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A bruise is a discoloration from damaged blood vessels under the skin. Usually, they are caused by injury, but not always. There are many types of bruises, but the one thing they all have in common is that there is no external bleeding. Unless the skin breaks open, the blood pools underneath it.

Bruises can be black, purple, brown, blue, or yellow. They can happen to anyone, although some people are more prone to bruising than others.

Hematoma

A hematoma usually appears after an injury. Blood collects and pools under the skin and may feel hard, rubbery, lumpy, or spongey.

Hematomas can look and feel serious, but they are usually not a cause for concern. They do not cause blood clots and generally heal within one to four weeks.

young boy looking at a bruise on his knee

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Purpura

Purpura are small purple spots between 4 mm and 10 mm in diameter. They appear on the skin, but they may also occur inside the mouth and throat.

Purpura develop when tiny blood vessels leak, and they usually look like a cluster of tiny dots. They can be a sign of an underlying condition, like thrombocytopenia or low platelets, but can also result from congenital disorders, drug interactions, or vitamin deficiencies.

close up of an arm with purpura bruising

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Petechiae

Petechiae are similar to purpura. Both are caused by tiny spots of bleeding under the skin. The main difference is that petechiae are less than 4 mm wide. They are flat and not painful or itchy, but they may be mistaken for a rash.

One way to tell the difference between petechiae and a rash is that a rash will turn pale when you push on it; petechiae will not. Low platelets or medications can cause petechiae, as can some severe conditions, including endocarditis, infection, and leukemia.

close up of petechiae bruising

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Senile Purpura

Age-related changes can lead to bruising called senile purpura. This type of bruise occurs in older people because they have less dense skin tissue, and their blood vessels are more fragile.

People with these bruises develop dark purple areas, commonly on the tops of their hands and forearms. New bruises can appear for seemingly no reason, and although they resolve over a week or so, they often leave behind a brownish discoloration that may be permanent.

senile pupura bruising on the skin of an elderly person

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Black Eye

A black eye is a type of bruise resulting from direct trauma to the face. Most black eyes are not serious and will resolve on their own, but not always. A black eye could signify a more significant injury, like an internal injury to the eye, a fracture around the eye, or a skull fracture.

If the problem is more serious, the person will experience other symptoms, such as double vision, bruising around both eyes, and nose bleeds, and should see a doctor immediately.

close up of a man with a black eye bruie

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Muscle Contusions

A contusion is typically just another name for a bruise, but a muscle contusion is a little different. Muscle contusions are the second most common sports injury. They occur from a direct blow to a part of the body that damages the underlying tissue and muscle fibers without breaking the skin.

Severe muscle contusions can form large hematomas over the affected area and cause pain and swelling, limiting weight bearing or range of motion on the joint near the injury.

doctor examining a large muscular contusion or bruise

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Subcutaneous Bruises

Bruises are also classified by where they appear. Subcutaneous bruises occur beneath the skin. They usually start out red and slowly fade to blue and purple, then to green or yellow before the skin returns to normal.

Placing ice over an injury right after it happens and elevating the injured area can reduce this type of bruising.

woman examining a subcutaneous bruise on the back of her leg

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Intramuscular Bruises

Intramuscular bruises occur within the underlying muscle and are another term for muscle contusions. These bruises are most common in male athletes, particularly those who play rugby, football, soccer, and ice hockey. Intramuscular bruises are often graded depending on their severity.

Although rare, severe cases can result in complications like compartment syndrome or rhabdomyolysis.

coach examining injured soccer player

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Periosteal Bruises

Bones can get bruised, too. These injuries are called periosteal bruises, and while they are less severe than fractures, they can still be extremely painful injuries. Bone bruises are sometimes called microfractures.

Blood can build up in the injured area beneath the thin layer of tissue covering the bone, or the person may experience swelling and bleeding inside of the bone. Many injuries can cause bone bruises, including car accidents, sports injuries, falls, and sprains.

doctor showing patient where bone is injured in xray

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Who Is Prone to Bruising?

Anyone can get a bruise, but some people are more prone than others. Genetics and diet play a role, or a person may just be clumsier than others and bump into things more often.

Women are more prone to bruising than men, and older adults have thinner skin, less fat, and more delicate blood vessels, leaving them at high risk for bruising. Physicians may also watch for frequent bruising to indicate abuse, especially in children and the elderly.

elderly woman with bruise inside elbow

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Medication

Some medications can contribute to bruising. Over-the-counter options like aspirin, ibuprofen, and naproxen can affect clotting times, as can prescription anticoagulants like warfarin and heparin.

Some antidepressants, steroids, and antibiotics can cause clotting problems, and topical steroid creams can thin the skin, making it more susceptible to bruising.

woman applying topical cream to a bruise

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When to See a Doctor

Everyone gets bruises, and they usually heal on their own. But easy bruising can be a sign of a serious problem. Some warning signs that something more serious is going on are

  • large bruises that frequently appear on the back, trunk, or face without a known reason,
  • excessive or prolonged bleeding,
  • a family history of bleeding disorders or easy bruising.

These could be caused by various conditions, including low platelets in the blood, platelets that do not function as they should, or problems with the proteins involved in blood clotting.

doctor examining knee bruise on patient

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Disclaimer

This site offers information designed for educational purposes only. You should not rely on any information on this site as a substitute for professional medical advice, diagnosis, treatment, or as a substitute for, professional counseling care, advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional.