Background
Ecchymosis (more commonly known as a bruise) describes the skin discolouration caused by the extravasation of blood from capillaries under the skin, whilst the skin surface remains intact. An ecchymosis is superficial (and flat), whereas a haematoma refers to a palpable, deeper collection of blood within tissues. Ecchymoses are larger than 1cm in diameter; similar superficial bleeds of 2mm-1cm are called purpura, and <2mm are petechiae. Ecchymoses are more obvious in lighter skin tones, hence more attention may be required when examining patients with darker skin tones.
Signs and symptoms
- Initial – blue or purple skin discolouration, this may appear dark brown or black in darker skin tones
- Later – turning green and yellow
- >1cm diameter
- Typically resolves in 1-3 weeks
Causes
Ecchymoses are a normal response to injury and are commonly seen in young, active children, therefore the occasional ecchymosis does not usually require medical attention. However problems arising in any part of the bruising process can lead to excessive and spontaneous ecchymoses, such as:
- Deficiency or dysfunction of platelets (in conditions such as leukaemia, autoimmune diseases or haemolytic uraemia syndrome)
- Defects in blood vessels (in conditions such as Marfan or Ehlers-Danlos syndrome)
- Deficiency in clotting factor(s) (in haemophilia, Von Willebrand disease or liver disease)
Therefore, those with unusual or extensive bruising, or bruising with no known precipitating factor should seek medical advice.
Management
There are no specific treatments for ecchymoses, however rest, elevation and cold compresses may help to alleviate symptoms. Simple analgesics such as paracetamol may also help. Currently, non-steroidal anti-inflammatories are not recommended as they may worsen the bruise.
References
Ecchymosis, in Science Direct, [https://www.sciencedirect.com/topics/medicine-and-dentistry/ecchymosis] accessed Friday 28th April 2023.
Vadera,S. et al. (2017) Bleeding and bruising, DermNet New Zealand, [https://dermnetnz.org/topics/bleeding-and-bruising] accessed Friday 28th April 2023.