Bumps & Bruises
(Contusions & Ecchymoses)

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Medical Author:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Medical Editor:

John P. Cunha, DO, FACOEP

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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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 is caused when tiny 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 bruise is medically referred to as a contusion. A purplish, flat bruise that occurs when blood leaks out into the top layers of skin is referred to as an ecchymosis.

The injury required to produce a bruise varies with age. Bruising occurs more easily in the elderly. 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 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 arthritis medications called nonsteroidal anti-inflammatories (for example, ibuprofen [Advil, Nuprin] and naproxen [Aleve]) and 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 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.

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, unexplained bruising, or even life-threatening bleeding.