Petechiae is a condition in which red spots of 1-2 mm appear on any part of the body. It occurs due to intradermal (between epidermis and hypodermis) capillary bleeding. These spots are non-blanching as they do not disappear on applying pressure. Both petechiae and purpura are non-blanching spots. Purpura is bigger than the petechiae and develops due to bleeding within the skin, and its size is more than 2 mm.
What is Petechiae
The blood clot is a series of controlled events that require endothelium (exposed), tissue factor, collagen, platelets, platelets activating factors (PAF), prothrombin, fibrinogen, von Willebrand factors (vWF), and other cofactors to work. Platelets are closely associated with regulating pro-angiogenic factors, such as vascular endothelial growth factor (VEGF), angiopoietin 1, etc. Petechiae, a hemorrhagic lesion that involves excessive bleeding, is a common phenomenon associated with thrombocytopenia. A noticeable decrease in the platelet count (10,000-20,000/cubic millimeter) occurs during thrombocytopenia. It disrupts the whole assembly, the endothelial barrier becomes leaky, and erythrocytes (blood cells) enter the surrounding tissues. This event and disruption of several other physiological events manifest into petechiae (superficial lesions) and purpura (deep lesions).
What Causes Petechiae?
The clinical conditions and the factors that cause petechiae are:
- Chronic diseases: Conditions like Thrombocytopenia, Idiopathic Thrombocytopenic Purpura (ITP), Thrombocytopenia with Absent Radius, the TAR syndrome, Neonatal Alloimmune Thrombocytopenia (NAIT), Fanconi Anemia, the Hemolytic Uraemic syndrome (HUS), Splenomegaly, Disseminated Intravascular Coagulation (DIC), Leukemia, the Ehlers-Danlos syndrome, Glanzmann Thrombasthenia, the Wiskott-Aldrich syndrome, the Bernard-Soulier syndrome, Systemic Lupus Erythematosus (SLE), and Liver disease may cause petechiae.
- Anticoagulants like warfarin-induced skin necrosis: Sometimes, warfarin leads to the formation of fibrin clots within the blood vessels (in the initial pro-coagulation stage). This disturbs the flow of blood to the skin and causes skin necrosis. The symptoms of warfarin-induced skin necrosis are:
- Red, purple, blue, or black appearance of skin.
- Pain and erythema.
- Hemorrhagic bullae/blisters.
- Infections: Bacterial (meningococcal, scarlet fever, and infective endocarditis), viral (parvovirus B19, enterovirus, ebola, hantavirus, and dengue), helminth (schistosomiasis), congenital (TORCH – Toxoplasmosis, Rubella or German measles, Cytomegalovirus, and Herpes Simplex), and rickettsial (rocky mountain spotted fever) conditions may cause petechiae.
- Other factors: Drug reactions, vitamin K deficiency, accidental/non-accidental injuries (leading to severe skin damage), or excess pressure applied during coughing/vomiting/weightlifting/straining may result in petechiae.
Other clinical conditions associated with petechiae. Clinicians consider petechiae for the prognosis or diagnosis of diseases like:
|Cardiovascular diseases (CVD)||Conjunctival petechiae are diagnosed during heart failure.The capillary wall damage in the presence or absence of coagulopathy (i.e., inability or impaired ability to clot blood) leads to petechiae.Endocarditis (inflammation on the inner lining of the heart) causes petechial rashes.|
|Traumatic brain injury (TBI)||The capillary shearing during traumatic brain injuries causes petechial hemorrhages. These hemorrhages are difficult to detect. Petechial hemorrhages can combine and form large, progressive secondary hemorrhages.|
|Meningitis||Rocky Mountain spotted fever: Initial stage – Erythematous macules are found on wrists, hands, and feet. Later stage – Petechiae advances towards palms, trunk, and soles.|
Neisseria meningitidis: Initial stage – Macular rashes are observed on extremities, face, palate, and conjunctiva.Later stage – Petechiae and purpuric rash culminate into sepsis.
The commonly observed rashes in other meningitis infections are macular, vesicular, petechial, and purpuric.
|Henoch-Scholein purpura||Characteristic red spots are observed on the posterior part of the body, such as the buttocks and back portion of the legs.|
|Scurvy||Besides other symptoms, petechiae and ecchymosis (skin bruises due to leakage of blood into skin tissues/mucous membranes) are distinctive features of scurvy.|
|Sepsis||Sepsis is associated with pathogenic infections. In severe sepsis conditions, disseminated intravascular coagulation (DIC) occurs. DIC involves skin petechiae.|
|Asphyxia||The characteristic feature of asphyxia is petechial hemorrhages. They are pinpoint (0.1-2 mm) blood spots found in the skin, sclera, conjunctiva, and serous membranes (pleura and pericardium).|
- Special attention for pregnant women and parents
Vitamin K deficiency – Vitamin K is a significant cofactor for blood clotting. Due to improper functioning of vitamin K-dependent coagulation factors (factor II, VII, IX, X), vitamin K deficiency bleeding (VKDB) syndrome occurs in neonates. It can occur due to several unknown reasons (idiopathic) or if pregnant women are suffering from acquired prothrombin complex deficiency (APCD) (secondary cause). This leads to a deficiency of vitamin K in breast milk. Prominent signs and symptoms of skin bleeding—petechiae, ecchymosis, or purpura can be observed at an infant or later during childhood. The symptoms of VKDB are similar to immune thrombocytopenic purpura, hemophilia, and leukemia.
Meningitis in children – Neisseria meningitidis or meningococcus is the most common cause of meningitis (invasive meningococcal disease, IMD) in children. Most children are cured, while some suffer from deafness and minor/major damage to neuron development. This bacterium is present in our nasopharynx. People and children are susceptible to Neisseria meningitidis due to factors such as environmental, genetic, low immunity, higher virulence of the pathogen, etc. Neisseria meningitidis causes purpura fulminans (PF). It is a thrombotic disorder that involves petechiae—large ecchymoses—and necrosis. Septicemia is commonly observed in children infected with meningitis.
What are the Symptoms of Petechiae?
Petechiae is associated with several chronic diseases, infections, and sepsis. Besides the symptoms of a particular disease, the initial signs and symptoms of petechiae are:
- Red, purple, blue, or black skin coloration.
- Breathing problems.
- Increase heart rate and change in pulse.
When to See a Doctor?
If you observe or suffer from any symptoms, chronic conditions, infections, or sepsis described above, please contact a doctor.
How to Prevent the Severity of Petechiae?
It is best to visit doctors when you start observing the initial signs and symptoms of petechiae. This will protect your vitals, such as the heart, brain, kidneys, and gut, etc., from being affected.
What are the Remedies Available for Petechiae?
There is no specific remedy or treatment method for petechiae. Petechiae appears due to a disease condition. So, depending on the particular clinical condition, medicines will be prescribed by doctors.
Some treatment methods or remedies for clinical conditions are:
|Disease or deficiency||Treatment/Remedy|
|Vitamin K deficiency||Vitamin K enriched food should be consumed.If a mother is suffering from VKDB, vitamin K shots should be given to the infant.|
|Immune thrombocytopenic purpura (ITP)||The treatment for adults will be as prescribed by doctors.|
|Henoch-Schonlein purpura||Doctor may prescribe or suggestNon-steroidal anti-inflammatory drugs (NSAIDs) or antibioticsDialysisKeep yourself protected from allergies.|
Petechiae is an indication (or alarm) for the early (majorly), middle, or late phase (majorly) of a disease. Hence, these small red spots should be taken seriously, as it marks the beginning of a critical condition (if you are not suffering from chronic diseases). So, a person should identify petechiae to prevent severe health ailments.
Frequently Asked Questions (FAQs)
What is the chance of leukemia if I am diagnosed with petechiae?
Your complete blood count (CBC), i.e., the number of red and white blood cells, will confirm leukemia if diagnosed with petechiae.
How do you tell if your petechiae are caused by leukemia?
If you are diagnosed with a lower number of leukocytes and have leukemia symptoms along with superficial non-blanching spots, this will confirm that petechiae are caused by leukemia.
Should I be concerned if I keep getting little red spots on my leg?
If the red spots are non-blanching and have symptoms like fever, inflammation, headache, and pain, you should visit a doctor.
Are red dots caused by breast cancer?
Red spots are caused by inflammatory breast cancer. There is a rare association between idiopathic thrombocytopenic purpura (ITP) and breast cancer in women (16). If red spots persist and they are non-blanching, you must visit a doctor.