Your skin’s health and appearance shifts all the time depending on your environment, lifestyle, and health conditions, among other factors.

Sometimes skin problems have an obvious cause, like sunburn or a mosquito bite. But other times rashes or dots appear on your skin that are harder to identify.

Petechiae are red, purple, or brown dots on the skin that are generally painless and itch-free. These dots form when your tiniest blood vessels, called capillaries, break and leak blood under the skin. This blood pools under the surface, creating the appearance of spots.

Petechiae aren’t considered a medical condition on their own. They’re often a symptom of another underlying health problem, such as infection, allergic reaction, or autoimmune disease.

In this article, we will explore some common potential causes of petechiae, symptoms to watch out for, and when to see a doctor.

You can develop petechiae for a number of different reasons, including injuries and infection. In many of these cases, petechiae are a symptom of an underlying health issue.

Here’s an overview of common causes of petechiae:

Medication

An allergic reaction to certain medications may cause clusters of red dots to appear on your skin. This could be petechiae or hives. Hives are often itchy, raised welts that are generally larger than petechiae. Medications known to cause petechiae in rare cases include:

Infections

Both viral and bacterial infections can cause red dots or other rashes to appear on your skin. Common infections linked to petechiae include:

Blood-related disorders

These include blood cancers, chronic conditions, and blood-related congenital disorders.

Other chronic conditions

Petechiae may come and go as a result of a chronic disease or illness. This includes autoimmune conditions, and certain congenital and connective tissue disorders. For example:

Acute injuries, allergic reactions, and a vitamin K deficiency are also associated with the symptom of petechiae.

Does COVID-19 cause petechiae?

Each new variant of SARS-CoV-2, the virus that causes COVID-19, seems to appear with new symptoms. Different variants of the virus have caused some level of skin symptoms, including petechiae. This is believed to be related to bleeding and coagulation changes brought on by COVID-19.

Although petechiae has been observed in people with COVID-19, it’s not the most common skin manifestation. One study estimated that only about 3% of people with COVID-19 develop this symptom.

Petechiae may not always appear alongside other noticeable symptoms. These tiny dots are usually flat, red, brown, or purple in color, and measure less than 2 millimeters (mm).

A hallmark of petechiae is that they’re nonblanching. This means they don’t fade away or disappear when you apply pressure to your skin.

Size is what differentiates petechiae from purpura. Purpura are also caused by broken capillaries leading blood to pool under your skin, but they’re larger than petechiae (over 2 mm).

Although you may itch, be sore, or have a fever alongside petechiae, these symptoms are usually related more to the issue that caused your petechiae than these spots themselves.

Treatment for petechiae depends on the underlying cause, since the dots are usually a symptom of another condition.

Petechiae that appear from an injury or infection usually resolve on its own in 2 to 3 days. You’ll likely need to rest and take antibiotics for a bacterial infection. Treatment for most viral infections includes rest and over-the-counter pain medication (OTC NSAIDs).

If you have a blood-clotting disorder, your doctor will design an individualized treatment plan. This could include taking reversal agents to counter anticoagulation medications.

Steroids, chemotherapy, and immunosuppressant drugs may also be used to control a variety of autoimmune or inflammatory disorders that could be causing you to develop petechiae.

Immunosuppressant drugs work by suppressing or modifying your immune system so it doesn’t cause inflammation to joints, tissues, and organs.

Learn about ways to prevent petechiae.

If your petechiae (or your child’s) develops alongside other symptoms like fever, talk with your doctor.

Febrile (feverish) conditions that appear with petechiae are especially common in children, accounting for about 2.5% of visits to the pediatric emergency department each year.

In these children, doctors will usually evaluate for a meningococcal infection first.

In a 2018 study, between 7% and 11% of cases of petechiae and fever in children were caused by meningococcal disease, and about 10% were caused by Group A staphylococcus infection. Overall, about 60% of these cases were linked to viral illnesses.

Learn more about when to see a doctor for petechiae.

There are many conditions that can cause red dots on your skin. You may need your doctor to help you differentiate between these conditions and petechiae.

Other conditions that can produce dots or skin irritation similar to petechiae include:

Petechiae are usually a symptom of another health issue. These spots form after blood leaks from your capillaries. They don’t itch and won’t disappear if pressed.

Common causes for petechiae include infections, certain chronic diseases, and even injuries.

Your doctor may have to run several tests to identify what’s causing the dots to appear on your skin. Treatment depends entirely on the underlying cause.

Most of the time, these red, purple, or brown dots will resolve in a few days, especially if the condition causing them has been addressed and managed.