What Causes Petechiae?
What is petechia?
The definition of petechia falls under the category of hemorrhaging. A petechia, or more commonly used in Latin plural, petechiae, are microscopically small dots which appear beneath the skin surface in red, brown or purple color. We refer to them in plural because they are barely seen individually and they are usually displayed in clusters. Petechiae belong to the larger group of vessel bleeding, the other two being purpura and ecchymosis. These three types of bleeding are divided by the size of bleed seen on the skin. By definition, petechiae cannot be larger than 3 millimeters.
The underlying mechanism responsible for the appearance of petechiae is rather simple. When the smallest of the blood vessels, capillaries, bleed, as a result, petechiae occur. These minor bleedings usually don’t cause any kind of inconvenience in terms of pain, itchiness or discomfort. It is very important to stress that petechiae need to be differentiated from regular bruising, rash and allergy. The simplest way to determine whether you have a bruise or petechiae is to perform the pressure test on the skin surface. When pressed upon with a finger, skin tone normally becomes paler. In case you have petechiae, skin after pressing remains red. Petechiae aren't dangerous by themselves, but they can be a symptom indicating that there is a problem. It is important to emphasize that sometimes there are other symptoms present besides skin abnormalities. These symptoms include:
- Gum bleed
- Nosebleed
- Hematoma
- Severe menstrual bleed
Combined with petechiae, these symptoms require immediate medical attention, especially if none of the causes listed below aren't noticeable.
Petechiae causes
There are many factors that can be deemed responsible for the occurrence of petechiae. These factors are divided into three major groups: non-infectious conditions, infectious conditions, and physical traumas.
Non-infectious conditions
When we speak about petechiae triggered by non-infectious conditions, they can be further divided into several subcategories. The first group consists mainly of conditions that are the result of deficiencies and malnutritions. These include:
- Vitamin C deficiency
- Vitamin K deficiency
- Low calcium levels
- Protein-energy malnutrition typical for children
So, if you notice the occurrence of petechiae and there are no apparent reasons for it, it may be good to pay attention to your quality of nutrition and include additional vitamin C and K and calcium supplements. In case your child displays signs of emaciation and has petechiae, consult your health care provider immediately.
The second subgroup indicates more severe health complications. The majority of them are related to blood and vessel functioning and involve complex analysis. Widely found are the following:
- An inflammation of the blood vessels (vasculitis)
- An abnormally low platelet count as a result of inhibited platelet functioning or clotting factor shortage (thrombocytopenia)
- A deficiency of red and white blood cells and platelets (aplastic anemia)
- Leukemia
The diagnosis for the majority of these conditions is ordinarily made by testing blood or bone marrow biopsy.
The final subcategory of causes which may result in petechiae comes as a consequence of taking certain medications. These medications include:
- Anticoagulants (Warfarin, Heparin)
- Atropine (Atropine)
- Carbamazepine (Carbatrol, Epitol, Tegretol, others)
- Chloral hydrate (Somnote)
- Desipramine (Norpramin)
- Indomethacin (Indocin)
- Naproxen (Aleve, Anaprox, Naprosyn)
- Nitrofurantoin (Furadantin, Macrobid, Macrodantin)
- Penicillin
- Quinine (Qualaquin)
If you have taken any of these drugs and after a short period (usually several hours) you can observe changes on your skin surface and occurrence of petechiae, there is a chance that you have a reaction to a given drug. Make an appointment with your doctor in order to make sure that a more dangerous reaction doesn't happen and your general health isn’t compromised.
Infectious conditions
You have already concluded that the presence of petechiae, particularly in children, shouldn’t be taken lightly. The next major group of causes which are accountable for petechiae can pose threat to the others as well. These are infectious conditions and in extreme cases, some of them may even result in death 48 hours within infection (meningococcemia). Clinical context of petechiae is therefore exceptionally important to consider. If you have traveled to some exotic destination, or if you have been exposed to the infected individuals, seek medical help immediately. A list of the infectious conditions that, among other symptoms, can also include petechiae consists of:
- Cerebral malaria – caused by a bite of an infected mosquito. Symptoms occur 10 to 15 days after the infestation and they include vomiting, high fever, headaches, and tiredness.
- Ebola – caused by Ebola viruses. Symptoms start fast, two days after viral infiltration, and they include muscle pain, fever, vomiting, diarrhea and rash.
- Hantavirus – This type of virus attacks rodents. Humans get infected if they get in touch with rodent saliva, urine or feces. The virus has rather prolonged incubation periods which can last up to 4 weeks. Symptoms are similar to the flu and characteristic of sudden breath shortage.
- Infectious mononucleosis – also caused by a virus. The majority of the population gets this disease during childhood with little or no symptoms at all displayed. Complications may arise if the illness affects adults. The most distinguishing symptom is enlargement of lymph nodes, fever, and sore throat.
- Meningococcemia – The blood infestation that manifests itself by inept clotting of blood in vessels. As a result of blood obstruction produced by upstream thrombi, tissue damage can happen.
- Scarlet fever – A Streptococcus bacteria is responsible for spreading the infection whose main symptoms include swollen lymph nodes, a sore throat, fever and a typical rash.
- Typhus – Symptoms don’t differentiate much from the other diseases and they include fever, a rash, and headache. Typhus is also caused by bacterial infection.
There are many others but for the informational purposes, we have listed only the most prominent. However, if you haven't been in a specific situation that getting any of these illnesses requires, you shouldn't worry yourself and focus your attention to find other possible reasons for the petechiae to show beneath your skin.
Physical traumas
Different types of physical trauma and contusions can cause petechiae and these traumas constitute our final group. Trauma induced petechiae are the most common of all petechiae and usually the first option your doctor will consider when investigating possible causes. Petechiae can pretty much occur anywhere on the body, but there are few specific and at the same time the most common areas. The areas in which petechiae appear in the majority of cases correspond to the manner of physical injury. We can divide them into two categories: facial/bust petechiae and petechiae on legs.
Petechiae on face
Petechiae on the face are the easiest to observe. There are many factors that can contribute to their outburst. Firstly, there are petechiae which appear as a result of violent coughing, crying and vomiting. This type of petechiae is usually manifested in the tissues surrounding the orbit of the eye and it doesn't pose any serious health threat. After a couple of days, the majority of petechiae will subside naturally.
Another way to get petechiae on your face, chest and neck involves any form of excessive straining, including weightlifting, severe physical labors and childbirth. Immediately after being born, many babies can have petechiae. In addition, severe sunburns sometimes can produce petechiae on the skin.
Choking, strangulation, biting, spanking and abuse in general causes petechiae. This type of petechiae is particularly of interest to forensics, given the fact that their presence refers to the possibility of violent death. Investigators take petechiae as a sign of asphyxiation and strangulation. These petechiae occur inside the mouth, on the neck, and sometimes within the eye. Also, it often happens that victims from car accidents among other injuries can also have petechiae.
Petechiae on the legs
Petechiae on the legs, as well as on the other parts of the body, usually appear in clusters. Initially, petechiae on the legs are no longer than 1 or 2 millimeters, but later their size can be doubled and in certain instances, they can even grow to 0.5 cm. Their color also depends on their stage: in the beginning, they are red, and in the final stages we can see them in dark brown or purple. This is caused by blood oxidation. Risk factors for getting petechiae on the legs aren’t different from the ones responsible for getting petechiae in general: viral and bacterial infections, reactions to certain types of medications, and as a result of chemotherapy and traumas.
Conclusion
If you notice that some kind of abnormalities in the form of redness have shown beneath your skin, the safest option is to pay a visit to the dermatologist. He or she will evaluate your condition adequately and run additional tests if needed. The underlying cause which has brought capillary hemorrhaging will determine possible treatments. Treatments will vary accordingly, for example, in case your petechiae are caused by infection, appropriate antibiotics will be prescribed. Only the most severe cases, when petechiae are a result of leukemia or cancer, can lead to surgery. Luckily, in the majority of instances, your petechiae are nothing more than the consequence of excessive strainings, such as strong coughing, sneezing or prolonged crying. They can be treated with ice, avoiding of further injuries, and patience.
