By Gary M. White, MD
Petechiae are small red spots caused by bleeding into the skin. (The singular lesion is a petechia.) A wide variety of conditions may cause a petechial rash. Those include but are not limited to:
- Prolonged straining, e.g., crying, coughing, vomiting, childbirth, and weightlifting.
- Thrombocytopenia (low platelets).
- Certain medical conditions, e.g., scurvy.
- Infections, e.g., meningococcemia, Rocky Mountain Spotted Fever, various hemorrhagic fevers, e.g., Dengue.
- Various medications, e.g., Coumadin, heparin, Plavix.
Always ask patients about other signs of bleeding, e.g., bruising, bleeding from the nose or other mucosal surfaces, blood in the stool. For the patient with the acute onset of petechiae and no obvious cause, laboratory workup should include a stat CBC to include platelets and bleeding times (e.g., PT and PTT).
Petechiae are almost always plural producing a petechial rash. There are certain patterns that are characteristic of specific conditions or diseases. For example, facial petechiae, especially around the eyes, indicate physical trauma such as by hard bouts of coughing, vomiting, or crying. Palatal petechiae are characteristic of streptococcal pharyngitis.
Treatment is dependent upon the cause.
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