Internal Medicine

Petechiae

definition

Petechiae are small, pinhead-sized red spots on the skin or mucous membrane. They are caused by bleeding from small blood vessels (Capillaries). If petechiae are present, they usually do not appear individually, but in a small or larger group of red dots. There are various causes for the development of petechiae. Depending on the cause, they can be located in different places.

Petechiae are not an independent disease but a symptom that can occur in the context of various diseases. It is typical of petechiae that they do not disappear or fade even with pressure (for example with a glass spatula). The therapy depends on the underlying disease. Finding a diagnosis is not always easy.

Causes of Petechiae

There are different diseases in which petechiae can occur. The appearance of these small punctiform hemorrhages often indicates a disorder in blood clotting. Usually a deficiency or a dysfunction of the blood platelets (thrombocytes) is the trigger.

As a rule, petechiae develop first around the ankles and lower legs. If there is extensive petechial bleeding in the context of a Thrombocytopenia, one speaks of a thrombocytopenic purpura. Inflammation of the small blood vessels can also lead to small leaks in the capillaries and thus to blood leakage from them with the formation of petechiae. One then speaks of one Vasculitis.

The platelet dysfunction can also be triggered by the use of medication. The so-called platelet aggregation inhibitors include, for example, acetylsalicylic acid (ASA) and clopidogrel. An overdose can lead to the development of petechiae.

Petechiae play an important role in forensic medicine for another reason: Petechiae in the area of the head (for example on the inner eyelids or on the oral mucosa) can indicate strangulation before death, i.e. unnatural death.

Find out more about this in our article about: Causes of Petechiae

Are petechiae caused by stress?

Petechiae are either caused by an inflammatory reaction of the small blood vessels or due to a lack or malfunction of the platelets.

Stress generally increases the body's susceptibility to disease, but there is no known direct connection to the development of petechiae. If petechiae occur without an identifiable cause and the doctor cannot identify any disease as a trigger, the cause often remains unclear. In addition to other explanatory approaches, it is then often assumed that stress can be partly responsible for the development.

However, there is no scientific evidence of such a connection.

Petechiae in thrombocytopenia

In medicine, a lack of blood platelets is called thrombocytopenia. If the body does not have enough blood platelets, primary hemostasis is impaired. This can be shown by petechiae. A slight deficiency can only be detected in the blood but usually does not yet lead to symptoms or abnormalities. Spontaneous punctiform hemorrhages into the skin or oral mucosa, which appear as petechiae, can only occur when the number of blood platelets is greatly reduced.

In the body, the blood flow constantly causes small injuries to the vessels, which can normally be sealed directly by the platelets. In the event of a deficiency, this is no longer possible and petechiae develop for no apparent cause. Thrombocytopenia can have various causes, but inflammatory causes as well as malignant diseases must be considered.

Learn more about this at. Thrombocytopenia

Petechiae in vasculitis

Vasculitis is an inflammation of the blood vessels and is one of the main causes for the development of petechiae. A distinction is made between an innumerable number of vasculitides, which can have various causes and can express themselves through different symptoms throughout the body.

Vasculitis should be considered if the number and function of blood platelets are normal and there are other symptoms or laboratory changes that may indicate such a disease. If vasculitis is suspected, special examinations are carried out so that treatment can be initiated if necessary.

If this is successful, the petechiae will disappear and no new ones will appear. However, some forms of vasculitis cannot be cured; their effects can only be limited with medication.

also read: Vasculitis

Petechiae in meningitis

Meningitis in connection with the appearance of petechiae is a very dangerous condition. Meningitis is an inflammatory disease of the meninges. It is triggered by pathogens such as bacteria or viruses and is typically associated with stiff neck, fever and a significantly reduced general condition.

Petechiae are not a typical symptom of "normal" meningitis. Conversely, petechiae alone without further signs do not indicate meningitis as the cause.

With a certain form of meningitis, namely that caused by meningococci (bacteria), the bacteria can be washed out into the bloodstream and thus lead to blood poisoning (sepsis). One then speaks of meningococcal sepsis. This blood poisoning can be accompanied by bleeding, i.e. large petechiae. The disease is very serious and acutely life-threatening and requires rapid intensive medical care.

Read more on the topic: meningitis

Petechiae in leukemia

The various forms of leukemia (white blood cancer), especially the acute forms, can lead to a lack of blood platelets. This happens because the bone marrow is attacked in acute leukemia. Cancer cells multiply here in large numbers; they only produce white blood cells. Hence the name leukemia. In healthy people, the red blood cells and platelets are also produced in the bone marrow in addition to the white blood cells.

Read more on the topic: How do you recognize leukemia?

In leukemia, however, the mass of cancer cells displaces the other healthy cells and there is often a shortage of red blood cells and platelets. The lack of platelets is known as thrombocytopenia and often manifests itself in the form of petechiae. Often these first show up in the ankle and lower leg area.

If petechiae occur in children and if there are also frequent bruises, as well as increased tiredness and reduced performance, these can be indicators of the presence of leukemia. A pediatrician should be consulted as soon as possible.

Read more on the topic: Leukemia in children

Petechiae in liver disease

Petechiae have nothing to do with the liver. However, there are other small red skin manifestations that are often found in patients with cirrhosis of the liver. These are known as spidernaevi (vascular spiders). In the middle there is a red point that looks like a petechia.From this point small light red branches pull outwards. A Spidernaevi usually measures a few millimeters. Such vascular spiders can be found mainly in the chest and face.

Read more on the topic: Symptoms of cirrhosis of the liver

Petechiae from vitamin deficiency

When petechiae occur, vitamin deficiency is a conceivable but very unlikely cause. Basically, a lack of vitamin C can lead to the punctiform skin bleeding along with other symptoms on the bones and gums. The disease known as scurvy occurred more often in the past due to the one-sided and vitamin-poor diet of seafarers. Vitamin C deficiency is extremely rare these days.

A deficiency in other vitamins is possible, but typically does not lead to the development of petechiae. A deficiency in vitamin K can also lead to bleeding, but it tends to lead to flat rather than punctiform bleeding into the skin.

Petechiae by pressure

In principle, strong pressure can lead to the formation of petechiae. For example, high blood pressure in the blood vessels (especially in the skin capillaries) can trigger punctiform hemorrhages. As a rule, however, this only occurs with a pre-existing decrease in the number of blood platelets or an impairment of their function.

External pressure tends not to lead to the development of petechiae. With strong pressure it comes to extensive bleeding and thus bruising.

In the field of forensic medicine, however, the development of petechiae through pressure is of particular importance. If a person is strangled to death, petechiae typically develop in the area of the eyes or the eyelids, so that these can provide clues as to the cause of death.

Petechiae from allergy

Petechiae can be triggered by a certain type of allergic reaction. For example, the administration of some drugs or a blood transfusion can cause a reaction in the body that destroys platelets. If their proportion drops sharply, spontaneous punctiform hemorrhages into the skin and mucous membranes and thus petechiae can occur.

However, common forms of allergies such as to food, grass or insect venom trigger symptoms in a completely different way than the allergic reactions described above. Therefore, petechiae are not the result of such common forms of allergy.

Petechiae in HIV

An infection with HIV can lead to a variety of symptoms. Usually, without treatment, the disease AIDS breaks out a few years after the infection, which is mainly characterized by a strong impairment of the body's own defense system. As a result, inflammatory reactions usually occur in different organs. Among other things, petechiae can develop in various ways.

However, it is not a typical symptom of HIV infection. If there are no other symptoms besides the appearance of petechiae, another cause of the punctiform hemorrhage is much more likely.

Find out more at: HIV-you should know that!

Symptoms accompanying petechiae

Depending on the disease in which the petechiae occur, the accompanying symptoms can be very different. If there is a shortage of blood platelets it can lead to nosebleeds and in women to a prolongation and increase of the regular bleeding.

In the case of Schönlein-Hennoch purpura, which belongs to the disease group of vasculitides, i.e. vascular diseases, symptoms in the gastrointestinal tract can occur. These include, for example, stomach pain, vomiting and blood in the stool. Inflammation of one or more joints, for example the ankle or knee joint, can also occur. This manifests itself as reddening and painful swelling of the joint.

Kidney involvement is also possible; this can progress to acute kidney failure. However, kidney involvement usually causes no symptoms.

If the petechiae occur as part of leukemia, there may also be a reduction in performance, increased fatigue, susceptibility to infection, increased occurrence of bruises, fever and swelling of the lymph nodes. So the accompanying symptoms are very different.

Read more on the topic: Purpura Schönlein Enoch

Therapy of petechiae

It cannot be said in general how petechiae are treated because petechiae are a symptom and not a disease. The causative illness must therefore be treated. Depending on which it is, the treatment approaches are very different. In the case of inflammatory changes in the blood vessels (vasculitis), cortisone-like drugs can be used. For the various forms of leukemia, chemotherapy and stem cell transplantation can be considered as therapies.

Where do petechiae occur?

Petechiae on the face

Petechiae on the face can be caused by strong coughing or vomiting, for example. They usually go away after a few days.

Petechiae on the face play an important role in forensic medicine. It is important to look for petechiae in the area of the eyelids and the oral mucosa, especially in the case of corpses on which no external influence can otherwise be recognized. The presence of petechiae strongly suggests that strangulation occurred shortly before death.

This can be important, for example, when the question arises whether it is a natural death or not. Petechiae indicate a non-natural cause of death.

Petechiae on the oral mucosa

When petechiae develop, the lining of the mouth is usually one of the first places they appear. They are typically seen as small red dots in the area of the palate. However, the location of petechiae does not allow conclusions to be drawn about the cause.

It can be both a less dangerous and a threatening malignant or inflammatory disease. Anyone who notices petechiae on the oral mucosa when looking in the mirror should therefore see a doctor promptly so that he can draw blood and, if necessary, initiate further diagnostic measures.

Petechiae on the abdomen

The abdomen is a rather unusual location for the appearance of petechiae. The localization in the area of the lower legs or the face is more common.

Petechiae on the arm

The arm is also a rather unusual place for petechiae to occur.

Petechiae on the lower leg

The ankles and lower legs are the most common places on the body for petechiae to appear. The small hemorrhages usually occur in larger groups. The possible causes have already been discussed above.

Petechiae in the baby

Especially in very young children, petechiae can occur even if they are fully healthy. Most common is strong persistent cough of the trigger for the formation of petechiae. Infections that are triggered by viruses also play a not insignificant role as the cause of the development of petechiae in childhood. However, if the petechiae persist for several days or become more, it is advisable to consult the treating pediatrician.

How long do petechiae persist?

How long petechiae persist depends on what triggered them. It is not uncommon for them to disappear again after days to weeks, even without therapy having been initiated. However, if, for example, leukemia is the cause, the petechiae can persist until treatment has been initiated and has an effect.

Are there petechiae that can be pushed away?

Petechiae can be distinguished from other punctiform skin changes in that they cannot be pushed away by pressure with a glass spatula. If apparent petechiae can be pushed away in the skin, they are not petechiae.

This phenomenon can be explained by the fact that petechial hemorrhage is an extravasation, which means that the blood is outside the vessels.
Push-away red dots, on the other hand, indicate that the blood is in the vessels.

A possible cause of skin manifestations with push-away red spots is a viral infection. But hemangiomas also fade on pressure.

You might also be interested in: Everything about hemangiomas

Does the hickey belong to the petechiae?

A so-called hickey occurs when a negative pressure is created through the partner's mouth while kissing on the skin. Similar to bruises caused by bumping, the negative pressure injures blood vessels and causes bleeding into the skin.

However, this typically results in extensive bleeding, which roughly corresponds to the area of the mouth opening of the causer. Petechiae, on the other hand, are punctiform hemorrhages, which do not represent the typical appearance of a hickey.

Like a bruise, a hickey heals again within a few days and changes its color from blue to green to yellow.

also read: Blue spot

Diagnosis of petechiae

If a patient with petechiae comes to the doctor, the anamnesis plays an important role first. This means that the doctor will inquire how long the symptoms have existed, whether new medications have recently been taken and what pre-existing conditions exist. Then the physical exam takes place. The doctor will see where the petechiae are and whether they are actually petechiae. This can be checked, for example, by the fact that petechiae remain and do not fade even when pressure is applied to the area.

A blood test will usually be done afterwards. This can provide information about whether there is a lack of platelets. If this is the case, further diagnostics must be carried out. Certain antibodies can also be detected in the blood, which can provide an indication of whether the small vessels are inflamed (vasculitis).

The diagnosis of petechiae is often tedious and not always easy. Not infrequently, no diagnosis is made and the petechiae disappear again after a while. Nevertheless, if petechiae appear, an attempt should be made to clarify the matter, as petechiae can hide both harmless causes and serious clinical pictures.