Petechia

Petechia
Petechia and purpura on the low limb due to medication-induced vasculitis
Classification and external resources
Pronunciation	petechia /pᵻˈtiːkiə/ petechiae /pᵻˈtiːkiiː/ ICD10 = R23.3
Specialty	Rheumatology
ICD-9-CM	782.7
MeSH	D011693

A petechia, plural petechiae, is a small (1–2 mm) red or purple spot on the skin, caused by a minor bleed (from broken capillary blood vessels).^[1]

Petechia refers to one of the three descriptive types of bleeding into the skin differentiated by size, the other two being purpura and ecchymosis. Petechiae are by definition less than 3 mm.

The term is almost always used in the plural, since a single lesion is seldom noticed or significant.

Causes

The most common cause of petechiae is through physical trauma such as a hard bout of coughing, holding breath, vomiting or crying, which can result in facial petechiae, especially around the eyes. Petechiae in this instance are harmless and usually disappear within a few days. Petechiae may be a sign of thrombocytopenia (low platelet counts) when platelet function is inhibited (e.g., as a side effect of medications or during certain infections), or in clotting factor deficiencies.^[1] They may also occur when excessive pressure is applied to tissue (e.g., when a tourniquet is applied to an extremity or with excessive coughing or vomiting).

If unsure, petechiae should always be quickly investigated. They can be interpreted as vasculitis, an inflammation of the blood vessels, which requires immediate treatment to prevent permanent damage. Some malignancies can also cause petechiae to appear. Petechiae should be investigated by a doctor to rule out the more dangerous conditions.

The significance of petechiae in children depends on the clinical context in which they arise. Petechiae in children can occur with viral infections. In this instance, they do not necessarily signify a serious illness. However, they are a hallmark signal of some potentially serious illnesses, such as meningococcemia, leukemia, and certain causes of thrombocytopenia, of which meningococcemia can cause death within 48 hours of infection. Therefore, their presence should not be ignored.

Petechiae (in the face) may also be present in cases of asphyxiation.

Categories of causes

Infections

• Babesiosis
• Bolivian hemorrhagic fever
• Boutonneuse fever
• Chikungunya
• Cerebral malaria
• Congenital syphilis
• Crimean–Congo hemorrhagic fever
• Cytomegalovirus
• Dengue fever
• Dukes' disease
• Ebola
• Endocarditis
• Influenza A virus subtype H1N1
• Hantavirus
• Infectious mononucleosis
• Marburg virus
• Neisseria meningitidis
• Rocky Mountain spotted fever
• Scarlet fever
• Typhus ^[2]

Non-infectious conditions

• Hypocalcemia
• Idiopathic thrombocytopenic purpura
• Leukemia
• Celiac Disease
• Aplastic anaemia
• Scurvy
• Lupus
• Childhood protein-energy malnutrition such as Kwashiorkor or Marasmus
• Erythroblastosis fetalis
• Henoch-Schönlein purpura
• Kawasaki disease
• Schamberg's disease
• Ehlers–Danlos syndrome
• Sjogren's Syndrome

Trauma

• Gua Sha, a Chinese treatment that scrapes the skin
• High-G training
• Hickey (injury)
• Asphyxiation (discussed below)
• Choking Game

Causes of particular types

Palatal petechiae.

Petechiae on the soft palate are mainly associated with streptococcal pharyngitis,^[3] and as such it is an uncommon but highly specific finding.^[4]

Facial petechiae, especially around the eyes, indicate physical trauma such as by hard bouts of coughing, vomiting or crying.

Forensics

Petechiae on the face and conjunctiva (eyes) can be a sign of a death by asphyxiation, particularly when involving reduced venous return from the head (such as in strangulation). Petechiae are thought to result from an increase of pressure in the veins of the head and hypoxic damage to endothelia of blood vessels.^[5]

Petechiae can be used by police investigators in determining if strangulation has been part of an attack. The documentation of the presence of petechiae on a victim can help police investigators prove the case.^[6] Petechiae resulting from strangulation can be relatively tiny and light in color to very bright and pronounced. Petechiae may be seen on the face, in the whites of the eyes or on the inside of the eyelids.

See also

• Purpura, which is the mid-sized type of hematoma (3mm-1 cm)
• Ecchymoses, which is the large type of hematoma (>1 cm)

References

1. Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; & Mitchell, Richard N. (2007). Robbins Basic Pathology (8th ed.). Saunders Elsevier. p. 86 ISBN 978-1-4160-2973-1
2. Grayson MD, Charlotte (2006-09-26). "Typhus". MedlinePlus Medical Encyclopedia. National Institutes of Health. Retrieved 2007-11-05.
3. Fact Sheet: Tonsillitis from American Academy of Otolaryngology. "Updated 1/11". Retrieved November 2011
4. Brook I, Dohar JE (December 2006). "Management of group A beta-hemolytic streptococcal pharyngotonsillitis in children". J Fam Pract 55 (12): S1–11; quiz S12. PMID 17137534.
5. Ely, Susan F.; Charles S. Hirsch (2000). "Ashpyxial deaths and petechiae: a review" (PDF). Journal of Forensic Science 45 (6): 1274–1277. Retrieved 2007-09-22.
6. "Investigating Domestic Violence Strangulation". BlueSheepdog.com. Retrieved 12 May 2011.