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Bruises and Blood Spots Under the Skin

Bruises and Blood Spots Under the Skin

Topic Overview

Bruises

Bruises develop 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, usually within 2 to 4 weeks, they often turn colors, including purplish black, reddish blue, or yellowish green. 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 are not a cause for concern and will go away on their own. Home treatment may speed healing and relieve the swelling and soreness that often accompany bruises that are caused by injury. But severe bruising, swelling, and pain that begin 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 does not 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, especially 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.

Occasionally after an injury, blood collects and pools under the skin (hematoma), giving the skin a spongy, rubbery, lumpy feel. A regular bruise is more spread out and may not feel like a firm lump. A hematoma usually is not a cause for concern. It is not the same thing as a blood clot in a vein, and it does not cause blood clots.

Bruises that do not appear to be caused by an accidental injury may be caused by abuse. It is important to consider this possibility, especially if the bruises can't be explained or if the explanations change or do not 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 are not 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 present all the time.

Sudden unexplained bruising or blood spots under the skin or a sudden increase in the frequency of bruising may be caused by:

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.

Check your symptoms to decide if and when you should see a doctor.

Check Your Symptoms

Do you have bruises or blood spots under the skin?
If a bruise is rapidly spreading, you need try to stop the bleeding under the skin. Wrap the area (not too tightly) with an elastic bandage, such as an Ace wrap, and keep it on until you see a doctor. You can also put direct pressure on the area for 15 minutes at a time.
Yes
Bruises or blood spots under skin
No
Bruises or blood spots under skin
How old are you?
Less than 3 years
Less than 3 years
3 years or older
3 years or older
Are you male or female?
Male
Male
Female
Female
Do you have symptoms of shock?
Yes
Symptoms of shock
No
Symptoms of shock
Has there been a decrease in how alert or aware you are or how well you can think and respond?
Yes
Decreased level of consciousness
No
Decreased level of consciousness
Do you have symptoms of a serious illness?
Yes
Symptoms of serious illness
No
Symptoms of serious illness
Are there any symptoms of infection?
Yes
Symptoms of infection
No
Symptoms of infection
Are there red streaks leading away from the area or pus draining from it?
Yes
Red streaks or pus
No
Red streaks or pus
Do you have diabetes, a weakened immune system, peripheral arterial disease, or any surgical hardware in the area?
"Hardware" includes things like artificial joints, plates or screws, catheters, and medicine pumps.
Yes
Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area
No
Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area
Do you think you may have a fever?
Yes
Possible fever
No
Possible fever
Do you have any abnormal bleeding?
Yes
Abnormal bleeding
No
Abnormal bleeding
Do you feel lightheaded or dizzy, like you are going to faint?
It's normal for some people to feel a little lightheaded when they first stand up. But anything more than that may be serious.
Yes
Feels faint
No
Feels faint
Are you bleeding now?
Yes
Abnormal bleeding now present
No
Abnormal bleeding now present
Do you think that the bruising may have been caused by abuse?
Yes
Bruises may have been caused by abuse
No
Bruises may have been caused by abuse
Has the number or size of bruises or blood spots increased for no clear reason?
Yes
Unexplained increase in size or number of bruises or blood spots
No
Unexplained increase in size or number of bruises or blood spots
Was the increase in bruises or blood spots fast?
Yes
Rapid increase in the number or size of bruises or blood spots
No
Rapid increase in the number or size of bruises or blood spots
Do you take a medicine that affects the blood's ability to clot, such as aspirin, warfarin (such as Coumadin), enoxaparin (Lovenox), or clopidogrel (Plavix)?
These medicines can cause bleeding and can make it harder to control bleeding.
Yes
Medicine may be causing bruises
No
Medicine may be causing bruises
Were the bruises caused by an injury?
Yes
Bruises caused by injury
No
Bruises caused by injury
Did a large, painful, very swollen bruise develop within 30 minutes after the injury?
Yes
Bruising within 30 minutes of injury
No
Bruising within 30 minutes of injury
Have you had bruises or blood spots for more than 2 weeks?
Yes
Bruises or blood spots for more than 2 weeks
No
Bruises or blood spots for more than 2 weeks

Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.

Symptoms of shock in a child may include:

  • Passing out.
  • Being very sleepy or hard to wake up.
  • Not responding when being touched or talked to.
  • Breathing much faster than usual.
  • Acting confused. The child may not know where he or she is.

Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.

Symptoms of shock (most of which will be present) include:

  • Passing out.
  • Feeling very dizzy or lightheaded, like you may pass out.
  • Feeling very weak or having trouble standing.
  • Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

  • Your age. Babies and older adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
  • Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
  • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

  • Make an appointment to see your doctor in the next 1 to 2 weeks.
  • If appropriate, try home treatment while you are waiting for the appointment.
  • If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care in the next hour.
  • You do not need to call an ambulance unless:
    • You cannot travel safely either by driving yourself or by having someone else drive you.
    • You are in an area where heavy traffic or other problems may slow you down.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:

  • Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
  • Long-term alcohol and drug problems.
  • Steroid medicines, which may be used to treat a variety of conditions.
  • Chemotherapy and radiation therapy for cancer.
  • Other medicines used to treat autoimmune disease.
  • Medicines taken after organ transplant.
  • Not having a spleen.

Symptoms of serious illness in a baby may include the following:

  • The baby is limp and floppy like a rag doll.
  • The baby doesn't respond at all to being held, touched, or talked to.
  • The baby is hard to wake up.

Symptoms of serious illness may include:

  • A severe headache.
  • A stiff neck.
  • Mental changes, such as feeling confused or much less alert.
  • Extreme fatigue (to the point where it's hard for you to function).
  • Shaking chills.

Symptoms of infection may include:

  • Increased pain, swelling, warmth, or redness in or around the area.
  • Red streaks leading from the area.
  • Pus draining from the area.
  • A fever.

Many prescription and nonprescription medicines may reduce your blood's ability to clot and cause bruising or bleeding under the skin. A few examples are:

  • Blood-thinning medicines (anticoagulants), such as aspirin, warfarin (such as Coumadin), enoxaparin (Lovenox), or clopidogrel (Plavix). Also, taking a nonprescription medicine with an anticoagulant may increase your risk of bruising and bleeding.
  • Medicines used to treat cancer.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (for example, Advil or Motrin).
  • Steroids, such as prednisone.

Abnormal bleeding means any heavy or frequent bleeding or any bleeding that is not normal for you. Examples of abnormal bleeding include:

  • Nosebleeds.
  • Vaginal bleeding that is different (heavier, more frequent, at a different time of month) than what you are used to.
  • Rectal bleeding and bloody stools.
  • Bloody or pink urine.
  • Gums that bleed easily when you eat or gently brush your teeth.

When you have abnormal bleeding in one area of your body, it's important to think about whether you have been bleeding anywhere else. This can be a symptom of a more serious health problem.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Home Treatment

If your bruise does not require an evaluation by a doctor, you may be able to use home treatment to help relieve pain, swelling, and stiffness.

  • Rest and protect a bruised area.
  • Ice will reduce pain and swelling. Apply ice or cold packs immediately to prevent or minimize swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day.
    • For the first 48 hours after an injury, avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages.
    • After 48 to 72 hours, if swelling is gone, apply heat and begin gentle exercise with the aid of moist heat to help restore and maintain flexibility. Some experts recommend alternating between hot and cold treatments.
  • Compression, or wrapping the bruised area with an elastic bandage (such as an Ace wrap), will help decrease swelling. Don't wrap it too tightly, as this can cause more swelling below the affected area. Loosen the bandage if it gets too tight. Signs that the bandage is too tight include numbness, tingling, increased pain, coolness, or swelling in the area below the bandage. Talk to your doctor if you think you need to use a wrap for longer than 48 to 72 hours. A more serious problem may be present.
  • Elevate the bruised area on pillows while applying ice and anytime you are sitting or lying down. Try to keep the area at or above the level of your heart to help minimize swelling.
  • Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage the bruised area if it causes pain.
  • If your bruise is causing pain, take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Read and follow all instructions on the label.
  • If desired, apply a natural product directly to the bruise.
  • Do not smoke or use other tobacco products. Smoking slows healing because it decreases blood supply and delays tissue repair. For more information, see the topic Quitting Smoking.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

  • A bruise lasts longer than 2 weeks.
  • Signs of skin infection develop.
  • Symptoms become more severe or frequent.
  • New symptoms develop.

Prevention

You can't always prevent bruises, but most of the time bruises are not a cause for concern.

  • If you take aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), or blood-thinning medicines (anticoagulants), keep regular appointments with your doctor so that he or she can monitor your medicine dosages and make any necessary changes or adjustments.
  • Eat a variety of foods to avoid dietary deficiencies. Nutritional deficiencies of vitamins C, K, or B12, or folic acid can affect blood clotting. Include a daily selection of:
    • Whole-grain and enriched breads, cereals, and grain products.
    • Vegetables.
    • Fruits.
    • Milk, cheese, and yogurt.
    • Meats, poultry, fish, eggs, dried beans and peas, and tofu.
  • Do not take dietary supplements that may increase bruising, particularly if you take a blood-thinning medicine. Dietary supplements that may increase bruising include fish oil, vitamin E, garlic, ginger, and ginkgo biloba.

Bruises are often the first sign of abuse. You may be able to prevent further abuse by reporting it and seeking help.

  • Call your local child or adult protective agency, police, or clergy or a health professional (such as a doctor, nurse, or counselor) if you suspect abuse.
  • Seek help if you or someone you know is a victim of domestic violence.
  • Seek help if you have trouble controlling your anger with a child in your care.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

  • Do you have a personal or family history of bleeding disorders or bruising easily?
  • Are you taking any prescription or nonprescription medicines? Bring a complete list of your medicines with you to your appointment.
  • Do you take any vitamins or dietary supplements? Describe your diet.
  • Have you had any recent injuries or blood transfusions?
  • Have you had any nosebleeds, bleeding gums, blood in the urine, unusual or unexpected heavy menstrual flow, or fever?
  • Have you had any recent illness or changes in your health?
  • Have you recently traveled outside the country or to a rural area?
  • Do you have any health risks?

Credits

By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer H. Michael O'Connor, MD - Emergency Medicine
Current as of June 4, 2014

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