Petechiae skin purpura

• What is Petechiae skin purpura?
• Statistics
• Risk Factors
• Progression
• Symptoms
• Clinical Examination
• How is it Diagnosed
• Prognosis
• Treatment
• References

What is Petechiae skin purpura?

A petechia, (plural Petechiae) refers to a small red or purple pin point dot on the body, due to broken capillary blood vessels. Events that cause an increase in pressure, such as coughing or vomiting can cause petechiae around the face or eyes. Minor trauma is another common cause of petechiae. In general, petechiae are commonly seen and usually of no concern.

If blood collects under the tissues, and reaches a centimeter or more in diameter, the area is now referred to as a purpura. An even larger area is called an ecchymosis (known as the common bruise).

However, petechiae represent bleeding into the skin or mucous membranes and may be due to a cause that is reversible. Thus if you or your child have any petechiae, you should seek your local health professional, to see if there are any reversible causes.

Statistics

Petechiae are commonly found within the population, due to events that occur every day and from minor trauma. However, they are more commonly found in patients with underlying disorders involving the platelets – a cell which helps us stop bleeding when we are cut, and also in patients with problems with coagulation factors (substances in the blood which help change blood from a liquid to solid state). The presence of petechiae usually warrants further investigation if no readily identifiable cause is present. They may be more commonly found in the elderly and in children, due to conditions such as injury, trauma, aging skin and from bacterial infections affecting the body.

Risk Factors

There are certain factors that can predispose someone to developing petechiae. Events such as lifting heavy objects can lead to petechiae on the shoulders. However, petechiae are a sign of low platelet counts and other disorders of coagulation. They may be a symptom of septicaemia, which manifests as an illness with fever. This is important to rule out in children, especially if due to menigococcus – a causative agent of meningococcal septicaemia.

Other common predisposing factors include:

• Injury or trauma
• Events causing an increase in pressure such as sneezing, laughing.
• Autoimmune disorders
• Thrombocytopenia
• Aging skin
• Idiopathic thrombocytopenic purpura
• Henoch-Schonlen purpura (HSP)
• Birth (increased pressure due to passage through the birth canal can result in petechiae in the newborn)
• Infections / illness affecting blood coagulation
• Medications such as those targeted against platelets and coagulation factors (Clopidogrel (Plavix), Warfarin, Heparin, or Aspirin).
• Radiotherapy and chemotherapy.
• Leukaemia
• Bacteraemia / Septicaemia

Progression

Most petechiae will resolve on their own, if there is no underlying disorder.

Symptoms

When you visit the doctor, he or she may ask the following questions, as necessary, to try and identify the most likely diagnosis and cause for your symptoms.

• What is your age, and is this the first time you have had abnormal petechiae / bruising / bleeding?
• Where are the lesions located and how have they evolved with time?
• Has there been recent trauma or episodes of straining, coughing or sneezing?
• Have you been ill lately?
• Have you had radiation or chemotherapy?
• Do you take any medications such as Clopidogrel (Plavix), Warfarin, Heparin, or Aspirin) or other blood thinners?
• Have you ever had anything like this before?
• Have you every had any problems with surgery / dental extractions?
• Is there a family history of petechiae or bleeding disorders?

Clinical Examination

When your doctor examines you, he or she may look for the following characteristics.

Petechiae are red due to the blood that has leaked out from the capillaries into the surrounding skin. Clinically, petechiae are small dots, the size of pin heads in the skin (

Often petechiae are found in areas of increased pressure, such as the feet and ankles. They are not present on the soles of the feet because these vessels are protected by surrounding fatty tissue. Petechiae that appear during an illness with a fever may suggest the presence of bacteria in the bloodstream, such as Meningococcus, which causes meningococcal disease.

How is it Diagnosed

Diagnosis of petechiae is primarily dependent on the history and clinical examination. The doctor may decide to do some blood tests, including:

• Bleeding time – this is the amount of time it takes for the blood to clot.
• Other tests that measure the blood’s clotting abilities, called Prothrombin time or Partial thromboplastin time (aPTT).
• Full blood count, which measures the amounts of all types of cells in the body.
• Platelet count – platelets are special blood cells that aid in the blood clotting process. If there are low levels of platelets available, the individual affected may be more likely to develop petechiae.In all cases of petechiae, you should be investigated by a doctor as soon as possible, to rule out the more dangerous conditions. Your doctor may refer you to a skin specialist called a dermatologist to rule out similar looking lesions, if there is any doubt about the diagnosis of petechiae.

Prognosis

If you are affected by petechiae, your outcome depends on the underlying cause of the petechiae. In most cases, they will be due to trauma, increased pressure or another easily reversible/preventable cause, and your petechiae will resolve spontaneously, on their own. In other cases, the outcome depends on treating the underlying cause. For example – if you have a disorder affecting the platelets (eg – Thrombotic thrombocytopenic purpura) you may need treatment with plasma exchange therapy. Bleeding disorders involving platelets, and other clotting factors will need replacement of the deficient blood component.

Treatment

Treatment of petechiae should be directed at the underlying cause. If a person has petechiae due to low platelet levels or clotting factors, the treatment would be a transfusion of platelets or other blood factors. A patient with petechiae due to injury or trauma doesn’t need any specific treatment for the petechiae, but the injury itself should be treated. Applying cold packs or ice after the injury may help reduce swelling and prevent further petechiae. These petechiae will fade with time.

For aging skin, skin protection is recommended. Trauma such as bumping or pulling on skin areas should be avoided. If a person has leukaemia or cancer, they need specific radiotherapy, chemotherapy or hormone treatment. Prompt treatment targeted at specific infections will help prevent septicaemia and the development of petechiae.

References

1. Buxton P. ABC of Dermatology. London: BMJ Publishing Group Pty Ltd; 2005
2. Burns, ER, Lawrence, C. Bleeding time – a guide to its diagnostic and clinical utility. Arch Pathol Lab Med 1989; 113:1219
3. Koreth, R, Weinert, C, Weisdorf, DJ, Key, NS. Measurement of bleeding severity: a critical review. Transfusion 2004; 44:605
4. Kumar V, Abbas A K & Fausto N. Robbins & Cotran Pathologic Basis of Disease. China: Elseiver Saunders; 2005
5. Michael J. Petechiae. E-medicine [serial online]. 2006 [cited 27th December 2006]
6. Murtagh J. General Practice – Bruising and Bleeding. Australia: McGraw-Hill Australia Pty Ltd; 2003
7. White G. Colour Atlas of Dermatology. Spain: Elsevier Limited; 2004