Bruises, or ecchymoses, are a discoloration and tenderness of the skin or
mucous membranes due to the leakage of blood from an injured blood vessel
into the tissues. Purpura refers to bruising as the result of a disease
condition. A very small bruise is called a petechia. These often appear as
many tiny red dots clustered together and could indicate a serious
Bruises change colors over time in a predictable pattern, so that it is
possible to estimate when an injury occurred by the color of the bruise.
Initially, a bruise will be reddish, the color of the blood under the
skin. After one to two days, the red blood cells begin to break down, and
the bruise will darken to a blue or purplish color. This color fades to
green at about day six. Around the eighth or ninth day, the skin over the
bruised area will have a brown or yellowish appearance, and it will
gradually fade back to its normal color.
Long periods of standing cause blood that collects in a bruise to seep
through the tissues. Bruises are actually made of little pools of blood,
so the blood in one place
may flow toward the ground, and the bruise may appear in another
location. For instance, bruising in the back of the abdomen may eventually
appear in the groin; bruising in the thigh or the knee will work its way
down to the ankle.
All persons develop bruises at many times during their lives. The
condition is entirely natural and normal.
Causes and symptoms
Healthy people may develop bruises from any injury that does not break
through the skin. Vigorous
may also cause bruises due to bringing about small tears in blood vessels
walls. In a condition known as purpura simplex, there is a tendency to
bruise easily due to an increased fragility of the blood vessels. Bruises
also develop easily in the elderly, because the skin and blood vessels
have a tendency to become thinner and more fragile with aging, and there
tends to be an increased use of medications that interfere with the blood
clotting system. In the condition known as purpura senilis, the elderly
develop bruises from minimal contact that may take up to several months to
The use of nonsteroidal anti-inflammatories such as ibuprofen and naproxen
sodium may lead to increased bruising. Aspirin,
medications, and cortisone medications also have this effect. The
anticlotting medications also known as blood thinners, especially the drug
warfarin (Coumadin), may be the cause of particularly severe bruising.
Sometimes bruises are linked with more serious illnesses. There are a
number of diseases that cause excessive bleeding or bleeding from injuries
too slight to have consequences in healthy people. An abnormal tendency to
bleed may be due to hereditary bleeding disorders, certain prescription
medications, diseases of the blood such as leukemia, and diseases that
increase the fragility of blood vessels. If there are large areas of
bruising or bruises develop very easily, this may herald a problem. Other
causes that should be ruled out include liver disease,
, and acquired immune deficiency syndrome (
). Bruising that occurs around the navel may indicate dangerous internal
bleeding; bruising behind the ear, called Battle's sign, may be due
to a skull fracture; and raised bruises may point to autoimmune disease.
A physician or healthcare professional should be consulted when accidents
involve extensive bruising or when bruises do not heal in a timely manner
(seven to 10 days). A physician should be called if bruises appear in
unusual locations on the body such as on the back or around the eyes or
wrists. Such injuries are often the result of abuse.
Bruising is usually a minor problem that does not require a formal medical
diagnosis. However, faced with extensive bruising, bruising with no
apparent cause, or bruising in certain locations, a physician will pursue
an evaluation that includes a number of blood tests. If the area of the
bruise becomes hard, an x ray may be required.
A bruise by itself usually requires no medical treatment. It is often
recommended that ice packs be applied on and off during the first 24 hours
after injury to reduce the bruising. After that, heat, especially moist
heat, is recommended to increase the circulation and the healing of the
injured tissues. Rest, elevation of the affected part, and compression
with a bandage will also retard the accumulation of blood. Rarely, if a
bruise is so large that the body cannot completely absorb it or if the
site becomes infected, it may have to be surgically removed.
Several types of alternative treatments are often recommended to speed
healing and to reduce the
associated with bruises. Most of these treatments are topical in nature
and frequently include vitamin K cream can be applied directly to the site
of injury. Astringent herbs such as witch hazel,
, can be used. This treatment will tighten the tissues and therefore
diminish the bruising. The homeopathic remedy,
, can be applied as a cream or gel to unbroken skin.
Oral homeopathic remedies may reduce bruising, pain, and swelling as well.
, at 30 ml (1 oz), taken one to two times per day is highly recommended.
The blood under the skin which causes the discoloration of bruising should
be totally reabsorbed by the body in three weeks or less. At that time,
the skin color should have completely returned to normal.
Sometimes a bruise may become solid and increase in size instead of
dissolving. This may indicate blood trapped in the tissues, which may need
to be drained. This condition is referred to as a hematoma. Less
Bruised arm of a child.
(© Garo/Photo Researchers, Inc.)
commonly, the body may develop calcium deposits at the injury site in a
process called heterotopic ossification.
Vitamin K promotes normal clotting in the blood and, therefore, may help
reduce the tendency to bruise easily. Green leafy vegetables, alfalfa,
broccoli, seaweed, and fish liver oils are good dietary sources of vitamin
K. Other good foods to eat are those containing bioflavonoids, such as
reddish-blue berries. These can assist in strengthening the connective
tissue, which decreases the spread of blood and bruising. Zinc and vitamin
C supplements are also recommended for this purpose.
A balanced diet that includes green leafy vegetables and broccoli should
provide a sufficient source of vitamin K. Vitamin C and zinc supplements
are also helpful.
—The medical term for a bruise, or skin discoloration caused by
blood seeping from broken capillaries under the skin.
—Plural, petechiae. A tiny purple or red spot on the skin
resulting from a hemorrhage under the skin's surface.
—A group of disorders characterized by purplish or reddish brown
areas of discoloration visible through the skin. These areas of
discoloration are caused by bleeding from broken capillaries.
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American Academy of Emergency Medicine.
611 East Wells Street, Milwaukee, WI 53202. Web site:
American Academy of Family Physicians.
11400 Tomahawk Creek Parkway, Leawood, KS 66211–2672. Web site:
American Academy of Pediatrics.
141 Northwest Point Boulevard, Elk Grove Village, IL 60007–1098.
Web site: http://www.aap.org/.
American Academy of Physical Medicine and Rehabilitation.
One IBM Plaza, Suite 2500, Chicago, IL 60611–3604. Web site:
American College of Emergency Physicians.
PO Box 619911, Dallas, TX 75261–9911. Web site:
American College of Osteopathic Emergency Physicians.
142 E. Ontario Street, Suite 550, Chicago, IL 60611. Web site:
American College of Sports Medicine.
401 W. Michigan St., Indianapolis, IN 46202–3233. Web site:
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