An Overview of Ecchymosis

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Ecchymosis is caused by the movement of blood from ruptured blood vessels into the top layer of the skin. This can occur following trauma to soft tissue, surgery, disordered cell function, or infection. Ecchymosis can occur anywhere there is skin, or in a mucous membrane, including the mouth. Ecchymosis does not cause any raising of the skin. Rather, you see a range of discoloration including red, blue, or purple. Ecchymosis may be associated with other symptoms such as pain or swelling.

Symptoms

The most definite sign and symptom of ecchymosis is a moderate to large portion of flat but discolored skin (greater than 1 centimeter). Additional symptoms may include pain, increased sensitivity, and swelling. Someone with ecchymosis may also experience symptoms of pain and swelling elsewhere in the body as a result of an injury such as a fall.

Causes

Ecchymosis can be caused by a traumatic incident, such as being hit with an object or falling on a hard surface. Certain medical conditions, such as cancer or blood clotting disorders, may cause ecchymosis. If the body lacks vitamin K or vitamin C, an individual is at risk of experiencing ecchymosis. If someone is diagnosed with an infection or is taking certain medications, such as Coumadin (warfarin) or aspirin, they are also at an increased risk for experiencing ecchymosis.

Children are most likely to experience ecchymosis during the summer, when living in a temperate climate, or during team sports season.

Ecchymosis may be caused by blood leaking into the tissues due to disordered cell function or due to trauma, while a bruise (hematoma) is defined as being caused by trauma.

Diagnosis

Ecchymosis is diagnosed primarily through a physical examination, during which a doctor assesses the area of discolored skin. The doctor will also ask about your medical history, medications you are currently taking, and injuries you may have sustained recently.

If the ecchymosis is severe enough, your doctor may order blood tests to measure your body’s healing responses, the level of inflammation, and blood cell count. This information will assist in determining the cause of the ecchymosis, if the mechanism is still unknown, and providing treatment.

The color of skin with ecchymosis assists a doctor in determining the age and the depth of the injury. A blue, red, or purple hue typically is indicative of a fresh spot of ecchymosis. Once several days have passed and the healing process has begun, the area of skin typically turns yellow, green, or brown. A research study analyzed photographs of ecchymoses to determine their age and concluded that yellow spots of skin were ecchymoses that were received more than 18 hours prior.

Treatment

Most instances of ecchymosis resolve without any intervention, as this injury is typically minor. If you are frequently experiencing pain resulting from ecchymosis, your doctor may complete more tests and evaluations to determine what the root cause is. Your doctor will then be able to treat the condition causing the ecchymosis to prevent more serious issues from evolving. Another course of action may be to stop taking certain medications that may cause ecchymosis.

Most minor or moderate ecchymosis are treated with non-steroidal anti-inflammatory medications (NSAIDs), such as ibuprofen, to reduce pain and swelling. Doctors typically recommend elevating the bruised area and applying ice to lessen symptoms such as pain and swelling. These practices, accompanied with rest, allow the body to absorb the blood within your tissues and heal the ecchymosis.

Prognosis

The prognosis for ecchymosis is typically very good. In most cases, ecchymosis is minor and resolves relatively quickly in healthy individuals. Once your doctor identifies the cause of the ecchymosis, they can instruct you to take steps to prevent it from occurring again.

You should contact your doctor if you develop new symptoms of ecchymosis after already being treated, your bruise is growing in size, or you are not seeing progress after 2 weeks.

Most cases of ecchymosis are minor and cause little pain or swelling. Most individuals experiencing minor ecchymosis must cope with temporary cosmetic changes due to discolored skin and bruises. These bruises usually resolve entirely once the ecchymosis is healed and the blood has been redistributed under the skin. This typically takes around two weeks.

A Word From Verywell

Ecchymosis is a relatively common condition that may occur independent of an overlying medical condition. In most cases, ecchymosis is not cause for concern. Symptoms of ecchymosis resolve in time and are often due to minor soft tissue injuries.

Most instances of ecchymosis occur due to soft tissue injuries, such as falls, sprains, and other impact-related injuries. If you are healthy, one of the best ways to prevent ecchymosis is to avoid soft tissue injuries. If you are an older adult, the best precautionary measure you can take to avoid ecchymosis is to prevent falls or other injuries in the home. If you are concerned about medications you are taking or a condition you are living with that may be causing ecchymosis, consult your doctor for more information.

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Article Sources

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  1. Epperla N, Mazza JJ, Yale SH. A review of clinical signs related to ecchymosis. WMJ. 2015;114(2):61-65.

  2. Loo M. Integrative medicine for children. Philadelphia, PA: Saunders Elsevier; 2008.

  3. U.S. National Library of Medicine. Bleeding into the skin. Published October 2, 2019.

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