What Causes Petechiae?

Medically reviewed by Elaine K. Luo, MD on September 13, 2017Written by Stephanie Watson

Overview

Petechiae are tiny purple, red, or brown spots on the skin. They usually appear on your arms, legs, stomach, and buttocks. You might also find them inside your mouth or on your eyelids. These pinpoint spots can be a sign of many different conditions — some minor, others serious. They can also appear as a reaction to certain medications.

Though petechiae look like a rash, they’re actually caused by bleeding under the skin. One way to tell the difference is by pressing on the spots. Petechiae won’t turn white when you press on them. A rash will turn pale.

Petechiae pictures

Causes of petechiae

Petechiae are formed when tiny blood vessels called capillaries break open. When these blood vessels break, blood leaks into your skin. Infections and reactions to medications are two common causes of petechiae.

Conditions that may cause petechiae include:

Possible causeAdditional symptoms and information
Cytomegalovirus (CMV)CMV is an illness caused by a virus. Other symptoms include fatigue, fever, sore throat, and muscle aches.
EndocarditisThis infection of the inner lining of the heart includes symptoms like fever, chills, fatigue, achy joints and muscles, shortness of breath, cough, and pale skin.
Hantavirus pulmonary syndromeThis viral infection causes flu-like symptoms and breathing problems. Other symptoms include fatigue, fever, and muscle aches.
InjuriesDamage to the skin, such as from blunt force (for example, a car accident), biting, or hitting can cause petechiae to form. A sunburn can also cause petechiae.
LeukemiaLeukemia is a cancer of your bone marrow. Other symptoms include fever, chills, fatigue, unintentional weight loss, swollen glands, bleeding, bruising, nosebleeds, and night sweats.
MeningococcemiaThis is a bacterial infection in the respiratory tract. Other symptoms include fever, headache, muscle pain, and nausea.
Mononucleosis (mono)Mono is a viral infection that’s transmitted through saliva and other bodily fluids. Other symptoms include extreme fatigue, sore throat, fever, swollen lymph nodes, swollen tonsils, and headache.
Rocky Mountain spotted fever (RMSF)RMSF is a bacterial infection transmitted by ticks. Other symptoms include high fever, chills, severe headache, muscle aches, nausea, and vomiting.
Scarlet feverThis bacterial infection can develop in people after they’ve had strep throat. Other symptoms include a rash, red lines on the skin, flushing of the face, red tongue, fever, and sore throat.
ScurvyScurvy is caused by too little vitamin C in your diet. Other symptoms include fatigue, swollen gums, joint pain, shortness of breath, and bruising.
SepsisThis is a life-threatening blood infection. Other symptoms include a high fever, fast heart rate, and trouble breathing.
StrainingActivities that cause you to strain can tear blood vessels in your face, neck, and chest. These activities include crying, coughing, vomiting, lifting weights, or giving birth.
Strep throatStrep throat is a bacterial infection that causes a sore throat. Other symptoms include swollen tonsils, swollen glands, fever, headache, nausea, vomiting, and body aches.
ThrombocytopeniaThrombocytopenia is a condition in which you have too few platelets — blood cells that help your blood clot. Other symptoms include bruises, bleeding from your gums or nose, blood in your urine or stool, fatigue, and yellow skin and eyes.
VasculitisVasculitis is marked by swelling, narrowing, and scarring of the blood vessels. Other symptoms include fever, headache, fatigue, weight loss, aches and pains, night sweats, and nerve problems.
Viral hemorrhagic feversInfections such as dengue, Ebola, and yellow fever are all viral hemorrhagic fevers. These infections make it harder for your blood to clot. Other symptoms include high fever, fatigue, dizziness, aches, bleeding under the skin, and weakness.
Petechiae are a side effect of certain drugs. Some examples of medications that may cause petechiae as a side effect include:Type of drug
ExamplesAntibiotics
nitrofurantoin (Macrobid), penicillin Antidepressants
desipramine (Norpramin)Anti-seizure drugs
carbamazepine (Carbatrol, Epitol, Tegretol, others)Blood thinners
warfarin, heparinHeart rhythm drugs
atropine (Atropen)Nonsteroidal anti-inflammatory drugs (NSAIDs)
indomethacin (Indocin), naproxen (Aleve, Anaprox, Naprosyn)Sedatives

Petechiae are a side effect of certain drugs. Some examples of medications that may cause petechiae as a side effect include:

Type of drugExamples
Antibioticsnitrofurantoin (Macrobid), penicillin
Antidepressantsdesipramine (Norpramin)
Anti-seizure drugscarbamazepine (Carbatrol, Epitol, Tegretol, others)
Blood thinnerswarfarin, heparin
Heart rhythm drugsatropine (Atropen)
Nonsteroidal anti-inflammatory drugs (NSAIDs)indomethacin (Indocin), naproxen (Aleve, Anaprox, Naprosyn)
Sedativeschloral hydrate

When to call your doctor

If you or your child has petechiae, call a doctor. Some of the underlying causes of petechiae are serious and need to be treated. It’s hard to know whether you have something mild or serious until you see your doctor for a diagnosis.

You should also call if you have serious symptoms like these:

  • high fever
  • trouble breathing
  • confusion
  • change in consciousness

Are there complications?

Petechiae themselves don’t cause complications, and they won’t leave scars. Some of the conditions that cause this symptom can have complications, such as:

  • damage to the kidneys, liver, spleen, heart, lungs, or other organs
  • heart problems
  • infections in other parts of your body

Treatment options

If a bacterial or viral infection caused the petechiae, your skin should clear up once the infection gets better. If a medication caused the petechiae, this symptom should go away once you stop taking the drug.

Check the spots often to see if they change. If the number of spots increases, you might have a bleeding disorder.

Before recommending a treatment, your doctor will identify what’s causing your petechiae and other symptoms. Your doctor may prescribe any of these medicines to treat the cause of the spots:

  • antibiotics to treat a bacterial infection
  • corticosteroids to bring down inflammation
  • medications that suppress your immune system, such as azathioprine (Azasan, Imuran), methotrexate (Trexall, Rheumatrex), or cyclophosphamide
  • chemotherapy, biologic therapy, or radiation to treat cancer

You can also try these home remedies to relieve your symptoms:

  • Rest.
  • Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol).
  • Drink extra fluids to prevent dehydration.

How to prevent petechiae

To prevent petechiae, you need to avoid the conditions that can cause them. But you can’t prevent all of the possible underlying causes of petechiae.

If you’ve had this reaction to a drug in the past, let your doctor know. Your doctor will probably recommend that you avoid the drug in the future.

To prevent infections that can cause petechiae:

  • Wash your hands often with soap and water, or use an alcohol-based hand sanitizer.
  • Try to stay away from anyone who appears to be sick.
  • Don’t share glasses, utensils, and other personal items.
  • Clean countertops and other common surfaces.
  • Practice safe sex.
  • Apply an insect repellant containing DEET before you go into wooded or grassy areas. Also, wear a long-sleeved shirt and long pants, and tuck your pants into your socks. Check your entire body for ticks when you get back home.
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