You might think you have a rash if you notice tiny, red dots on your skin. However, it’s possible that those pinpoint, red spots on the skin are caused by a skin condition called petechiae (puh-TEE-kee-ee). Petechiae are tiny, pinhead-sized dots that might be brown, red, or purple. They are caused by tiny blood vessels bleeding under your skin.
Petechiae 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 are not itchy or painful, and they are flat, so you can’t feel them. They tend to appear in groups.
Distinguishing Petechiae from Rashes
One way to help distinguish between petechiae and a rash is by pressing on the spots. Petechiae are caused by having low or poor-functioning platelets. Many things cause low platelets, and it is important that you see your doctor to help you find the cause. Low platelets and petechiae can be caused by many different things, some of which are serious.
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. This is a key difference from many common rashes, which might fade or disappear when pressed.
Causes of Petechiae
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. 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.
Medications
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 antiplatelet medications, aspirin, and steroids.
Infections
Both viral and bacterial infections can cause red dots or other rashes to appear on your skin. Common infections linked to petechiae include:
- Enterovirus infection
- Parvovirus B19 infection
- Dengue virus infection
- Meningococcal infection (meningitis)
- Scarlet fever
- Infective endocarditis
- Rocky Mountain spotted fever
- Septicemia/sepsis
- Congenital TORCH syndrome (concurrent infection with Toxoplasma gondii, other agents, rubella, cytomegalovirus, and herpes simplex virus)
Blood-Related Disorders
These include blood cancers, chronic conditions, and blood-related congenital disorders. Conditions such as thrombocytopenia, leukemia, types of anemia, platelet dysfunction, coagulation disorders, vascular diseases, Bernard-Soulier syndrome, and Glanzmann thrombasthenia can be associated with petechiae.
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, such as Ehlers-Danlos syndromes (EDS), lupus, chronic liver disease, and Wiskott-Aldrich syndrome. Acute injuries, allergic reactions, and a vitamin K deficiency are also associated with the symptom of petechiae.
Petechiae in Babies and Children
As a parent, discovering a rash on your child’s skin can be an alarming experience. The immediate questions of what caused it and whether it is serious are common. While many spots and bumps are harmless, understanding how to identify some of the most common childhood rashes provides peace of mind and helps you know when professional medical advice is necessary.
Rashes are common in newborns and young babies as their skin comes into contact with new irritants and environments outside the womb. It's very normal to experience newborn skin peeling too, but knowing when this is eczema, baby hives, or another type of a rash can be tricky to work out. Your baby has really delicate skin which can be easily irritated by products and ingredients.
Petechiae in children can be a sign of a serious medical condition. If you notice small, red pinprick spots on your child's chest, abdomen, and limbs, especially if they do not disappear when pressed (glass test negative), it is crucial to seek medical attention. A rapidly evolving petechial or purpuric ‘rash’ is a marker of very severe disease.
Recognizing Common Childhood Rashes
Navigating the world of common childhood rashes can feel overwhelming, but recognizing their key features is a powerful tool for any parent.
Eczema (Atopic Dermatitis)
Eczema is one of the most prevalent of all common childhood rashes. It is a chronic condition characterized by dry, sensitive skin. It appears as patches of dry, red, and intensely itchy skin. In infants, it often shows up on the cheeks and scalp. In older children, it is typically found in the creases of the elbows and knees. The skin may become scaly, ooze, or crust over from scratching. Common causes are linked to genetic and environmental factors, including dry skin, irritants like soaps or detergents, and allergens. Management involves keeping the skin well-moisturized with thick, fragrance-free creams, and a pediatrician may prescribe topical steroid creams for flare-ups.
Diaper Rash (Irritant Dermatitis)
Nearly every baby experiences diaper rash at some point. It is an irritation of the skin in the diaper area, appearing as red, tender-looking skin in the diaper region. In more severe cases, there may be sores or bumps. Prolonged exposure to a wet or dirty diaper is the primary cause. Chafing and sensitivity to diaper materials or wipes can also contribute. The best approach is to keep the area clean and dry, change diapers frequently, allow for some diaper-free time, and use a barrier cream containing zinc oxide. If the rash does not improve, it could be a yeast infection, which requires antifungal cream from a doctor.
Hand, Foot, and Mouth Disease
This is a common viral illness, usually caused by the Coxsackievirus, that is highly contagious and spreads easily in childcare settings. It starts with a fever and sore throat, followed by painful sores in the mouth. A non-itchy rash with red spots, sometimes with blisters, develops on the hands and feet. The rash can also appear on the buttocks or genital area. As a viral illness, it must run its course. Focus on comfort care: provide plenty of fluids, offer soft foods, and use over-the-counter pain relievers for fever and pain.
Hives (Urticaria)
Hives are itchy, raised welts on the skin that are often a sign of an allergic reaction. Hives look like raised, pink or red welts with clear edges. They can vary in size and may appear anywhere on the body. A key feature is that they tend to move around, with old spots fading as new ones appear. Often triggered by an allergic reaction to a food, medication, or insect sting, viral infections can also cause hives. Mild hives may resolve without treatment, but antihistamines are the primary treatment to relieve itching and swelling.
Heat Rash (Miliaria or Prickly Heat)
Heat rash appears as tiny little red bumps or blisters on the skin and happens when children get too hot. Heat rash presents as pink or red on white skin, but is difficult to identify on black and brown skin as the skin will not necessarily change colour, although it can look spotty. If your child is old enough, ask about symptoms: does your skin feel sore or itchy? Are you very thirsty?
Chickenpox
Chickenpox causes an itchy rash, spots, and fluid-filled blisters, among other symptoms, and is particularly prevalent between March and May. This initial rash can be harder to see on black and brown skin, so it's advised to look under the forearms and in the mouth and inside of eyes. Chickenpox is usually mild and can be managed at home with rest, fluids, and pain relief.
Scarlet Fever
Scarlet fever usually starts with a sore throat and high temperature, followed within 12-48 hours by a rash. It is characterised by a fine, pinkish-red rash that feels like sandpaper. It often occurs with a sore throat, fever, and swollen glands.
Measles and Rubella
Measles is highly contagious and causes a mass of red spots around the neck, behind the ears, and on the face. Contact your doctor if you suspect measles. Rubella causes a pinkish-red rash that starts on the face and spreads to the rest of the body. It's usually mild but can be dangerous if contracted during pregnancy.
Meningitis Rash
The meningitis rash occurs when septicaemia (blood poisoning) has taken hold. According to Mini First Aid, DO NOT wait for the rash if you suspect meningitis. Also look out for blotchy skin, getting paler or turning blue on white skin, but with an ashy or grey appearance on black and brown skin. There will be other symptoms to look out for, including high fever, cold hands and feet (even with a high fever), and a pale, dusky, or blue colouring around the lips. A meningitis rash appears as reddish or purple spots that don't fade when pressed with a glass. The rash usually starts as small, red pinpricks before spreading quickly and turning into red or purple blotches. However, in cases of meningitis, the rash can be very scanty, blanching, atypical, or even absent. Please remember that a very ill person needs medical help even if there are only a few spots, a rash that fades, or no rash at all. Trust your instincts; someone who has meningitis or septicaemia could become seriously ill very quickly.
Measles, Rubella, & Mumps: Alterations in Health - Pediatric Nursing | @LevelUpRN
When to Consult a Pediatrician
While many common childhood rashes can be managed at home, certain signs warrant a call to your pediatrician. Trust your instincts; if you are worried, it is always best to seek a professional opinion.
Call Your Kid’s Doctor If:
- The rash is accompanied by a high fever - This could signal a more serious infection.
- The rash is painful - Discomfort is a sign that medical evaluation is needed.
- The rash looks infected - Signs of infection include yellow crusting, pus, or significant swelling.
- You see petechiae - These are tiny, pinprick-like red or purple spots that do not fade when you press on them. Petechiae can be a sign of a serious medical condition and require immediate medical attention.
- The rash does not improve - If a rash persists or worsens despite home care, a professional diagnosis is necessary.
If your petechiae (or your child’s) develop alongside other symptoms like fever, talk with your doctor. Febrile (feverish) conditions that appear with petechiae are especially common in children. In these children, doctors will usually evaluate for a meningococcal infection first.
Treatment for Petechiae
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 their 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.
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.
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. Sometimes, petechiae can be a sign of a medical emergency.
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.