Key points
The petechiae are point-like micro-haemorrhages, the result of the leakage of blood from the small blood vessels.
Petecchie: characteristics
- Dimensions: by definition, they do not exceed 3 mm
- Shape: smooth surface, irregular shape, often rounded
- Cromia: varies from bright red to blue-violet. In the final stage, the petechiae are greenish and yellowish
- Localization: petechiae are typical of lower or upper limbs. They can also appear on the face, abdomen, kidney, retina and mucous membranes.
- Symptoms: none. The petechiae are not painful.
Petechiae: causes
- Petechiae dependent on alteration of blood coagulation capacity: amyloidosis, rheumatoid arthritis, hemophilia, leukemia, lupus erythematosus, mononucleosis, measles, thrombocytopenia, anticoagulant therapy
- Petechiae dependent on other diseases: vitamin K deficiency, dengue, bacterial endocarditis, scurvy, Cushing's syndrome, trauma, vomiting and cough.
Petecchie: therapies
Treatment for petechiae depends on the cause.
Definition of petechiae
The petechiae are small punctate hemorrhages smaller than 3 mm in size, expression of the leakage of blood from the small blood vessels.
Although they are a mild form of superficial bleeding, without external blood loss, petechiae may be associated with more severe bleeding.
It is rare to observe only one or two petechiae on the skin: more often, in fact, the small point-like hemorrhages are grouped, so as to develop a real skin rash. The petechiae may overlap or grow side by side: by doing so, they can easily be confused by purple or ecchymosis.
But we see the general characteristics of petechiae, the triggering causes and possible treatments.
Generality
DIMENSIONS AND CHROMIAS
The petechiae are small hyperpigmented and point-like spots that grow on the skin and mucous membranes, generally due to the lack of blood coagulation elements. These skin micro-macules are as big as the head of a pin; they have a smooth surface and an irregular shape, usually round.
Since they are blood spills in a tissue following a rupture of small vessels, even the petechiae have the typical color variation that characterizes all types of hematomas. At first, the petechiae take on a bright red color; subsequently, they dress in a bluish or purple color, then gradually fade to golden-yellow green. In most cases, petechial lesions are self-resolving in a few days.
The petechiae do not lighten with acupressure.
LOCATION
Petechiae are micro-lesions typical of the skin. The petechial rush tends to manifest itself particularly in the lower limbs, especially in the feet and ankles. However, it is not uncommon to find petechiae on the abdomen or in other areas of the body.
Ideally, the petechiae can develop in any anatomical location: therefore, they do not constitute an exclusive lesion of the skin as could be assumed. Petechial lesions can therefore form in any tissue sprayed by the systemic circulation: for example, among the various signs associated with bacterial endocarditis, petechiae also stand out. The concomitant presence of petechial lesions at the level of the retina, skin, mucous membranes (especially the sublingual mucosa) and kidney must alarm: in this case, it is conceivable that the cause of the petechiae lies precisely in bacterial endocarditis. In similar situations, at the kidney level, petechiae tend to develop in the cortical region, giving rise to a picture known as "flea bites".
SYMPTOMS
The petechiae run in a completely asymptomatic way: in fact, these small bruises on the skin are not associated with any pain or discomfort. More than symptoms, petechiae are associated with "signs", that is to say purely aesthetic manifestations.
Causes
We have analyzed how petechiae constitute the immediate expression of rupture of blood capillaries. But why do the small ducts of the circulatory system break?
The rupture of a capillary, with the subsequent release of blood into the underlying tissue, can result in alterations in the coagulation capacity of the blood, or in various pathologies or disorders.
- Peteches dependent on coagulation abnormalities can be caused by:
- Amyloidosis: disease characterized by the abnormal deposition of low molecular weight proteins in the extracellular site. The appearance of red spots on the skin (purpura, petechiae, ecchymosis) is a characteristic symptom of amylodosis.
- Rheumatoid arthritis
- Hemophilia: a disease characterized by a marked tendency to bleed. The blood coagulation defect predisposes the patient to petechiae.
- Leukemia: petechiae are the result of a reduction in the number of circulating platelets, a distinctive element of leukemia.
- Systemic lupus erythematosus
- Mononucleosis, measles and rubella: similar infections predispose the patient to the formation of small red spots on the skin.
- Plateletopenia: blood disorder characterized by a more or less significant reduction in blood platelets (<150, 000 units per mm3 of blood)
- Idiopathic thrombocytopenic purpura: this is an autoimmune disease that is distinguished by the destruction of thrombocytes by auto-antibodies. Among the most frequent consequences, the appearance of red spots on the skin (eg petechiae, purples, etc.) stands out
- Long-term therapy with chemotherapy drugs or oral antidiabetic drugs
- Petechiae are sometimes associated with other diseases, such as:
- Vitamin K deficiency: fortunately rare disease, manifested by a more or less evident haemorrhagic syndrome (petechiae, ecchymosis, etc.), expression of the inadequate synthesis of coagulation factors.
- Dengue (acute viral disease triggered by Flavivirus infections, the same pathogens involved in the manifestation of yellow fever). Some patients with mild dengue suffer from haemorrhagic manifestations such as epistaxis, gingival bleeding and subcutaneous punctate hemorrhage (petechiae). In the most severe cases, petechiae can turn into real bruises.
- Bacterial endocarditis (analyzed in the previous paragraph)
- Infantile scurvy: it is a disease with severe vitamin C deficiency. In the context of scurvy, the walls of the blood capillaries are fragile and weakened, therefore the affected patient manifests petechiae and ecchymoses throughout the body.
- Cushing syndrome: among the most recurrent clinical manifestations associated with Cusching syndrome, petechiae and ecchymoses also stand out. The loss of the subcutaneous tissue predisposes the patient affected to the rupture of the vessels, therefore to the formation of micro-hematomas.
- Traumas: petechia can also result in slight trauma to the skin.
- Vomiting and coughing: retching and violent coughing can weaken the capillary walls until they break. In similar situations, petechiae are formed on the face, especially around the eyes.
Even the aging of the skin exposes the subject to the risk of breaking blood vessels: as age progresses, the wall of blood vessels becomes more fragile, therefore more prone to hematoma, petechia and ecchymosis.
Drugs and therapies
Although they often constitute a mere aesthetic disorder, we must not forget that petechia can conceal a serious underlying disease; therefore, medical advice is always advised.
There is no specific therapy for the treatment of petechiae: the treatment is subject to the triggering cause. For example, the petechiae induced by scurvy can be removed by a specific vitamin C-based therapy. The administration of Vitamin E also seems to benefit the disappearance of petechiae: tocopherol inhibits the increase in permeability of the capillary walls, induced by drugs or bacterial / viral infections.
Platelet-dependent petechiae can sometimes be treated with steroid drugs - useful for reducing bleeding - or by administering immunoglobulins (in the case of thrombocytopenia dependent on abnormal immune responses).
Chemotherapy is indicated for the treatment of leukemia: this form of cancer can also favor the formation of petechiae. The treatment of leukemia favors the restoration of the composition of the blood, consequently, the petechia disappear.
For further information: read the article on drugs for the treatment of petechiae.
