What Are Bruises?
A bruise is a common skin discoloration that results from the breakage of tiny blood vessels leaking under the skin after a traumatic injury. Blood from damaged blood vessels beneath the skin collects near the surface to appear as what we recognize as a black and blue mark. This mark is from skin discoloration by red blood cells and their contents. A bruise is also known as a contusion.
What Are Causes and Risk Factors for Bruises?
People typically get bruises on the body when they bump into something or when something bumps into them. Risk factors for bruises include the following:
- Bruises can occur in some people who exercise rigorously, such as athletes and weight lifters. These bruises result from microscopic tears in blood vessels under the skin. Bruising in athletes can also result from direct impact/trauma and be accompanied by an underlying hematoma (clotted blood).
- Unexplained, random bruises that occur easily or for no apparent reason may indicate a bleeding disorder or result from blood-thinning medications (anticoagulants), especially if the bruising is accompanied by frequent nosebleeds or bleeding gums.
- Often, what are thought to be unexplained bruises on the shin or the thigh, for example, actually result from bumps into a bedpost or other object and failing to recall the injury.
- Bruises in elderly people frequently occur because their skin has become thinner with age (senile purpura). The tissues that support the underlying blood vessels have become more fragile.
- Bruising on the back of the hands and arms (called actinic purpura or solar purpura) occurs because skin there is often sun-damaged and thin.
- Bruising occurs more commonly with vitamin C deficiency (ascorbic acid deficiency or scurvy).
- Bruising can be a sign of physical abuse of the child (child abuse).
- Alcohol abuse can cause people to bruise more easily.
- Certain medical conditions, including leukemia, hemophilia, liver disease, Cushing's disease, Marfan's syndrome, Ehlers-Danlos syndrome, connective tissue diseases, iron-deficiency anemia, or aplastic anemia, can lead to easy bruising and bleeding.
- People taking certain types of medications may bruise more easily. These medications include: nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin); blood thinners such as warfarin (Coumadin), clopidogrel (Plavix), and heparin; steroids (prednisone); and some medications used to treat cancer.
What Are Bruise Symptoms and Signs?
- Initially, a fresh bruise may actually be reddish. It will then turn blue or dark purple within a few hours, then yellow or green after a few days as it heals.
- A bruise is commonly tender and sometimes even painful for the first few days, but the pain usually goes away as the color fades.
- Bruises may itch as they heal.
- Because the skin is not broken in a bruise as with a scrape or cut there is little risk of infection.
- Repeated bruising of an area can leave permanent yellowish-brown staining from iron depositing in the skin.
- Bruises usually last about one to two weeks, though some may take a little longer to heal.
When Should Someone Seek Medical Care for a Bruise?
- Call the doctor if the bruise is accompanied by swelling and extreme pain.
- Call the doctor if one is taking a blood-thinning medication for a medical condition and notices significant bruising.
- Call the doctor if bruises occur easily or if bruises appear for no reason.
- Call the doctor if the bruise is painful and under a toenail or fingernail.
- Call the doctor if a bruise does not improve within two weeks or fails to completely clear after three or four weeks, or if a bruise won't go away.
- Call the doctor if you have excessive bruising or increased bruising.
- Go to the hospital's emergency department if one thinks he/she has a broken bone along with the bruise.
- Some bruises, such as those on the head or the eye, can cause a lot of anxiety.
- If a bruise or hematoma occurs on the head (sometimes called a "goose egg"), but the person did not black out, is able to remember the accident, is not on blood thinners, and does not have dizziness, nausea, or vomiting, then it may not be a serious head injury. On the other hand, if the person cannot remember what happened, a concussion is suspected, or if there are any concerns about the injury, he or she should be taken to the nearest emergency department.
- If a bruise occurs on the face just above the eye, one can expect the bruise to travel to the area just under the eye, possibly causing a black eye, because of the effects of gravity. As long as someone is able to move the affected eye in all directions and does not have vision changes or a headache, it may not be a serious injury that requires a visit to the hospital. If there are any concerns about injury to the eye, see a doctor.
How Do Health-Care Professionals Assess and Diagnose a Bruise?
If an injury is obviously a bruise and the doctor does not suspect any broken bones, the doctor will probably not perform any tests.
- If there is swelling or severe pain, the doctor may get an X-ray of the area to make sure there are no broken bones.
- If bruising occurs frequently and for no apparent reason, the doctor may have blood tested to look for a bleeding disorder.
- Certain bruises, a pattern of bruises over time, and in various stages of healing may alert a doctor to the possibility of physical abuse.
Black Eye Treatment
Most cases of a black eye can be cared for at home with OTC pain medication, ice, and rest. Seek medical care if the eye becomes infected or does not heal within two weeks.
Are There Home Remedies for Bruises?
The treatment for a bruise is most effective right after the injury while the bruise is still reddish and fresh. Follow these home remedies to get rid of the discoloration of bruising more quickly.
- A cold compress such as an ice pack or a bag of frozen peas should be applied to the affected area for 20 minutes every hour in order to speed healing and reduce swelling by constricting the underlying blood vessels in response to the cold. Do not apply ice directly to the skin. Wrap the ice pack in a towel.
- If the bruise takes up a large area of the leg or foot, the leg should be kept elevated as much as possible during the first 24 hours after the injury.
- Acetaminophen (Tylenol) or ibuprofen (Advil) may be taken for pain as instructed on the bottle. Avoid aspirin because aspirin slows the blood from clotting and may prolong the bleeding.
- After about 48 hours, heat in the form of a warm washcloth or a warm heating pad applied to the bruise for 10 minutes two or three times a day may increase blood flow to the bruised area, allowing the skin to reabsorb the blood more quickly. Ultimately, the bruise will fade in color.
There are some herbal and homeopathic remedies that claim to help relieve the pain, swelling, or discoloration of bruises. These treatments have not been proven to be effective by scientific testing. Before using any alternative remedy, consult your doctor as some may interact with medications you take or may cause allergic reactions on the skin in some individuals.
- Arnica montana is a homeopathic remedy touted to help relieve pain and reduce swelling and discoloration due to bruises. It is often sold as a cream that is applied to the skin.
- Apple cider vinegar is reported to increase blood flow to an injury, thus breaking up blood clots in bruised areas. It is usually diluted with warm water and applied as a compress.
- Epsom salt baths relax muscles and can help reduce pain and swelling associated with bruises.
- The enzyme bromelain, found in pineapples, is a natural anti-inflammatory also reported to help dissolve blood clots, and may help reduce swelling associated with bruising.
- Tea contains tannins that constrict (narrow) blood vessels. Tea bags from black tea or green tea applied directly to bruises are reported to help reduce discoloration from bruising.
- Aloe vera is known for its healing properties, and many believe it speeds healing of bruises. Aloe gel is usually applied directly to the skin.
What Are Treatment Options for Bruises?
Doctors have no special treatment for bruises other than the techniques described under home remedies: ice packs and later heat, over-the-counter medications for pain, and elevation of the bruised area, if possible.
- A suspected victim of domestic abuse may be referred to a law-enforcement official and/or a social worker.
- If a bruise does not heal after three to four weeks, or if it swells or becomes more painful, it may indicate a hematoma (blood collecting under the skin). If this occurs, a doctor can drain the hematoma.
- If you are on blood-thinning medication, blood tests might be ordered to evaluate if your medications need to be adjusted.
Is It Possible to Prevent Bruises?
- Wear protective gear while playing contact sports such as soccer, football, or hockey.
- Place furniture away from doorways and common walking paths within the home.
- Keep phone and electrical cords away from open areas where one may trip and fall.
- Be sure floors are kept dry and rugs are slip resistant.
- Keep floors free of clutter.
- Install a small night light or use a flashlight if one needs to walk to the bathroom during the night.
- If a doctor has prescribed anticoagulant medications (blood thinners), have regular monitoring and adjust medications as necessary.
- If you are prone to easy bruising, make sure you are getting enough vitamin C. It is best to get this nutrient from whole foods such as fruits and vegetables. Talk to your doctor for advice on incorporating these foods into your diet. If you choose to take supplements, consult your doctor for the dose that is right for you.
What Is the Prognosis of Bruises?
Bruises typically take about two weeks to disappear without complications. Repeated bruising of the leg in the elderly can lead to weakened, yellow-brown skin that tears easily when abraded.