| Lesion | Appearance | Blanching | Key Features |
|---|
| Cherry angioma | Bright red, dome-shaped papule, 1–5 mm | Blanches | Benign vascular proliferation; increases with age; trunk, extremities |
| Petechiae | Pinpoint (1–2 mm), flat, non-blanching | Non-blanching | Capillary hemorrhage; thrombocytopenia, vasculitis, sepsis, trauma, coughing/vomiting |
| Purpura | 3–10 mm non-blanching macules/patches | Non-blanching | Extravasated blood; same causes as petechiae but larger; palpable = vasculitis |
| Ecchymosis | >1 cm bruise | Non-blanching | Trauma, coagulopathy; evolves colors (red→blue→green→yellow) |
| Telangiectasia | Fine, linear/arborizing red vessels | Blanches | Dilated venules/capillaries; hereditary (HHT), rosacea, scleroderma, sun damage, radiation |
| Spider angioma | Central arteriole + radiating legs | Blanches | High estrogen (pregnancy, OCP, liver disease); face, neck, arms |
Blanching Test
Press with glass slide or finger: blanches = vascular (blood in vessel); non-blanching = extravasated blood (hemorrhage).
When to See a Doctor
- New petechiae/purpura without trauma.
- Rapidly increasing lesions.
- Associated fever, joint pain, abdominal pain, hematuria.
- On anticoagulants with unexplained bruising.
- Cherry angiomas bleeding repeatedly or cosmetic concern.
Workup
CBC, platelets, PT/INR, PTT, renal/hepatic panel, urinalysis, inflammatory markers, ANCA if vasculitis suspected.
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