Non-itchy red spots on skin: Causes & treatment options

You step out of the shower one morning and notice red spots on your back or chest. Or you’re applying sunscreen and new red spots on your face. But these spots don’t itch, so you’re wondering: What caused this rash or outbreak?

Itchy or not, red spots are not a medical diagnosis. They can develop for many different reasons. Sometimes, red spots that don’t itch are temporary and go away without explanation or treatment. But red spots on the skin that multiply or don’t go away can be a sign of infection or an underlying medical condition like psoriasis or a blood disorder. Below, we cover possible causes and treatment options for red spots on skin that do not itch. 

What causes red spots that aren’t itchy?

There are many possible causes of red spots that aren’t itchy. According to Christopher Bunick, MD, dermatologist and associate professor at Yale School of Medicine Department of Dermatology, one of the most common types of red spots are vascular lesions called cherry hemangiomas.

Cherry hemangiomas

Cherry hemangiomas, or angiomas, are bright red skin growths the size of a pinhead. The slightly raised spot is red because it comprises blood vessels. 

“They generally range from 1 millimeter to 3 millimeters in size and may bleed if traumatized,” Bunick explains. “They come with age and genetics.”

Cherry angiomas are not cancerous or contagious, but they do not go away on their own. If you want the spots removed for cosmetic reasons, consult a dermatologist.

Acne vulgaris and acne rosacea

Acne vulgaris is a skin condition involving clogging and hair follicle inflammation. It causes pimples, whiteheads, blackheads, and cysts. Acne rosacea, on the other hand, causes red spots and visible blood vessels without blackheads.

“Rosacea typically presents as red papules or pustules on the mid-face, whereas traditional acne can present as red papules, pustules, or nodules on the face, neck, chest, and back,” Bunick says. “They generally do not itch but often are painful if inflamed.”

Both acne vulgaris and acne rosacea tend to be chronic conditions. But they are not contagious. In some cases, patients can soothe symptoms and prevent outbreaks at home with gentle skin care products and over-the-counter (OTC) medications such as Differin 0.1% (adapalene) gel. In other instances, a dermatologist might prescribe antibiotics, retinoids, or other drugs.

Blood blisters

A blood blister is a raised spot on the skin filled with blood instead of fluid (like a typical blister). Blood blisters may look red, purple, or black because the blood leaks from the injured blood vessels under the skin. They are typically small and round.

Blood blisters may occur when skin is injured through pinching, burning, or friction, says Erika Luren, NP and owner of Parasol Aesthetics, Dermatology & Wellness in Las Vegas, Nevada. They are not contagious.

“There is no need to pop such a blister, as the body will dry it up and heal new skin beneath on its own, typically over one to two weeks,” Luren says.

“A doctor should be seen if [a blood blister] lasts more than seven days, if new ones keep appearing, or if it happens without any trauma,” says Upinder Singh, MD, chief medical officer of Valley Oaks Medical Group in Nevada. You can speed up the healing process by keeping the area clean and covered with a sterile bandage.

Vascular birthmarks

“Also called capillary malformations, such as ‘stork bite’ on the posterior neck or ‘angel’s kiss’ on the forehead, these are flat pink to red or red-purple patches,” Bunick explains. “They can be anywhere on the body and generally do not itch.”

Birthmarks may be present at birth or may develop in very early childhood. They are not contagious and do not typically require medical attention. Bunick says some vascular birthmarks can be treated with a pulsed dye laser if the patient wants to get rid of them for cosmetic reasons.

Psoriasis

Psoriasis is an autoimmune skin condition. While the underlying cause is still unknown, psoriasis develops when the body mistakes its own healthy skin cells for invaders and then attacks them. Although some types of psoriasis, like plaque psoriasis, may be itchy, guttate psoriasis may cause small red spots on the skin that don’t itch. Luren says this less common type of psoriasis often develops after an upper respiratory infection such as a sore throat. 

“Guttate psoriasis has the appearance of round to teardrop-shaped, red scaly bumps or thicker patches that erupt after illness. It is a form of psoriasis that may show up once and never appear again. Or, it could turn into classic, lifelong psoriasis.”

Unlike plaque psoriasis, guttate psoriasis may go away on its own. But if it doesn’t, a dermatologist can recommend treatments to keep flare-ups under control. Treatment options may include hydrocortisone cream, antibiotics, retinoids, or phototherapy. 

Bleeding into the skin

Bleeding into the skin can cause red to red-purple spots, sometimes less than 5 millimeters in size but sometimes larger, depending on the cause, according to Dr. Bunick.

There are several types and causes of bleeding into or under the skin, none of which are contagious:

• Purpura: Matchhead-sized red or purple spots caused by blood disorders, weak blood vessels, infections, injuries, or certain medications
• Petechiae: Pinhead-sized red, brown, or purple spots caused by minor injury or a more systemic blood disorder
• Ecchymoses: The medical term for bruises, which can appear red if blood vessels are broken in the course of physical trauma

Purpura and petechiae may not cause other symptoms, but ecchymoses (bruising) typically causes pain and tenderness. 

“Ecchymoses will self-resolve over time, but some petechiae due to serious causes, like infections, may need in-office medical care,” Dr. Bunick says. 

Treatment for purpura and petechiae depends on the underlying cause. For example, red spots caused by a bacterial infection might require antibiotics. If petechiae are caused by leukemia (cancers of the blood), chemotherapy or radiation may be necessary.

Folliculitis

Folliculitis is an infection of the hair follicles. Like contact dermatitis or eczema, folliculitis usually causes itchiness and bumpy or scaly skin. However, sometimes folliculitis can cause red spots on the skin that are not itchy.

“Red bumps around hair follicles can be small and often asymptomatic or larger and more painful, the latter being inflamed groups of hair follicles,” Dr. Bunick explains. In other words, the severity of symptoms such as pain and itchiness may depend on whether you have a single infected hair follicle or an entire section of infected hair follicles.

Folliculitis itself is not contagious on its own, but if a bacterial infection causes it, it may be possible to spread the bacteria by sharing washcloths, towels, and other personal items. 

In many cases, folliculitis goes away on its own without treatment. Home remedies such as warm compresses and OTC anti-inflammatory creams can help. If medical treatment is required, a healthcare provider may prescribe antibiotics for bacterial folliculitis or antifungal medications such as fluconazole for fungal folliculitis.

Hives

Hives, or urticaria, are a common skin condition that causes raised red spots or welts. Though the spots are usually itchy, some people experience hives without itchiness.

Hives develop when the body releases histamines, the immune system’s response to invaders and allergens. That’s why most people break out in hives due to stress or an allergic reaction. However, some people develop hives due to heat, friction, pressure, and other physical factors. In these instances, the hives might appear as red spots that do not itch. 

Hives are not contagious. They usually go away within a few days without treatment, especially if the trigger (often a new detergent, lotion, shampoo, or moisturizer) is removed. However, discomfort from hives can be soothed with cold compresses and anti-inflammatory lotions such as calamine. OTC antihistamines are also commonly used to treat hives. 

Other possible causes

It’s worth repeating that red spots are a symptom, not a diagnosis. There are many reasons red spots can form or spread on the skin. Some other less common causes of non-itchy rash include:

• Rocky Mountain spotted fever (RMSF): A bacterial disease spread through tick bites
• Rubella: A contagious viral infection that causes a red rash and joint pain
• Scarlet fever: A rash associated with bacterial pharyngitis that causes tiny, flat red blotches that gradually turn into sandpaper-like bumps 

Many other types of rashes look like red spots on the skin. However, these causes of red spots are usually itchy:

• Shingles
• Chickenpox
• Poison ivy
• Eczema (atopic dermatitis)
• Heat rash
• Insect bites
• Ringworm or other types of fungal infection

When to see a doctor

While red spots or a rash may not itch, it can still be caused by conditions that need medical attention, such as autoimmune disorders, infections, or medication reactions, according to Dr. Bunick. 

Make an appointment to be evaluated by a health care professional if the red spots:

• Last longer than two weeks
• Do not respond to home remedies or OTC medications
• Are accompanied by signs of severe infection, such as fever, nausea, muscle and joint pain, or severe swelling

Even skin conditions that are not medical emergencies, such as rosacea or severe acne, can cause scarring if left untreated. When in doubt, talk to your doctor about any new or persistent skin rashes so that you can be evaluated and offered appropriate treatment.

Most importantly, red spots on the skin are treatable 

Red spots on the skin may be caused by hemangioma, acne, rosacea, folliculitis, bleeding under the skin, and more. The cause of red spots on the skin may resolve on its own without treatment. However, if red spots on the skin continue, worsen, or are accompanied by other unexplained symptoms, such as fatigue, unexplained bleeding, or bruising, it could be a sign of an infection, a blood disorder, or leukemia. If red spots are accompanied by allergy symptoms, it could be a sign of hives and require antihistamines or steroids. Only your healthcare provider can rule out infection or other serious health conditions. Visit your doctor to determine the best treatment for red spots on the skin.