Bruises Health Article

Definition

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 problem.

Description

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.

Demographics

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 exercise 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 completely heal.

The use of nonsteroidal anti-inflammatories such as ibuprofen and naproxen sodium may lead to increased bruising. Aspirin, antidepressants, asthma 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, alcoholism, drug addiction, and acquired immune deficiency syndrome (AIDS). 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.

When to call the doctor

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.

Diagnosis

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.