The appearance of small, discolored spots on the skin is a common concern. These spots typically manifest as tiny red, purple, or brown markings, representing a change within the superficial layers of the skin. They generally involve the network of minute blood vessels, known as capillaries, that lie just beneath the skin’s surface. These changes are usually benign and do not signal a serious underlying health condition. Understanding the distinctions between the types of spots can provide clarity and help determine when medical evaluation is necessary.
Spots Caused by Underlying Bleeding
Some of the most common spots are the result of blood leaking out of a capillary and pooling just under the skin’s surface, a process medically known as extravasation. These hemorrhagic spots are classified based on their size, which helps in identifying the severity of the underlying cause. The smallest type is called petechiae, which are pinpoint spots measuring less than two millimeters in diameter. These tiny, non-raised dots are often caused by minor trauma or sudden pressure changes that temporarily rupture the fragile capillary walls.
Strenuous activities can commonly lead to petechiae, particularly on the face, neck, and chest. A forceful bout of coughing, sustained vomiting, or heavy weightlifting can cause enough pressure to break small vessels in the upper body. Similarly, the pressure from tight clothing, such as elastic bands or restrictive waistlines, may lead to small clusters of these red spots. These instances are harmless and fade within a few days as the body reabsorbs the blood.
Slightly larger hemorrhagic spots, ranging from two millimeters up to one centimeter, are categorized as purpura. Like petechiae, these spots result from blood leaking out of damaged vessels, but they cover a greater area. The largest category of extravasated blood is ecchymosis, which describes a patch larger than one centimeter, commonly recognized as a bruise. Ecchymoses typically occur from a direct injury that damages larger vessels, allowing a substantial amount of blood to collect beneath the skin.
The color of these spots changes over time. Initially appearing reddish-purple, they transition through shades of blue, green, and yellow before finally disappearing. While the presence of these spots often relates to simple trauma, a sudden, widespread appearance of petechiae or purpura without apparent injury may suggest a systemic issue affecting blood vessel integrity or the blood’s ability to clot.
Vascular Growths Mistaken for Blood Spots
Cherry angiomas are frequent vascular growths, appearing as small, bright red, dome-shaped bumps on the trunk and limbs. These benign lesions are formed by a proliferation of endothelial cells lining the inside of blood vessels. They tend to increase in number as a person ages, leading to their alternate name, senile angiomas.
Another common vascular spot is the spider angioma, which features a central red spot with tiny capillaries radiating outward, resembling a spider’s legs. This lesion is a localized collection of dilated small blood vessels that often appears on the face, neck, or upper chest. Unlike bleeding spots, a spider angioma will temporarily disappear or blanch when gentle pressure is applied. This blanching occurs because the pressure pushes blood out of the dilated vessel, which quickly refills once pressure is released.
Telangiectasias, often referred to as spider veins, are distinct from bleeding spots and raised angiomas. These are small, widened blood vessels that appear as fine, thread-like lines, most often visible on the legs and face. They are permanent dilatations of existing capillaries that cause the vessels to become more prominent near the skin surface. While they can be a cosmetic concern, these dilated vessels are a structural change and are not usually indicative of a bleeding disorder.
Determining When to Seek Medical Attention
A key initial step in evaluating a new spot is performing the blanching test to determine the cause of the color. If a red or purple spot is due to blood that has leaked out of the vessel, it will not turn white when pressed firmly. This occurs because the blood is no longer contained within the vessel and cannot be pushed away by the pressure. If the spot is due to inflammation or a dilated vessel, such as a spider angioma, it will temporarily turn pale before the color returns.
While many spots are harmless, seek prompt medical evaluation if they are accompanied by other systemic symptoms. The sudden onset of widespread petechiae or purpura, especially combined with a fever, should be addressed urgently, as it may signal a serious infection. Other warning signs include unexplained fatigue, joint pain, weight loss, or evidence of bleeding elsewhere, such as frequent nosebleeds or bleeding gums. These symptoms can collectively suggest a problem with the body’s clotting mechanism or a systemic condition affecting blood vessel integrity.
A healthcare provider will typically begin with a physical examination and a review of your medical history, including any medications you are taking. Diagnosis may involve laboratory testing to assess the function of your blood and clotting system. A complete blood count (CBC) is often ordered to check the number of platelets, the cell fragments that help the blood clot. Further coagulation studies, such as prothrombin time (PT) and partial thromboplastin time (PTT), may also be necessary to evaluate the efficiency of the clotting factors.