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Bumps & Bruises (Contusions & Ecchymoses

What is a bruise?

You fall off your bike, bang your shin on the coffee table (that you swore you would move months ago) or run into a wall and wake up with a wallop of a bruise. What is a bruise and what can you do about it? A bruise, or contusion, is caused when blood vessels are damaged or broken as the result of a blow to the skin (be it bumping against something or hitting yourself with a hammer). The raised area of a bump or bruise results from blood leaking from these injured blood vessels into the tissues as well as from the body's response to the injury. A purplish, flat bruise that occurs when blood leaks out into the top layers of skin is referred to as an ecchymosis.

Why do bruises occur more frequently in some people than in others?

The injury required to produce a bruise varies with age. While it may take quite a bit of force to cause a bruise in a young child, even minor bumps and scrapes may cause extensive bruising or ecchymosis in an elderly person. Blood vessels become more fragile as we age and bruising may even occur without prior injury in the elderly.

The amount of bruising may also be affected by medications which interfere with blood clotting (and thus cause more bleeding into the skin or tissues). These drugs include many prescription arthritis medications called non-steroidal anti-inflammatories (e.g. ibuprofen/ADVIL, NUPRIN and naproxen/ALEVE ) as well as over-the-counter medications, such as aspirin. Warfarin (COUMADIN) is often prescribed by doctors specifically to prevent clotting in patients who have had blood clots in their legs or heart. Warfarin can cause particularly severe bruising, especially if the level of the medication becomes too high. Cortisone medications, such as prednisone, promote bruising by increasing the fragility of the tiny blood vessels in the skin. In addition, patients with inherited clotting problems (such as in hemophilia) or acquired clotting problems (such as in patients with liver diseases like cirrhosis), can develop extensive bruising or even life-threatening bleeding.

What does a bruise look like and why does it change color?

Bruises follow a predictable pattern and it is possible to tell by looking at a bruise how old it is. When it first appears, a bruise will be reddish looking, reflecting the color of the blood in the skin. By 1-2 days, the reddish iron from the blood undergoes a change and the bruise will appear blue or purple. By day 6, the color changes to green and at day 8-9, the bruise will appear yellowish-brown. In general, the bruised area will be repaired by the body in 2-3 weeks after which the skin will return to normal.

What if the bruise doesn't get better or the area stays swollen?

On occasion, instead of going away, the area of a bruise will become firm and may actually start increasing in size. It may also continue to be painful. There are two major causes for this. First, if a large collection of blood is formed under the skin or in the muscle, instead of trying to clean up the area, the body may wall the blood off causing what is called a hematoma. A hematoma is nothing more than a small pool of blood that is walled off. This may need to be drained by your health care practitioner.

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