Petechia is easily distinguishable from erythema (redness of the skin) by applying pressure onto the area. When the cause of the red dots is broken blood vessels under the skin, it is medically termed petechia. These dots may vary in appearance and can be due to allergies, inflammation or infections. Some reasons are rather harmless whilst some reasons are fairly serious and require medical attention. Trust your instincts, someone who has meningitis or septicaemia could become seriously ill very quickly.The appearance of red dots on the skin can be very alarming and can be due to a variety of reasons. Please remember that a very ill person needs medical help even if there are only a few spots, a rash that fades, or no rash at all. When we talk about meningitis, we often think ‘rash’, but it is incredibly important to know that a rash won’t always appear. However, in cases of meningitis the rash can be very scanty, blanching, atypical or even absent. Most patients with overwhelming meningococcal septicaemia develop a rash - it is one of the clearest and most important signs to recognise. What should I do if someone has lots of other meningitis symptoms, but no rash? Devastatingly, as the extremities become starved of oxygen, they can become blackened which can lead to scarring and amputation. The extremities are normally worst affected: often the feet and hands (but can extend over a whole arm or leg) and sometimes the ears, nose or lip. This results in extensive purpuric areas, usually called ‘ purpura fulminans’, which look like large bruises over the skin and can be very dark in colour. In response to the blood vessels leaking as the disease progresses, the body produces an overwhelming clotting response, which stops oxygen from reaching the extremities. What might happen after the rash has appeared? The meningitis “rash” can start as a blanching rash, but nearly always develops into a non-blanching red, purple or brownish petechial rash or purpura, meaning it will not disappear when pressed. If it disappears when pressed, this is known as a blanching rash. Many people are familiar with the so-called “tumbler test” or “glass test”, whereby a glass or other clear surface is pressed onto the rash. The 'glass test' can be used to determine if a rash is or is not a symptom of meningitis. The rash can be more difficult to see on dark skin, but may be visible in paler areas, especially the soles of the feet, palms of the hands, abdomen, or on the inside of the eyelid or roof of the mouth. Petechiae are 1 to 2 mm in diameter and commonly appear in clusters in areas where pressure occurs from elastic in underwear, nappies or stocking. Isolated and dispersed pin-prick spots may first appear, so it is important to search the whole body for small petechiae, or red and purple spots. If you, or someone you know, appears to be suffering from a rash of this kind, please seek medical help immediately. As part of the MRF helpline team, I have had a parent describe a rapidly evolving rash as “like someone using a biro to draw all over the skin”.
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