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That Skin Condition That Looks Like a Rash Could Be Petechiae

You might think you have a rash if you notice tiny dots on your skin. But it’s possible that those pinpoint, red spots on the skin are caused by a skin condition called petechiae (puh-TEE-kee-ee). How can you tell the difference? Here are a few things to know about petechiae.

Petechiae are tiny, pinhead-sized dots that might be brown, red or purple. They are caused by tiny blood vessels bleeding under your skin. They tend to appear on your lower body, but it’s possible to find them in your mouth, inside your eyelids or on your arms. They aren’t itchy or painful. They are flat, so you can’t feel them, and they tend to appear in groups. “They can be so clustered together that it can look more like a rash,” said Jayne Peterson, MD, an internal medicine physician with Banner - University Medicine.

One way to help distinguish between petechiae and a rash is by pressing on the spots. Petechiae remain purple, red or brown, while a rash will turn pale or lighter in color.

What causes petechiae?

“Petechiae are caused by having low or poor-functioning platelets,” Dr. Peterson said. Platelets, or thrombocytes, are a type of blood cell that helps you heal after an injury, and petechiae can appear when your platelets are not working well or are too low. 

“Many things cause low platelets. It is important that you see your doctor to help you find the cause,” Dr. Peterson said. Petechiae can fade on their own in two to three days, but even if they go away, it’s still important to see your doctor so you can be treated for whatever caused them.

Low platelets and petechiae can be caused by many different things, some of which are serious. Conditions that cause petechiae include:

  • Low levels of vitamin C (scurvy) or vitamin K
  • Some viral infections such as mononucleosis, viral hemorrhagic fevers, cytomegalovirus (CMV) infection and hantavirus
  • Some bacterial infections, such as strep throat with scarlet fever and Rocky Mountain spotted fever
  • Common medications like nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, antidepressants and blood thinners
  • Leukemia 
  • Liver disease
  • An infection of the heart lining called endocarditis
  • Inflammation in the blood vessels called vasculitis
  • Bleeding disorder

Treatment for petechiae

At home, you can help petechiae clear up by getting plenty of rest, applying cold compresses and drinking fluids. But even if petechiae go away, you’ll still need to see your doctor. Because petechiae are a sign of an underlying condition that’s causing problems with your platelets, treating them means treating whatever is causing them. Your doctor might recommend:

  • Vitamin C or vitamin K supplements if you’re deficient
  • Immunosuppressing drugs
  • Antibiotics, if you have a bacterial infection
  • Steroids, which can help lower swelling in blood vessels
  • Treatment for leukemia, such as chemotherapy, radiation, immunotherapy or bone marrow transplant

Sometimes, petechiae can be a sign of a medical emergency. If you have petechiae and any of these other symptoms, call 911 or have someone take you to the emergency room:

  • Spots that spread quickly
  • Fever
  • Trouble breathing
  • Dizziness or confusion

Can you prevent petechiae?

You can’t prevent all causes of petechiae. But good hygiene practices can help you avoid some of the infections that can trigger them:

  • Wash your hands frequently.
  • Clean high-touch surfaces like door handles, light switches, phones and countertops regularly.
  • Wear long-sleeved shirts and long pants and use insect repellant if you’re in an area where you could be exposed to tick bites. Diseases like Rocky Mountain spotted fever, which is caused by tick bites, can lead to petechiae.
  • Don't share objects that might have come into contact with someone else's mouth or nose, such as a cup or toothbrush.

Petechiae can be confused with cherry angioma

Petechiae can look like cherry angiomas, which are small, red areas that are usually raised, so you can feel them. Cherry angiomas can appear when you get older or when you are pregnant, and they tend to be more common in people who have had a lot of sun exposure, though they aren’t cancerous. Cherry angiomas don’t go away on their own and don’t need to be removed unless they are larger and begin bleeding, or you don’t like the way they look. 

The bottom line

Petechiae are a skin condition that can look like a rash. But these pinprick-sized dots, which are caused by bleeding under the skin, could be a sign of a serious, even life-threatening, medical condition. Even if petechiae go away, it’s essential to see your doctor to find out what was causing them.

Have concerns about diagnosing and treating petechiae?

Schedule an appointment with a primary care provider near you.

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