Bumps & Bruises
(Contusions & Ecchymoses)
Medical Author: William C. Shiel Jr., MD, FACP, FACR
What is a bruise?
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 (medically referred to as a contusion) 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 purplish,
flat bruise that occurs when blood leaks out into the top layers
of skin is referred to as an ecchymosis.
Why do bruises occur more frequently in some
people than in others?
The injury required to produce a bruise varies with
age. 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 or ecchymosis 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 prescription
arthritis medications called nonsteroidal
antiinflammatories
(for example, ibuprofen [Advil, Nuprin] and naproxen [Aleve]) as well as
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 particularly
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. In addition, 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 or even life-threatening
bleeding.
Next: What does a bruise look like, and why does it
change color? »
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