Bruising

Key points

Bruising is an extravasation of blood into a tissue, the consequence of a blunt trauma capable of damaging the walls of the blood vessels, without interrupting the integuments.

Bruising: causes
The most frequent bruises are induced by trauma or bruises of light to medium entity. In addition to these elements, bruising can result from alterations in blood coagulation (haemophilia, leukemia, thrombocytopenia), some diseases (phlebitis, lupus, scurvy) and anticoagulant therapies.

Bruising: symptoms
The main symptom of bruising is pain, the intensity of which depends on the severity of the bruise inflicted. Pain is often associated with swelling and local heat perception.

Ecchymosis: signs
Chroma → The bruising color varies over time: red (immediately after the lesion), blue / purple (after 4-6 days) and green-yellow (after 7-10 days).
Dimensions → the bruising does not have a defined shape. In general, the diameter of the bruising is between 1 and 2 cm

Ecchymosis: cures
A mild bruise does not require any specific treatment. Ice packs can speed up healing times.

Definition

By definition, ecchymosis is an extravasation of blood into a tissue, the expression of a contusion capable of breaking the walls of blood vessels, without however interrupting the integuments (skin). Severe bruising, characterized by a copious accumulation of blood in a tissue, they dress of more important pathological significance: in similar circumstances, bruising is precisely defined hematoma.
Bruising can be found directly on the skin, or involve a mucous membrane. Similarly to the actual hematoma, trauma and contusions are not the only triggers for bruising: also alterations in the coagulation capacity of the blood, leukemia and anticoagulant therapies they can in fact cause similar bruises.

Causes

The most frequent bruises are the result of a violent action exerted by an object on the skin.
Similar injuries can be produced in different ways:

1. Compression: Blood vessels undergo a crushing tear
2. Decompression: the suction causes the capillaries to burst, which occurs by external decompression
3. Traction: the ducts of the blood circulation are stretched, until they are torn
4. Pressure imbalance: typical of physical exertion. Some sports practices (eg weight lifting) require exaggerated physical effort: blood pressure increases, so the capillaries tend to break. Even asphyxiated convulsions (characterized by a "temporary respiratory inability), epileptic seizures and retching of pertussis can promote a pressure imbalance, up to bruising

Bumps, blows, bruises or light-to-moderate trauma are the typical causes of bruising; however, as mentioned in the opening words, the violent action of an object on the skin is not the only possible cause.

Risk factors

ALTERATIONS OF the blood coagulation capacity contribute to the development of bruising. In this sense, the most recurrent pathologies are:

• Hemophilia: marked bleeding tendency. The blood clotting inability that characterizes haemophilia (hereditary disease) is the expression of a total or partial insufficiency of the so-called factor VIII or factor IX. The lack or absence of these fundamental factors for coagulation predisposes the patient to bruising.
• Thrombocytopenia (or thrombocytopenia): this is a clinical condition characterized by a reduction in blood platelets (3 blood).Platelets play a cardinal role in regulating haemostasis, therefore they intervene in the blood coagulation process. A reduction in the platelet count can predispose the subject to bleeding, bruising, petechiae and hematomas.
• Leukemia (blood cancer): the reduction in the number of circulating platelets - a distinctive feature of leukemia - can cause nosebleeds (epitaxis), major bleeding after a small abrasion, intestinal bleeding, skin bleeding and massive bruising or bruising.

Other DISEASES predisposing to bruising have also been identified:

• phlebitis (inflammation of the surface veins)
• systemic lupus erythematosus (infrequent)
• scurvy: severe Vitamin C deficiency disease. Scurvy also predisposes a person to bruising. In this pathology, the tendency to hemorrhages and the formation of petechiae and ecchymosis are the result of the high permeability of blood vessels. Let us briefly recall that ascorbic acid is essential for the formation of connective tissue, whose function is to provide elasticity and strength. to the wall of the vessels; the fragility of the connective tissue enormously increases the permeability of blood vessels, hence the risk of bleeding.

Even anticoagulant therapies - therefore the intake of drugs such as coumadin, heparin and dicumarol - can predispose the patient to bruising, regardless of a bump or contusion.

Symptoms

For further information: Bruising Symptoms

As analyzed, bruising often originates from trauma or bruises of varying degrees of severity. The main symptom of bruising is therefore local PAIN, perceived at the point where the injury occurred. The intensity of the pain is clearly subjective, and is proportional to the violence with which the contusion was inflicted. More than the actual "pain", most patients affected by bruising complain of tingling or tension in the injured part. The pain increases by exerting pressure on the bruising; often, this symptom is associated with local edema - therefore swelling - and perception of heat.

Signs and characteristics

CHROME

The color of the bruising varies over time: as the lesion is reabsorbed, different colored shades can be observed on the surface of the skin. Initially, the bruise appears reddish-blue; after 4-6 days, the color of the bruise fades to green. After a week or ten days, the bruise discolours, until it takes on a golden-yellow color.

Following a limited trauma, local red blood cells are phagocytosed and degraded by macrophages. The discoloration of the bruising is an expression of the enzymatic conversion of hemoglobin into bilirubin.

The chromatic variations of the bruises over time are very useful clues to chronologically place the violent blunt action. A red bruise indicates a trauma suffered a few hours ago, while a yellowish bruise denotes a healing bruise.

SIZE AND SHAPE

Generally, bruises do not have a definite shape. However, to distinguish them from the more minor lesions - petechiae and purpura - it has been established that the diameter of the bruising must exceed at least the centimeter. Compared with hematomas, bruises are smaller (the bruise does not exceed 2 cm) and generally less severe: often, bruises extend to the point of being confused with a hematoma, creating real ecchymotic masks.
It is not uncommon for bruising to reproduce on the skin the blunt instrument or the "object that originated it": in this case, the lesion assumes the connotation of "figurative bruising".

LOCATION

Generally, bruising occurs at the point where a contusion occurred. However, some variants of bruising appear further away: just think of eyelid bruises in the context of fractures of the base of the skull.
At other times, bruises prove to be the only external sign of profound compromises, even of extreme severity.

Care

Minor bruises tend to resolve themselves within a few days: the bleeding is slowly reabsorbed, disappearing completely after a short period of time. To speed up healing times, it is advisable to apply ice packs on the trauma: the vasoconstricting effect of cold (cryotherapy), limits the leakage of blood from vessels injured by the trauma. In addition to this property, ice gives a good anesthetizing effect , temporarily masking the pain.
In case of severity (ecchymotic masks), it is possible to take anti-inflammatory drugs orally, or to apply locally - directly on the surface of the bruising - analgesic ointments.
When the lesion is the result of alterations in the blood coagulation capacity, it is necessary to trace the cause that induced the bruising, and to intervene accordingly.