Ecchymosis

Ecchymosis is a subcutaneous discoloration resulting from the leakage of blood into the skin or mucous membranes after rupture of small vessels. It is typically a bruise larger than about 1 centimeter in diameter and is distinguished from petechiae (tiny spots less than 3 millimeters) and purpura (larger than petechiae but smaller than ecchymoses).

Most ecchymoses follow blunt trauma and are harmless, but they can also occur with disorders of blood clotting or platelet function, liver disease, or with medications that affect coagulation such as anticoagulants and antiplatelet drugs. Age-related skin fragility and conditions causing vascular weakness can contribute as well. Nontraumatic cases should prompt evaluation for bleeding diatheses if they are unexplained, recurrent, or widespread.

Pathophysiology involves blood escaping from damaged vessels and pooling in the surrounding tissues. Over several days the color changes as hemoglobin is broken down: red-blue or purple initially, then green (biliverdin), then yellow (bilirubin), with most ecchymoses resolving within two to three weeks depending on size and individual healing.

Clinical features typically include a painless patch of discoloration at a site of trauma. Larger or painful ecchymoses, or those occurring without obvious trauma, warrant assessment for an underlying bleeding disorder or systemic illness.

Management focuses on treating the underlying cause, protecting the area, and symptomatic care. Cold compresses in the first 24–48 hours, followed by warm compresses as needed, can reduce swelling and aid resorption. Analgesia may be used as needed; avoid nonsteroidal anti-inflammatory drugs if bleeding risk is a concern. Persistent or recurrent spontaneous bruising requires medical evaluation.