Difference Between Petechiae Purpura and Ecchymosis

Skin manifestations are one of the most vital signs that are frequently overlooked by patients as well as by some healthcare professionals. They often signify the prevalence of an underlying condition that requires medical attention. Not identifying these dermatological changes properly can put the patients’ lives in peril. Petechiae, purpura, and ecchymosis are three of the commonest manifestations that are predominantly associated with vasculitis. They can be seen in various other diseases also. Petechiae are pinhead-sized macules of blood in the skin. A large macule or a papule of blood that is not blanched by the application of pressure using a glass lens is identified as purpura whereas large extravasation of blood into the skin is known as ecchymosis. So the difference in these skin changes lies in their size. The key difference between Petechiae, Purpura and Ecchymosis is that Petechiae are the smallest and ecchymoses are largest, Purpura is usually smaller than ecchymoses but larger than Petechiae.

CONTENTS

1. Overview and Key Difference
2. What is Petechiae
3. What is Purpura
4. What is Ecchymosis
5. Side by Side Comparison – Petechiae vs Purpura vs Ecchymosis in Tabular Form
6. Summary

What are Petechiae?

Petechiae are pinhead-sized macules of blood in the skin.

Causes of Petechiae

• Thrombocytopenia
• Leukemia
• Endocarditis
• Sepsis
• Injuries
• Mononucleosis
• Scurvy
• Vasculitis
• Viral hemorrhagic fever
• CMV infection
• Adverse effects of different drugs such as antidepressants and anticonvulsants

Management

Before starting the management, the exact cause of Petechiae has to be identified. When there is an infection, appropriate anti-microbial agents have to be used to counter the infection. If the Petechiae is a result of adverse drug reactions, consider the replacement of those medications with some other drugs.

What is Purpura?

A large macule or a papule of blood that is not blanched by the application of pressure using a glass lens is identified as purpura.

Causes of Purpura

• Thrombocytopenia
• Senile purpura which is due to weakening of capillary walls with age
• Corticosteroid therapy
• Vasculitis
• Schamberg’s disease

The underlying cause has to be identified and treated.

What is Ecchymosis?

A large extravasation of blood into the skin is known as ecchymosis.

Causes of Ecchymosis

• Some medications such as warfarin, antibiotics, and corticosteroids
• Bleeding disorders

Similar to the other two conditions, in ecchymosis also the underlying cause has to be aptly treated. Once that is done ecchymoses spontaneously disappear.

What is the Difference Between Petechiae Purpura and Ecchymosis?

Summary – Petechiae vs Purpura vs Ecchymosis 

Petechiae are pinhead-sized macules of blood in the skin. A large macule or a papule of blood that is not blanched by the application of pressure using a glass lens is identified as purpura. Large extravasation of blood into the skin is known as ecchymosis. These skin changes are differentiated from each other according to their size. Petechiae are the smallest of the three and ecchymoses are the largest. Purpura is of moderate size. This is the difference between these three dermatological manifestations.

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Reference:

1.Gawkrodger, David J. Dermatology: An Illustrated Colour Text. 3rd ed., Churchill Livingstone; 2002.

Image Courtesy:

1.’Oral petechiae’By Mdscottis – Own work, (CC BY-SA 3.0) via Commons Wikimedia  
2.’Purpuraschoenleinhennoch’By Peter Rammstein – Own work, (CC BY 3.0) via Commons Wikimedia 
3.’shiner’by Katy Warner (CC BY-SA 2.0) via Flickr