Bruising Susceptibility

Bruising is an area of discolored skin that develops when the lining of small blood vessels is damaged, allowing blood cells to escape into the skin and tissues.  This condition most often occurs after a person knocks or otherwise injures a part of the body. There are three types of bruises:

1. Subcutaneous - beneath the skin.
2. Intramuscular - within the underlying muscle.  It is often difficult to use the muscle that has been bruised.
3. Periosteal - bone bruise.  This is the most severe and painful.

Causes and Development

As a person ages, he or she will bruise more easily.  The layer of protective fat just under the skin becomes thinner.  The small blood vessels also become more fragile and are more easily damaged.  Frequent long-term exposure to the sun can also cause the skin to be more fragile and likely to bruise.  A tendency to bruise easily may run in families.

Possible causes of bruising include:

• Blood disorders, including problems with blood clotting such as hemophilia A or hemophilia B
• Blood-related diseases such as leukemia
• Liver disease, such as cirrhosis
• Lymphomas
• Certain disorders in which bone marrow cells grow at an abnormal rate
• Nutritional deficiencies, such as deficiency in vitamins C, K, B12, or folic acid
• Sepsis, or severe infection in the bloodstream
• Systemic lupus erythematosus (SLE)
• Trauma, injury or physical abuse
• Prolonged coughing or vomiting
• Medications, such as blood thinners
• Surgery or other medical procedures
• Allergy-related disorders

Signs and Symptoms

Bruises can last from days to months and usually occur in several stages.  A bruise generally starts out as a pinkish-red area or as tiny red dots or blotches on the skin.  The bruise may be very small and may blend in with the texture of the skin, or it may be large, swollen, and painful.  Within days to a week or so, the bruise becomes more purple.  As it heals, it becomes brownish-yellow.  Generally, bruises heal and disappear within 2 to 3 weeks.

Treatment and Prevention

The way one deals with bruising obviously depends on the cause.  Some cases of bruising may be prevented or reduced if the cause is eliminated, such as replacing vitamins in someone who has vitamin deficiency.

Sometimes it may not be possible to determine or treat the underlying cause.  In such cases, being careful not to bang or knock the skin against hard surfaces will decrease the likelihood of developing bruises.  In general, wearing protective clothing will also prevent or lessen bruising.  Avoiding excessive exposure to the sun may minimize skin damage.

Some tips:

• Place ice on the bruise to help it heal faster and to reduce swelling.  Place the ice in a cloth, not directly on the skin.  Keep the ice on the bruise for about 15 minutes per hour for the first 24-48 hours.  After that, applying a hot pack to the area will help the bruise heal more quickly.
• Keep the bruised area raised above the heart, if practical.  This helps keep blood from pooling in the bruised tissue.
• Try to rest the bruised body part by not overworking the muscles in that area.
• If needed, use a pain killer such as acetaminophen (Tylenol) to help reduce the pain from the bruise.

If a person is taking a blood thinner (e.g.  aspirin or warfarin), it is important that they take it exactly as prescribed in order to reduce the likelihood of bruising.

A person who has hemophilia may be given blood transfusions; a person who has nutritional deficiencies may be given special dietary recommendations; a person who has leukemia or cancer may require special medications and procedures; a person who has bacteria in the blood may need antibiotics.

Seek medical attention if...

See a doctor if...

• Rarely, there will be a feeling of extreme pressure in a bruised area, especially if it is large or very painful.  This may be due to a condition known as compartment syndrome.  Increased pressure on the soft tissues and structures beneath the skin can decrease the supply of vital blood and oxygen to the tissues.  This is potentially life-threatening and you should receive emergency care promptly; surgery frequently needs to be performed to relieve the extreme buildup of pressure.
• You are bruising spontaneously without any injury, fall, or other cause.
• There are signs of infection around the bruised area such as streaks of redness, pus or other drainage, or fever.