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Capillaries are tiny blood vessels that link arterioles (small arteries) to venules (small veins). When these capillaries are subjected to intense pressure, blood may leak out from them into the skin or mucus membrane. The leaked blood appears as tiny hemorrhagic spots of about 3 mm in diameter on the skin. These spots are called petechiae. These petechial hemorrhagic spots usually appear in clusters. They are generally harmless. Petechiae are initially red in color and then become blue or purple as they age. They tend to disappear in a few days.

Petechiae may result from a variety of reasons. These include:

  • Prolonged straining
  • Certain medications
  • Some infectious diseases
  • Medical conditions
  • Old age

Prolonged straining can lead to hemorrhagic capillaries after activities like crying profusely, excessive coughing or after an intense bout of vomiting. Excessive pressure due to severe constipation, weightlifting or childbirth may also lead to petechiae.

Though petechiae may occur in any part of the body, they are more common on the face, neck and chest. They are also common on the lower legs, feet and ankles.

Petechiae occurring on the face after vomiting may lead to a blotchy appearance.

They occur due to increased intra-thoracic and intra-abdominal pressure during retching - a reverse movement of the stomach associated with vomiting, but without actually throwing up. This can impair the flow of blood returning from the head and neck regions to the heart, which in turn increases the pressure in the capillaries, and blood leaks out from them.

Certain medications

Some medicines like aspirin, carbamazepine, atropine, cimetidine, naproxen, morphine, penicillin and indomethacin are known to produce petechial hemorrhages when used for prolonged periods of time. Chemotherapy medicines can also produce this symptom. Patients on these medications should be warned about this side effect in advance.

Infectious diseases

Many types of bacterial, fungal and viral diseases can produce petechiae both on the skin and on the inner surface of mouth or eyelids. The infections which may result in petechiae include cytomegalovirus infection, endocarditis, meningococcemia, mononucleosis, Rocky Mountain spotted fever, Scarlet fever, viral hemorrhagic fever, sepsis and streptococcal infections.

Medical conditions

A few medical conditions like leukemia and auto-immune disorders can also lead to petechiae on the skin and mucus membranes. These spots are common in people suffering from a vitamin K deficiency or infantile scurvy as well.

Old age

Petechial hemorrhages are often seen in the geriatric population as the blood vessels become brittle with age. They cannot withstand excessive pressure and tend to bleed easily.

Vomiting as a cause of petechial hemorrhages

As discussed earlier, an intense bout of vomiting is one of the most common causes of petechiae on the face and neck. This is caused by the rupture of capillaries due to increased intra-thoracic and intra-abdominal pressure.

Some of the reasons behind recurrent vomiting include food poisoning, acute gastritis, gastrointestinal ulcers and bulimia.

In certain cases, intense vomiting may be a symptom of a serious pathological condition. It may be indicative of meningitis, brain tumors or an intestinal obstruction. It may be seen in cases of acute appendicitis or in patients who have suffered a head injury.

Frequent vomiting during pregnancy can lead to a condition called hyperemesis gravidarum. The recurrent vomiting associated with this condition may cause fluid and mineral imbalances in the pregnant woman, endangering both her life and that of the fetus.

Recurrent and intense bouts of vomiting are also seen in alcoholics. These bouts may result in a tear in the mucus membrane of the esophagus, a condition better known as Mallory-Weiss syndrome.

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