ecchymoses

Ecchymosis is a discoloration of the skin or mucous membranes caused by bleeding underneath the skin from ruptured vessels, resulting in a bruise. Ecchymoses are typically larger than 1 centimeter in diameter and non-blanching when pressed. They occur when blood extravasates into the subcutaneous tissue after vascular injury, most often from blunt trauma.

Causes and risk factors include trauma from everyday injury, sports, or accidents. They can also arise from conditions that impair coagulation or platelet function, such as inherited bleeding disorders (eg, hemophilia), liver disease, vitamin C deficiency, or disseminated intravascular coagulation. Medications that affect hemostasis, including anticoagulants (warfarin, heparin) and antiplatelet agents (aspirin, clopidogrel), increase susceptibility. Age-related skin fragility, glucocorticoid use, and certain vasculopathies can contribute as well. In some cases, spontaneous ecchymosis prompts evaluation for vasculitis, connective tissue disorders, occult trauma, or malignancy.

Clinically, ecchymoses appear as nonpigmented or blue-purple patches that gradually change color as they resolve, typically progressing from red-blue to green and then yellow-brown before fading. They are non-blanching and may vary in size. Distinguish ecchymoses from petechiae (small pinpoint non-blanching lesions) and purpura (medium-sized non-blanching lesions). A history of trauma helps, but unusual sites, extensive, recurrent, or painless bruising without obvious cause warrants further evaluation for a bleeding disorder or systemic disease.

Diagnosis involves history and physical examination, with laboratory tests guided by suspicion. Basic investigations may include complete blood count, platelet count, prothrombin time/international normalized ratio, activated partial thromboplastin time, and liver function tests. Imaging is reserved for suspected occult injury or internal bleeding.

Management targets the underlying cause and supportive care. Initial cold application can reduce swelling, followed by warmth if appropriate. Analgesia with acetaminophen is preferred; nonsteroidal anti-inflammatory drugs may worsen bleeding. Most ecchymoses heal spontaneously over days to weeks, but recurrent spontaneous bruising or progressive ecchymosis should prompt specialist evaluation.