Ecchymosen

Ecchymosis, commonly referred to as a bruise, denotes a subcutaneous bleed where blood collects outside the vessels, producing a non-elevated, discolored patch on the skin. The plural form in English is ecchymoses; ecchymosen is a plural form used in some other languages.

Causes and pathophysiology

Ecchymoses arise from rupture of small blood vessels, allowing red blood cells to leak into surrounding tissue. They can result from blunt trauma or occur spontaneously in the presence of bleeding disorders, anticoagulant or antiplatelet medications, liver disease, or deficiencies such as vitamin C or vitamin K. Age-related fragility of skin and vessels also increases susceptibility. In some conditions, widespread or recurrent ecchymoses prompt evaluation for systemic disease, including hematologic disorders or vasculitis.

Clinical features

Ecchymoses present as irregular, non-tender or tender patches that change color as the blood breakdown products are metabolized. They are typically larger than simple petechiae and may appear anywhere on the body. They can be solitary or multiple and may vary in size from several millimeters to several centimeters.

Differential and evaluation

Key distinctions include purpura and petechiae, which are smaller bleeding manifestations. When ecchymoses are spontaneous, extensive, or accompanied by other bleeding signs (e.g., easy bruising, mucosal bleeding), laboratory evaluation is warranted. Tests may include full blood count, platelet function, coagulation studies (PT/INR, aPTT), liver function, and review of medications and nutritional status.

Management

Most ecchymoses from minor trauma heal spontaneously within days to weeks. Treatment focuses on addressing the underlying cause, stopping or adjusting contributory medications when safe, and symptomatic care (such as compression or cold packs initially). Recurrent or unexplained ecchymoses require medical assessment to rule out systemic illness.