Petechiae: Causes, Symptoms and Treatment

Petechiae are small pinpoint spots that appear in clusters on your skin. They can be found anywhere on the body and are red, purple or brown, and do not change colour under pressure.. You can get petechiae for many different reasons, so it’s essential to see a doctor to work out what is causing it. Petechiae can signal a serious underlying health issue, and you may need urgent medical attention.

Last reviewed: 21/03/2023 by Dr Babak Ashrafi

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What skin conditions are similar to vitiligo?
What are the symptoms of petechiae?
What causes petechiae?
How are petechiae diagnosed?
How are petechiae treated?
How to prevent petechiae
What skin conditions are similar to petechiae?

What are petechiae?

Petechiae are red, purple or brown spots smaller than 2mm. They do not disappear when you put pressure on them and usually appear on your legs, buttocks, stomach or arms. When they are larger than 2mm, they are called purpura.

Petechiae are caused by bleeding under the skin. While petechiae can be quite common, you should still see a doctor about it to make sure it isn’t being caused by a serious underlying health condition.

If you care for a child who develops extensive and unexplained petechiae, seek immediate medical advice.

What are the symptoms of petechiae?

Petechiae can look different depending on where you get them on your body. Here are some of the signs to look for in petechiae spots:

do not change colour when you put pressure on them (called non-blanching)
red, purple or brown
less than 2mm
round in shape, like a pinpoint
lie flat against your skin
appears in clusters

Petechiae are not normally painful or itchy.

How long petechiae last and whether there are long-lasting complications from them depends on what’s caused them in the first place.

You can tell if spots are non-blanching (their appearance doesn’t change under pressure) by using the glass test. This is where you press a glass against the spots to see if they disappear. If they do not disappear, they are non-blanching.

When should I talk to a doctor about my petechiae?

Talk to your doctor about your petechiae if they are widespread and you do not know why they have appeared. Petechiae can indicate an underlying health condition which may need immediate treatment.

Get urgent medical attention if you have petechiae and you also:

have a fever
feel very unwell and are getting worse
notice the spots are spreading or getting bigger
see other bruising on your body
experience changes in your heart rate or pulse
have trouble breathing
experience a shift in consciousness or confusion

If you are looking after a child who develops petechiae, seek urgent medical attention.

What causes petechiae?

You get petechiae when tiny blood vessels called capillaries leak blood into the skin.

There are three main reasons that the blood vessels can leak:

1. Physical straining in the body

Petechiae can appear when your body severely strains itself during the following:

vomiting
coughing
childbirth
weight-lifting
injury

2. Reaction to medications

It is possible to get petechiae as a side effect of taking medication, including sedatives, anti-seizure drugs, antibiotics, antidepressants, blood thinners, heart-rhythm drugs and nonsteroidal anti-inflammatories.

Examples of these medications include:

phenytoin
quinine
penicillin
aspirin
lidocaine/prilocaine cream
furosemide
warfarin
carbamazepine
desipramine
atropine

3. Medical conditions

Various medical conditions can cause petechiae.

Reactions to insect bites or infections caused by insects, such as Rocky Mountain Spotted Fever
Viral infections such as Dengue fever, enterovirus and parvovirus B19
Bacterial infections such as meningitis
Sepsis
Autoimmune diseases
Cancer, such as leukaemia
Vitamin K deficiency
Scurvy
Thrombocytopenia (where your blood platelets decrease)
Henoch-Schölein purpura (where your blood vessels become inflamed)
Vasculitis (where blood vessels become inflamed)

Having petechiae does not automatically mean you have one of these conditions. These conditions usually occur with several other symptoms. It is essential to tell your doctor about all your symptoms so that they can work out the underlying condition and start your treatment as soon as possible.

What increases my risk of getting petechiae?

As petechiae can appear as a result of many different causes, there are no specific risk factors that increase your chance of getting it.

How are petechiae diagnosed?

A doctor can diagnose petechiae by examining the non-blanching, pinpoint spots. To determine what is causing them, the doctor may ask you questions about your health, conduct a physical examination and order specific tests.

How are petechiae treated?

How a doctor treats petechiae will depend on what has caused them.

Physical straining: the treatment will involve resting, drinking lots of fluids and possibly taking medication (e.g. to stop you from being sick or coughing).

Reaction to a drug: the treatment may involve waiting until the end of the course or finding an alternative medication.

Specific medical condition: doctors will prescribe treatments to help with that condition. These can include:

antibiotics to treat an infection
medications for overactive immune systems
cancer treatments such as chemotherapy and radiation
drugs to reduce inflammation

How to prevent petechiae

As so many factors can cause petechiae, it is impossible to prevent all potential underlying causes. Keeping fit and healthy through regular exercise, a balanced diet, drinking plenty of water and getting enough sleep can help to reduce your chances of developing a severe medical condition.

If certain medications cause you to get petechiae, you can avoid taking them where possible.

As infections can cause petechiae, taking the following precautions can reduce your risk of getting an infection:

careful and regular hand washing
practise safe sex
avoid those who are ill
avoid sharing utensils and glasses with others
use insect-repellent and take precautions to prevent ticks

What skin conditions are similar to petechiae?

Purpura is a similar condition to petechiae. The difference is that the spots are bigger than 2mm if you have purpura.

Cherry angioma has similar-looking spots to petechiae, but some key differences exist. They are usually deep red or cherry pink, can be larger than petechiae and appear in isolation rather than clusters. Cherry angioma is a small benign growth on the skin rather than bleeding in the skin.