Bruises, also known as ecchymoses, are common, especially in the elderly. They appear due to various causes, and most are benign. However, there are rare circumstances where bruising is concerning and requires medical attention.
Most bruising is benign and resolves without intervention, such as those caused by age, minor trauma, supplements, sun damage, or family history.
However, some cases result from medications or herald more dangerous medical conditions, like cancer, liver disease, blood disorders, Cushing's syndrome, or vitamin deficiencies.
All bruising should be examined by a doctor.
What is a bruise?
Bruising occurs when small blood vessels under the skin burst and cause bleeding. The blood gets trapped under the skin leading to the characteristic red-purple discoloration of the skin. Over time, they fade to green-yellow color and back to normal skin, or they may persist as a brown discoloration on the skin. They may or may not be tender or swollen.
What causes bruising?
There are many different causes of bruising, some benign and some serious. A doctor should evaluate all bruising to determine the cause.
Minor accidents. Minor accidents are one of the top causes of bruising. Oftentimes, the accident is so minor that the person doesn't even remember doing it.
Age. Another common reason for bruising is age. As we age, our skin gets thinner, and the blood vessels move closer to the skin's surface. Also, as we age, we lose fat under the skin, which adds an extra layer of protection or cushion for the blood vessels. Both of these occurrences allow for easy bruising.
Family history. Many times, bruising runs in families. Also, women are more likely to bruise than men.
Prescription medications. Certain medications cause bruising. The most common ones are blood thinners that prevent clotting, such as Coumadin, heparin, Xarelto, Pradaxa, and Eliquis. Other types of blood thinners work by stopping platelet aggregation, such as Plavix, Brilinta, and Effient. Some antibiotics, NSAIDs (Celebrex), steroids, chemotherapy, and antidepressants can cause bruising as well.
Over-the-counter medicines. People who take over-the-counter pain remedies, such as aspirin or NSAIDs (Advil or Aleve), can experience more frequent bruising. Many people are on aspirin for the prevention or treatment of heart attack or stroke. If you think aspirin may be causing bruising, do not stop it without talking to your doctor first. It could have deadly consequences.
Supplements. Many supplements can thin the blood and lead to more frequent bruising, such as garlic, ginseng, ginkgo, fish oil, St. John's wort, saw palmetto, and omega-3s.
Vitamin deficiencies. Vitamin C or K deficiencies can lead to easy bruising. Vitamin C is required for the manufacture of collagen, which is part of our blood vessels. Without vitamin C, the blood vessels are fragile and rupture, leading to bruising. This condition is more commonly known as scurvy. Vitamin K is essential to blood clotting. Without it, your blood cannot clot, and you will bleed and bruise excessively. Some diseases of the intestines and liver, cystic fibrosis, malnutrition, and fat malabsorption can cause vitamin K deficiency.
Blood disorders. Inherited blood disorders, such as hemophilia and Von Willebrand disease, can lead to easy bruising. These conditions lack various clotting factors that lead to excessive bleeding and bruising.
Liver disease. Damage to the liver causes a decrease in the production of clotting factors and platelets. Without these, you will bleed and bruise excessively. Liver disease can be caused by cancer or excessive alcohol consumption.
Cancer. Certain blood cancers – like aplastic anemia, leukemia, and myelodysplastic syndrome – are characterized by bleeding and bruising, because there are not enough platelets in circulation to clot the blood.
Cushing's syndrome. This syndrome is caused by excess cortisol in the body. Excess cortisol breaks down collagen resulting in fragile blood vessels. When blood vessels are fragile, they break and cause bruising and bleeding.
Sun damage. Since the sun causes premature aging by destroying collagen and elastin, the destruction of these proteins also makes the skin fragile. Fragile skin leads to easy bruising.
What are signs of dangerous bruising?
Most benign bruises occur on the extremities and resolve without treatment over the next week or two. Here are some warning signs to look for:
- Bruising lasting longer than one to two weeks
- Occurring in unusual locations like the face and trunk
- Associated with uncontrollable bleeding from the skin, nose, mouth
- Blood in urine or stool
- Heavy menstrual cycles
- Accompanied by other systemic symptoms, such as fever, fatigue, itching, shortness of breath, or bone pain
- Very large bruises
- Numerous bruises
If you experience any of these, see your doctor immediately.
How is bruising diagnosed?
Your physician will first discuss your history and then perform a physical exam. Based on the findings, lab tests or imaging may be necessary.
Can bruising be treated?
Treatment for bruising varies depending on the cause. If it is caused by minor accidents, age, or family history, exercise extra care when performing daily activities. Go slow and watch where you are moving. Use a cane or walker if you are unstable. Wear protective gear if you are performing physical activities.
If sun damage is the culprit, wear UPF clothing, hats, and sunscreen when outside. It is important to protect your skin from sun damage, not just because it prevents premature aging and thinning of the skin, but also because it prevents deadly skin cancers.
If it is due to prescription medication, a supplement, or doctor-prescribed aspirin, do not stop it on your own. Ask your doctor first about stopping it or finding an alternative treatment. Stopping without permission can have deadly consequences.
Medical conditions, such as liver disease, Cushing's syndrome, cancer, blood disorders, and vitamin deficiencies, require a doctor's care. Treatment of the underlying condition can help alleviate bruising.
Bruising on the skin is a common medical condition. Most causes are harmless, but some can be deadly. A physician should examine all bruises to determine the cause and begin a treatment plan if needed.