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. Pupura 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.
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 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 diminish back to its normal color.
Long periods of standing will cause the 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 downhill after awhile and appear in another. 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.
Causes & symptoms
Healthy people may develop bruises from any injury that doesn't 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 is 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 (Advil) and naproxen (Aleve) may lead to increased bruising. Aspirin, antidepressants, asthma medications, and cortisone medications also have this effect. The anti-clotting medications also known as blood thinners, especially the drug warfarin (Coumadin), may be the cause of particularly severe bruising.
Sometimes bruises are connected 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.
Bruising is usually a minor problem, which does not require a medical diagnosis. However, faced with extensive bruising, bruising with no apparent cause, or bruising in certain locations, a physician will pursue an evaluation that will include a number of blood tests. If the area of the bruise becomes hard, an x ray may be required.
Several types of topical applications are usually recommend to speed healing and to reduce the pain associated with bruises. Vitamin K cream can be applied directly to the site of injury. Astringent herbs such as witch hazel, Hamamelis virginiana, can be used. This will tighten the tissues and therefore diminish the bruising. The homeopathic remedy, Arnica montana, can be applied as a cream or gel to unbroken skin.
Oral homeopathic remedies may reduce bruising, pain, and swelling as well. Arnica montana, at 30 ml (1 oz), taken one to two times per day is highly recommended. For ledum, 30 ml (1 oz) one to two times per day is also useful.
A bruise by itself needs no medical treatment. It is often recommended that ice packs be applied on and off during the first 24 hours of 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 effected 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.
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 completely return 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 be need to be drained. This is referred to as a hematoma. Less 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 dietary sources of vitamin K. Other good foods to eat would be those containing bioflavonoids, such as reddish-blue berries. These can assist in strengthening the connective tissue, which will decrease the spread of blood and bruising. Zinc and vitamin C supplements are also recommended for this.
Editors of Prevention Magazine Health Books, eds. The Doctors Book of Home Remedies. Prevention Health Books, 2000.
Feinstein, Alice, ed. Prevention's Healing With Vitamins: The Most Effective Vitamin and Mineral Treatments for Everyday Health Problems and Serious Disease. Prevention Health Books, 1998.
Williams, William J. Williams' Hematology. New York: McGraw-Hill, 1995.
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