Tiny purple or red spots (petechiae) or bruises (purpura)

A rash is rarely the first symptom to appear when a serious illness is present. Usually other symptoms will occur before the rash. Common early symptoms of a serious illness include fever, a general feeling of illness (malaise), or a decreased level of activity.

There are 2 types of rashes that may be the first noticeable symptom of a serious illness:

• Petechial rash looks like tiny, flat purple or red spots (petechiae). Petechiae range from pinpoint-size to BB-size. The red spots of a petechial rash do not turn white (blanch) when you press on them. This type of rash is more likely to occur in children, but it can occur at any age. In rare cases, petechiae may occur on the face after severe vomiting or retching or a choking injury. If more petechiae are not developing, this type of rash is usually not concerning.
• Purpura is sudden, severe, widespread bruising caused by certain bleeding disorders. Other symptoms are usually present as well, such as fever or decreased activity level. Purpura differs from normal bruising caused by bumping into objects or falling; purpura causes many more bruises, and there is no clear cause for the bruises. Purpura is more likely to occur in adults, but it can occur at any age.

Some children may have tiny, flat or raised red spots (hemangiomas or nevi) that are present all the time, such as "stork bite" or a birthmark. If they have been present for a while, these spots are not a concern. However, if new red or purple spots develop rapidly over hours, this may indicate a serious bleeding disorder or infection that requires immediate medical treatment.