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Bruising : What it is and how to address it

knee
(Photo: Shutterstock)
It is likely that every person had a bruise at one point or another. We often get bruised as kids while running around and falling down. When we are younger, we can usually shrug these bruises off and carry on with our day. However, as we get older, bruising can become more problematic. They can appear seemingly without cause and come in different colors, which may be concerning. More often than not, these bruises are not of great concern, but understanding the potential causes and types of bruising can help one recognize if a bruise is of particular concern.اضافة اعلان

What is a bruise?
A bruise, also referred to as a contusion, occurs when the small blood vessels known as capillaries, located under the skin, get damaged and begin to leak blood. Since the skin is not broken, the blood begins to pool underneath the skin. Bruising may occur spontaneously or due to physical trauma.

Types of bruises
Bruises come in many shapes, sizes, and colors. Typically, after an injury, the skin of the affected area becomes red and within a day or two it may turn into the classic blue, black, purple bruising. The bruise may show for roughly 5–10 days, at the end of which the outer edges of the bruise become green or yellow. People may become concerned by the change in color, but it is a natural process which means that the body is healing and absorbing the pooled blood. Bruising may be accompanied by swelling. Bruises can be classified based on cause and appearance.

Ecchymosis, the true medical term for bruising, typically appears as purple patches that do not become white or pale when pressure is applied to the skin. They are generally bigger than 1cm and take 1-3 weeks to completely heal.

Hematoma, a more severe form of bruising, is usually the direct result of physical trauma, such as a fall, and can cover more areas of the body. Hematomas are often accompanied by swelling, and are painful.

Petechiae is a unique form of bruising that appears as tiny red dots on the surface of the skin. Generally, they are less than 4mm in size and, like ecchymosis, fail to become white when pressure is applied. Petechiae may appear in a particular area, such as arms, legs, or abdomen, and give the appearance of a rash.

Purpura is similar to ecchymosis and can be red, purple, or brown in color. They are generally 4–10mm in diameter, which makes them larger than petechiae but smaller than ecchymosis.

As we age, our skin becomes thinner, dryer, and more prone to damage. As a result, we bruise more easily. This is often referred to as senile purpura.

Symptoms that are cause for concern
It is normal for bruises to appear as a direct result of physical injury. However, certain types of bruises, particularly their origin, can be of greater concern.

If you have bruising associated with other symptoms, then you may need to seek medical attention. Bruising in conjunction with a suspected bone fracture from a hard blow or fall should be evaluated. Bruising with intense swelling and pain may be indicative of internal injury. Bruising that is associated with other forms of bleeding may also be of concern. This can include bruising under the fingernails or after taking aspirin or blood thinners, bleeding from the gums, nose, or mouth, or blood in urine, stool, or eyes. These symptoms may be indicative of a more serious underlying condition.

Causes of bruising
Physical injury is the most common cause of bruising. It is normal and often no need for alarm unless the bruising is severe and potentially associated with a broken bone. Unexplained and spontaneous bleeding is far more concerning. Certain supplements and medications, such as blood thinners, corticosteroids, certain painkillers, and even fish oil can make it more difficult for your body to make the blood clot, which increases the risk of bruising.

If you are taking medication that produces bruising, it is often a warning sign that your medication may need adjustment. There is also a whole host of inherited conditions that can make it difficult for the blood to clot and therefore make you more prone to bruising. These can include deficiencies of factor VII, X, V, or II, as well as Von Willebrand disease, hemophilia A, and Christmas disease. Lastly, bruising of the legs may be caused by an underlying condition. Typically, blue bruising on the legs may be the result of varicose veins, but black bruises without any known cause can be more severe, indicating a condition known as deep vein thrombosis (DVT), whic is characterized by a clot in the vein. DVT has the potential to be life threatening and require immediate medical attention

Who is at risk?
Bruising is most common in the older population. This is due to multiple factors, including the natural decline in the body’s ability to heal quickly, as well as thinner and weaker skin. Ultimately, this causes the capillaries to be more vulnerable and fragile, thus increasing the risk of bruising.

Women tend to bruise more easily than men. It is believed that this is due to women having more fat and less collagen (an important compound in skin that provides structure).

Those who regularly take certain medications are at higher risk. Certain painkillers known as NSAIDs and blood thinners such as anticoagulants and antiplatelets make it difficult for the body to produce clots. Similarly, corticosteroids, both applied to the skin and ingested, make the skin thinner and the individual more prone to bruising. Much like medications, certain supplements such as ginkgo, ginger, and vitamin E can have a blood thinning effect.

Treating bruising
Most important in case of bruises is to resolve any underlying condition that may exist. Once that is properly managed, preventing is also important. This means exercising caution when participating in activities that increase the likelihood of physical injury. Protective equipment such as paddings can help.

If you already have a bruise, there are a few home remedies that may help. Placing an ice pack can help reduce swelling, whereas a warm compress can help improve blood flow and expedite healing. Icing the area can start as soon as the bruising appears, but warm compresses should wait until 48 hours after appearance. Avoid placing the ice pack directly on the bruise and instead wrap it in a towel. Both ice and warm compression can be applied several times a day, but ice packs should only be applied for 10 minutes at a time.

Rest and elevation are also important for a speedy recovery. When elevating, ensure that the affected area is above the level of the heart. Lastly, in order to manage pain, over-the-counter medication can be used. Paracetamol (Panadol) is preferred and NSAIDs such as aspirin, ibuprofen, and naproxen should be avoided.


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