Petechiae are red, nonblanching macular lesions produced by intradermal capillary hemorrhage that are tiny (1-3 mm). Purpura are bigger, often elevated lesions caused by skin bleeding (Figures 181-2 and 181-3). Petechiae can be found anywhere in the body where there is tissue blood supply, such as the brain, gastrointestinal tract, liver, lungs, and skin. Purpura are more common and usually involve only one area of the body. The cause of petechiae and purpura is generally unknown. Some factors may increase your risk of developing them include: smoking, alcohol use, taking drugs or medications that affect the immune system, having chronic diseases such as diabetes or leukemia, or having genetic conditions such as thrombocytosis (increased number of platelets) or leukocytosis (increased number of white cells). Rarely, patients with severe acute infection, such as from streptococcal bacteria, can develop purpura. Patients with chronic kidney disease or cancer may also develop purpura. Patients who have had a recent episode of acute illness or injury, such as viral infection or trauma, may also have purpura. The pain, anxiety, and discomfort associated with purpura can lead to depression and anxiety disorders. Patients with these problems should be treated properly to reduce their symptoms.