One of the most unpleasant sights you may find accidently on your skin are those red dots all over the place. Skin and nails are considered a mirror to your body because they reflect the overall condition of your internal health. This is largely due to two unique features. Firstly, because your skin covers a surface area of 1.73 square meters, which makes it the largest organ in your body. Secondly, because the skin is very rich in blood and nerve supply, therefore any change in blood chemistry is more likely to reflect on your skin and nails than any other external organ.
Then, you woke up one morning and found some pinprick red dots on your hands, forearms. This troubles you because they can mean anything from a mild condition that rarely calls for concern to some severe life-threatening health problems. It is important to know that the difference between one and the other can only be distinguished by your physician, and this article can by no means substitute medical advice, but it helps you understand the causes for general medical knowledge.
Causes of pinprick red dots
1) Miliaria (sweat rash)
Miliaria is a medical term for sweat rash, and they are one of the commonest causes of these red dots. Sweat rash occurs when the small sweat glands in our skin are clogged, and they can’t release their secretions on the surface of the skin.
In most cases, this results in colorless vesicles that appear without much trouble. However, if the obstruction is more severe, they get infected and appear red and inflamed. Sweat rash can result from overtight clothes, especially those made of nylon or other waterproof material, and they can occur in those who use medication patches. It is a common condition in infants and is usually diagnosed in the newborn owing to a variety of causes, especially their underdeveloped sweat ducts. It is especially common in adults who moved recently to hot areas from cold climates. In the case of deep sweat rash -that with a reddish appearance-, it causes discomfort and heat exhaustion.
Miliaria treatment
In most cases, the condition is mild and if the vesicles are clear, no medications are needed. However, in the case of red sweat rash, more measures are taken including preventing sweating as much as possible by avoiding excessive exertion in humid climates, air conditioning and avoiding any tight clothes or replacing them with one made of cotton or linen to absorb the produced sweat and prevent clogging.
Medications may be used for such conditions in case of infection and to relieve the irritation. They include calamine or boric acid as well as topical antibiotics in case of infection. If your condition is more severe, your dermatologist may advise using retinoids. Those drugs act to reform your sweat ducts and prevent their clogging, and are chiefly used for severe acne.
They should never be used as a self-medication due to severe side effects like hepatitis and alterations on your cholesterol balance.
2) Petechiae
Our skin is very rich in blood vessels to keep it viable, and injuries to such blood vessels are very likely, especially considering it is organ that shields us from the outside environment. That’s why we have a system of bleeding control called hemostasis. Hemostasis is complex and relies on your vessels contracting following injury, your platelets adhering to the defect to plug it and your coagulation system activating. Any defect of such components can cause a variety of manifestations from mildly symptomatic bleeding after moderate trauma to spontaneous bleeding. The skin shows various manifestations depending on the system affected.
If your platelets are reduced or non-functional, small minute bleeding can occur on the inside of the skin causing slightly raised red spots measuring a few millimeters. They are found more commonly on the extremities since they are more liable for trauma, but they can also be found on the trunk. Associated manifestations include bleeding from your gums or vagina and blood in your urine or stool. If the cause is severe enough like immune thrombocytopenia, and your platelet count falls beyond a certain value, you will bleed into your cranial cavity -the part of your skull which houses your brain- and this can be fatal. The main differentiating characteristic is that these dots don’t fade if you press on them owing to them not being a sign of “inflammation” but a type of bleeding.
Diagnosis
Your doctor will ask you about other bleeding manifestations and will order a CBC to check your platelet count or associated anemia due to the continuous bleeding or as a concurrence with platelet deficiency. They may also order a coagulation profile to check your coagulation system.
Treatment
Treatment of petechiae depends on the cause and can include platelet transfusion in severe cases or steroids and other immunosuppressive drugs in immune thrombocytopenia. Other causes are treated accordingly, whether they be liver dysfunction, infection or in some rare occasions, cancer.
3) Meningitis rash
If the word meningitis makes you tremble, you’re not alone. Meningitis, especially that caused by bacteria, is one of the most lethal infections unless treated, and urgent diagnosis and treatment are lifesaving in most cases.
Meningitis manifests with many symptoms as headache, nausea, vomiting, blurring of vision, photosensitivity, and seizures. Your doctor will also perform some clinical test called Kernig and Brudzinski, which involves testing how “excitable” your nervous system is, and then may order a CSF examination to obtain a sample from your spinal fluid and check for bacteria and inflammatory cells. One of the commonest bacteria causing meningitis is Neisseria meningitidis or meningococci. In case of meningitis caused by meningococci, a peculiar rash develops. It is theorized that this rash develops due to inflammation of the blood vessels.
The rash starts at the extremities, then advances to cover many parts of the body. In advanced cases, this rash can end in gangrene and loss of the limbs. Meningitis can also cause other severe side effects such as blindness, deafness, paralysis, or death from brain herniation. Rapid administration of broad-spectrum antibiotics such as ceftriaxone is effective in most cases, but your doctor will perform a culture on your CSF to ensure the usage of a suitable antibiotic for your bacterial strain.
4) Allergic rash
Allergy is a general term that includes a variety of manifestations and forms. Allergy in general means an abnormal body response towards a foreign protein or substance. Allergic manifestations vary from a mild rash to severe shock and death. What is different in allergic rash is that it is itchy on the contrary to the above types of rash. This itchiness is due to the release of the chemical mediator histamine. Allergic rash can result from exposure to a certain material applied directly to the skin, ingested, injected or even inhaled.
In the case of local allergic rash, it tends to occur at the site of exposure, usually on the hands, arms, feet and legs. They can show up after applying cream, perfume, jewelry, tattoos, henna and other beauty products. They can also follow sun exposure in some patients.
Treatment
Allergic dermatitis is treated by avoiding exposure to the substance that caused the condition. Medications include antihistamines, corticosteroids and calamine lotion. Allergic dermatitis is usually a mild condition. However, if they developed suddenly and are associated with breathing difficulty or loss of consciousness, you should call an ambulance or go to the nearest emergency as it can be life-threatening.