What is bruises (contusions)?

Bruises form when small blood vessels under the skin tear or rupture, most often from a bump or fall. Blood leaks into tissues under the skin and causes the black-and-blue color. As bruises (contusions) heal, they often turn colors, including purplish black, reddish blue, or yellowish green. They usually heal within 2 to 4 weeks. Sometimes the area of the bruise spreads down the body in the direction of gravity. A bruise on a leg usually will take longer to heal than a bruise on the face or arms.

Most bruises aren't a cause for concern. They will go away on their own. Home treatment may speed healing and relieve the swelling and soreness from bruises that are caused by injury. But severe bruising, swelling, and pain that start within 30 minutes of an injury may mean a more serious problem, such as a severe sprain or fracture.

If you bruise easily, you may not even remember what caused a bruise. Bruising easily doesn't mean you have a serious health problem, especially if bruising is minimal or only shows up once in a while.

• Older adults often bruise easily from minor injuries. Bruises are most common in injuries to the forearms, hands, legs, and feet. As a person ages, the skin becomes less flexible and thinner because there is less fat under the skin. The cushioning effect of the skin decreases as the fat under the skin decreases. These changes, along with skin damage from exposure to the sun, cause blood vessels to break easily. When blood vessels break, bruising occurs.
• Women bruise more easily than men, especially from minor injuries on the thighs, buttocks, and upper arms.
• A tendency to bruise easily sometimes runs in families.

In some cases after an injury, blood collects and pools under the skin (hematoma). This gives the skin a spongy, rubbery, lumpy feel. A regular bruise is more spread out. It may not feel like a firm lump. A hematoma usually isn't a cause for concern. It's not the same thing as a blood clot in a vein. And it doesn't cause blood clots.

Bruises that don't seem to be caused by an accidental injury may be caused by abuse. It's important to consider this possibility, especially if the bruises can't be explained or if the explanations change or don't match the injury. Report this type of bruising, and seek help to prevent further abuse.

Blood spots

Blood spots under the skin may be either purpura or petechiae. Purpura might look like bruises, but they aren't caused by an injury as most regular bruises are. Petechiae don't look like bruises. They are tiny, flat, red or purple spots in the skin. But they are different than the tiny, flat, red spots or birthmarks (hemangiomas) that are on the skin all the time.

Some people have sudden unexplained bruising or blood spots under the skin, or they may suddenly get bruises more often. This may be caused by:

• A medicine, such as aspirin or blood thinners (anticoagulants).
• An infection that causes the buildup of toxin in the blood or tissues (sepsis).
• A bleeding or clotting disorder, such as hemophilia, von Willebrand disease, thrombocytopenia, or another less common bleeding or clotting disorder.
• Other diseases that affect clotting. Examples include:
  • Chronic inflammatory diseases, such as lupus.
  • Liver disease, such as cirrhosis.
  • Some types of cancer, such as Hodgkin lymphoma, leukemia, or multiple myeloma.
• Inflammation of a blood vessel (vasculitis).
• Malnutrition, such as deficiencies of vitamins B12, C, or K, or folate.

Medical treatment for abnormal bruising or blood spots focuses on preventing or stopping bleeding, changing or adjusting a medicine that may be causing the bruising, or treating the medical problem that is causing the bruising.

If the skin is injured over a bruise, be sure to watch for signs of a skin infection.

• Give pain medicines exactly as directed.
  • If the doctor gave your child a prescription medicine for pain, give it as prescribed.
  • If your child is not taking a prescription pain medicine, ask the doctor if your child can take an over-the-counter medicine.
  • Do not give your child two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• Put ice or a cold pack on the area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your child's skin.
• If you can, prop up the bruised area on pillows as much as possible for the next few days. Try to keep the bruise above the level of your child's heart.