Petechiae


What are Petechiae?

Petechiae are small pin head size hemorrhages seen on the skin. They are multiple in number and less than 1-2 mm in diameter. They are really small and looks like a person has had multiple pin prick lesions. They are caused due to rupture of the capillary blood vessels beneath the skin. They are reddish to purple in color and the size and color do not change size on pressing. They are almost always referred as plural because one spot is never seen alone. They occur in clusters and look like skin rashes. They do not change color or merge with each other on pressure. This is the characteristic feature which helps to differentiate them from other rashes.

In patients with excessive coughing and sneezing, the pressure around the face and the eyes tends to increase and gives rise to small pin point hemorrhages that look like brown spots on the face. These are called as facial petechiae.

The other lesions that may be thought of as differential diagnosis with it are purpura and ecchymosis. In some cases blood collects under the skin within the tissues and the size reaches up to one centimeter in diameter. This is then termed as a prurpura. The commonest cause of these patches is blunt trauma or injury leading to extravasations of blood in the superficial layers of the skin. It is not a serious problem and does not lead to any deformity. The spots tend to go away on their own within few days. Thrombocytopaenia is a condition where the platelet levels of the individual falls due to some illness or blood disorder. In such cases petechiae are very common. So such conditions need to be ruled out as they are serous in nature. In some cases these pin point hemorrhages may be a result of sunburns and minor injuries.

Incidence

There is no such fixed data on the incidence. It is seen uniformly in both the genders and in people of all age groups and both sexes. It is more common in patients with underlying medical conditions related to blood platelet counts. People who have certain diseases that affect the bleeding and clotting time of blood are also more prone to getting petechiae. Old people have fragile skin and blood vessels are more superficial so they tend to get these hemorrhages more easily when subjected to a blunt trauma.

Petechiae Causes

  1. The commonest cause of petechiae is physical trauma or injuries which leads to rupture of the blood vessels beneath the skin. Strains like a violent bout of coughing, vomiting or crying can lead to small hemorrhages on the face which are called as facial Petechiae. Sunburns can also cause small hemorrhages on the face.
  2. When excessive pressure is applied to any tissue, pin point hemorrhages can occur as the delicate blood vessels get ruptured. This is seen commonly when a tourniquet is tightly applied before collection of venous blood for laboratory investigations.
  3. Medical conditions: there are some medical conditions where these pin point hemorrhages are more common. They are:
  1. Leukemia: Leukemia is a type of blood cancer affecting the bone marrow and the lymphatic system of the body. It can affect children and adults.
  2. Thrombocytopaenia: It is a condition that occurs due to a fall in the platelet count in the body. The platelets are responsible for stopping the blood flow in event of an injury in the tissues or blood vessels within the body. So low platelets are associated with an increased tendency to hemorrhages. These are seen as multiple small brownish spots on the skin.
  3. Infectious diseases: Petechiae can be caused by bacterial, viral or fungal infections and some of them are:
  • Streptococcal infections
  • Meningococcemia
  • Endocarditis
  • Autoimmune diseases
  • Infectious Mononucleosis
  • Scarlet fever
  • Sepsis
  • Dengue
  • Chikungunya
  • Congential syphilis
  • Ebola
  • Typhus
  • Cytomegalovirus
  • Marburg virus
  • H1N1 swine flu
  • Dukes disease etc
  1. Persistant straining: This can be the cause of petechiae in the following conditions:
  • Excessive and long standing coughing
  • Child birth-pushing stage in labor
  • Weight lifting
  • Chocking
  • Heavy physical work
  1. Sunburns
  2. Some medical conditions may occur in the body as a result of deficiencies of important vitamins and minerals .These also characterized by these hemorrhages
  • Scurvy
  • Vitamin K deficiency
  • Vitamin B deficiency
  1. Medications: These small spots can be a side effect of some types of medications like:
    • Penicillin
    • Quinine
    • Naproxene
    • Atropine
    • Warfarin
    • Heparin
    • Carbamazapine
    • Desipramine
  1. Sepsis: Sepsis is a serious medical condition that leads to low platelet count and increases the chances of bleeding. The low platelet count can be a reason for the petechiae.
  2. Allergic reactions: There is a condition called allergic purpura in which there is bleeding under the skin and formation of brownish spots.
  3. Autoimmune diseases: The disease that begin to affect the immunity of the body by attacking the white blood cells and causing self damage are called autoimmune diseases. Lupus, SLE and Rheumatoid arthritis are examples of such diseases. Resulting thrombocytopaenia leads to formation of small pin point hemorrhages.
  4. Injury or blunt blow to the skin can also cause hemorrhage and result in Petechiae
  5. Other conditions:
  • Aplatic anemia
  • ITP-Idiopathic thrombocytopaenic purpura

Symptoms of Petechiae

  1. The most important symptom is the presence of discoloration of the skin. The spots can appear anywhere on the body. They are initially reddish in color. Later on the color becomes bluish purple and stays that way.
  2. The spots do not have itching in them and they are at skin level without being raises.
  3. They are always present in clusters and never seen singly.
  4. The lesions are pin head in size and do not change color or shape when pressure is applied on them.
  5. Easy bruising of the skin is seen to be associated.
  6. Dots are 1mm in diameter and if they are larger in size and look more like patches, they are called purpura.
  7. The most common location you can notice Petechiae is the face, shoulders, back, ankle and legs.
  8. There are some signs and symptoms that can be associated with them like:
  • Hematoma-a clot of blood beneath the skin
  • Tendency to easy bruising
  • Sudden nosebleeds without any apparent reason
  • Hemarthrosis also known as joint hemorrhage.
  • Menorrhagia in females- heavy menstrual bleeding from the uterus.
  • Bleeding from gums while brushing the teeth.

Diagnosis of Petechiae

Once the characteristics of the skin discoloration are noted, the diagnosis is established and the next step is to find out the underlying cause. The most important thing is to assess the patients’ platelet count. The tests that are routinely carried out are:

  • CBC –complete blood count to assess the WBC counts
  • Bleeding time and Clotting time. These tests are done to measure the time taken by the body to form a clot when there is bleeding from any part of the Body. If these normal times are affected, then the bleeding tendency increases.
  • Prothrombin Time
  • APTT-activated partial thromboplastin time
  • Platelet count is the most important investigation. A low platelet is always associates with a bleeding tendency.
  • Bone marrow examination if leukemia is suspected.

Treatment of Petechiae

  1. Treating the injury causing the hemorrhage is of utmost importance. It also includes taking care of problems causes due to strain like heavy work, chronic cough etc.
  2. If the patient is encountering high pressure activities like weight lifting, he needs to stop them immediately
  3. Radiotherapy and chemotherapy for patients with leukemia. The patient may need other cancer specific treatments too.
  4. IV antibiotics may be needed for patients with sepsis or other severe infections. At times, hospitalization with antibiotics and other medications may be needed.
  5. If the platelet count is very low, the patient may need a blood platelet transfusion. That is the only mode of treating the bleeding tendency.
  6. Petechiae associated with deficiencies like Vitamin C or Vitamin K deficiency must be treated with vitamin supplements and a diet rich in those vitamins.

Home Treatment for Petechiae

  1. Cold compress is also a very effective home remedy for petechiae as it causes constriction of the blood vessels and prevents bleeding from the capillaries. It also helps to reduce the pain and inflammation. You could use a gel based ice pack or ice cubes wrapped in a thick towel. Place the compress for 20 minutes two to three times a day.
  2. You must avoid trauma and blunt injuries when you have a tendency to easy hemorrhages.

Petechiae Pictures

Petechia lower leg

Petechia picture – The lower leg | By James Heilman, MD (Own work) [CC BY-SA 4.0], via Wikimedia Commons

Petechia and purpura

Petechia And Purpura | By James Heilman, MD (Own work) [CC BY-SA 3.0 or GFDL], via Wikimedia Commons

 

Oral petechiae

Oral Petechiae Picture | By Photo Credit:Content Providers: CDC/Dr. Heinz F. Eichenwald [Public domain], via Wikimedia Commons

Meningococcal petechiae

Meningococcal Petechiae (source: DermNetNZ, CC license)

Leave a Reply