 
• Immune system suppression
• Pregnancy and childbirth
• Restrictive diets
• Taking blood thinners

Diagnosing the underlying causes of petechiae includes a medical history, physical exam, and diagnostic tests. Your healthcare provider will ask about your medications, diet, family medical history, and when the petechiae first appeared. They also want to know about recent illnesses, infections, or injuries. Share if you’re experiencing other symptoms, like fever, fatigue, or headache.

Your provider will also conduct a physical exam to check the petechiae’s size, color, and distribution. They will also examine your body for signs of underlying health concerns such as liver or spleen enlargement, signs of bruising, bleeding, trauma, or inflammation (swelling), and swollen lymph nodes (small organs in areas like the neck and armpits).

Sometimes a urine test is ordered to check for blood, protein, or viruses. Blood tests are ordered to check the following:

• Anti-neutrophil cytoplasmic antibody (ANCA) to check for autoimmune diseases
• Blood clotting factors 
• Blood culture to identify specific bacteria 
• Complete blood count (CBC) (includes platelet count)
• C-reactive protein (CRP) to check for swelling
• Immunoglobulin A (IgA) to check for allergies or autoimmune disease
• Kidney function tests like blood urea nitrogen (BUN), creatinine, or glomerular filtration rate (GFR)
• Liver function tests like alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
• Prothrombin time (PT) or partial thromboplastin time (PTT) to assess bleeding risk
• Tick disease titers like Lyme disease or Rocky Mountain Spotted fever
• Viral antibodies for things like hepatitis C or mononucleosis (mono)

Providers may also order imaging studies to evaluate internal structures for disease or injury. These include computed tomography scan (CT), magnetic resonance imaging (MRI), ultrasound, and X-rays.

If your healthcare provider suspects problems with your blood vessels, skin, or bone marrow, they might perform a skin or bone biopsy. A biopsy involves taking a small piece of tissue using a unique tool and looking at it closely under a microscope. Your provider will numb the area first. Sometimes, they also give you medicine to make you sleepy.

Petechiae treatment focuses on addressing the underlying cause. Here are some common approaches to treatment:

• Allow petechiae to go away on its own if it stems from minor causes
• Antibiotics or antivirals for infections
• Blood product transfusions for conditions like thrombocytopenia
• Chemotherapy, immunotherapy, or radiation for leukemia
• Cold compress for injuries
• Corticosteroids to reduce swelling 
• Diet changes or vitamin supplements for nutritional deficiency
• Intravenous immune globulins (IVIG) to boost the immune system 
• Laser treatment for cosmetic reasons (rare)
• Medication adjustments 
• Monitoring for symptoms like fever, fatigue, or unusual bruising

Preventing petechiae involves addressing and managing the underlying risk factors and health conditions that can cause them. The following are some general tips:

• Avoid alcohol as it can damage vessels, cause dehydration, or induce vomiting
• Avoid sharing glasses, utensils, your toothbrush, or needles with others
• Discuss supplements (like vitamin C, E, or K) with your provider 
• Drink plenty of water 
• Eat a healthy diet (lean proteins, fruits, vegetables, and whole grains)
• Avoid lifting heavy objects
• Maintain a healthy weight to reduce strain 
• Reduce your exposure to skin irritants, allergens, and tight clothing
• Refrain from smoking, which can damage blood vessels
• Review your medications and chronic disease care with your provider
• Seek medical attention for signs of infection, such as fever
• Support your immune system through handwashing, rest, and exercise
• Use insect repellent and wear protective clothing to prevent tick bites

Because petechiae is a symptom of an underlying issue, it’s important to seek medical attention, especially if you also have symptoms like bleeding, fever, fatigue, or severe headaches. Untreated underlying conditions can lead to complications such as:

• Anaphylaxis: This condition is a severe, life-threatening allergic reaction that causes difficulty breathing, low blood pressure, shock, and organ damage.
• Anemia: Blood disorders or vitamin C deficiency (scurvy) can cause chronic anemia (low red blood cells), reducing the blood’s oxygen-carrying ability. This can lead to fatigue and weakness.
• Cardiovascular disease: Blood vessel, lung, and heart disease can cause blood clots, stroke, or heart attacks. 
• Chronic inflammation: Autoimmune disorders can cause ongoing inflammation (swelling).
• Hemorrhage: Large doses of blood thinners, blood clotting disorders, severe vitamin K deficiency, or severe infections can lead to hemorrhage (excessive bleeding).
• Organ damage: Severe infections, blood disorders, autoimmune disorders, and chronic health conditions can cause heart, kidney, or eye damage.
• Sepsis: This condition is a severe life-threatening response to infection that causes inflammation and organ damage.

Petechiae, small red, purple, or brown spots on the skin, are a symptom rather than a standalone condition.

Sometimes, these spots are harmless and indicate excessive strain or wearing something too tight. But, petechiae can signal severe conditions such as infections, blood disorders, or autoimmune diseases.

Seeking medical attention is important, especially if you have other symptoms like bleeding, fever, or fatigue. Early diagnosis and treatment of the underlying cause can help prevent life-threatening complications.