We’ve all experienced an unsightly blue/black discolouration on our skin—usually from an injury or bumping into something. Bruising, otherwise known as a contusion, is the body’s natural reaction to localised trauma. Some people bruise more easily than others and this is usually the case in the elderly. Frequent bruising can be a sign of something more serious such as an underlying medical condition or a side-effect of certain medications.
What is a bruise?
A bruise is a common skin injury that is usually caused by the impact of a blow, cuts or injury such as a sprained ankle. Small blood vessels called capillaries are ruptured from the impact and leak out into the surrounding area—causing the typical blue-and-black mark within a few hours. Generally speaking, harder blows lead to larger bruises but in some people who bruise easily a small bump can cause a large bruise.
Eventually your body reabsorbs the blood—fading the bruise and changing the colour to yellow or green as it heals. Although usually seen as harmless, a bruise can be tender and painful to touch. There is no risk of infection as the skin isn’t broken.
What causes bruising?
Fragile skin
Some people bruise more easily than others and this is usually the case in the elderly.
As you age your skin becomes thinner as some of the protective fatty layer that helps cushion your blood vessels from injury is lost.
Bruising on the back of the hands and arms (called actinic purpura or solar purpura) occurs because skin there is often sun-damaged and thin.
Vigorous exercise
Weightlifters or athletes may experience bruising. This is because microscopic tears occur in the small blood vessels under the skin due to extreme forms of exercise. Bruising in athletes can also result from direct impact/trauma and be accompanied by an underlying hematoma (clotted blood).
Medical conditions
Easy bruising sometimes indicates a serious underlying condition, such as a blood-clotting problem or a blood disease.
Medications
Certain types of medications can cause you to bruise more easily. This includes blood thinners such as warfarin, clopidogrel and heparin; non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin; prednisone; and some medications used to treat cancer. Certain supplements that have similar properties such as fish oil, ginkgo and vitamin E should also be taken into consideration.
Abuse
Other serious causes of bruising include domestic violence or abuse. If a loved one has an unexplainable bruise, particularly in an unusual location such as on the face, be aware of the possibility of abuse.
See your doctor if you are experiencing:
- Large, frequent bruising—especially if they appear on your trunk, back or face, or seem to develop for no known reasons
- Easy bruising and a history of significant bleeding, such as during a surgical procedure
- Bruising which has developed suddenly, especially if you recently started a new medication
- Have a family history of easy bruising or bleeding
These signs and symptoms can indicate:
- Low levels of the blood components that help it clot after injury (platelets)
- Abnormally functioning platelets
- Problems with proteins that help the blood clot
Certain medical conditions which lead to easy bruising and bleeding include:
- Leukaemia
- Haemophilia
- Liver disease
- Cushing’s disease
- Marfan’s syndrome
- Ehlers-Danlos syndrome
- Connective tissue diseases
- Iron-deficiency anaemia or aplastic anaemia
Preventing and healing bruising
Once a bruise has formed, there are a few things you can implement to speed up the healing process and provide pain relief. Most bruises eventually disappear as your body reabsorbs the blood, although healing might take longer as you age. It might help to elevate the affected area and apply ice on and off for the first 24 hours.
Vitamin C
Certain nutrients are important for the health and integrity of our blood vessels. A deficiency in vitamin C (ascorbic acid), can make our capillaries more prone to rupturing and damage.
Severe vitamin C deficiencies are often classified as scurvy, but some people can have suboptimal intakes of this important nutrient which makes them more susceptible to bruising.
For prevention and healing of bruising take with bioflavonoids and rutin.
Bromelain
A proteolytic enzyme, naturally found in pineapples, bromelain is a natural anti-inflammatory reported to dissolve blood clots reduce swelling associated with bruising. It has been found to reduce oedema, bruising, pain, and healing time following trauma and surgical procedures.
Herbal liniment
There are a variety of herbs which come in a spray, cream or gel form which you can apply to the affected area for pain relief, reduced swelling and inflammation—speeding up recovery time. They may contain ingredients such as panax pseudoginseng, angelica polymorpha, boswellia, myrrh and mint.
Arnica
Arnica montana is a common homeopathic remedy indicated in bruises, swelling and sprains. It is taken in the form of pillules or small tablets, either leading up to surgery or after a bruise has occurred. It can also be applied topically to promote healing and reduce swelling. Arnica is safe to take if you are concerned about interactions with medications.
Medication review
If you experience easy bruising it might be worthwhile discussing with your doctor or pharmacist what medications you are on and if there are any potential side-effects such as increased bruising, dizziness or sleepiness. They may review your medications to determine whether the dosage can be dropped or an alternative could be offered. This includes medications which are available off the shelf or via prescription.
It is also worthwhile having your vision and hearing tested as even a small change can cause you to fall more frequently.
Lifestyle suggestions
To prevent falls, bumps and bruising in the elderly consider some of these lifestyle suggestions:
- Avoid potential accidents by removing clutter
- Arrange furniture for easy negotiation
- Use good lighting in the home
References
- https://www.mayoclinic.org/healthy-lifestyle/healthy-aging/in-depth/easy-bruising/art-20045762
- https://www.emedicinehealth.com/bruises/article_em.htm#what_are_causes_and_risk_factors_for_bruises
- https://www.webmd.com/skin-problems-and-treatments/guide/bruises-article#1
- Kouzi SA, Nuzum DS. Arnica for bruising and swelling. Am J Health Syst Pharm. 2007 Dec 1;64(23):2434-43 https://www.ncbi.nlm.nih.gov/pubmed/18029949
- Xiao B, et al. Soft tissue contusion repairing effects of Hong Yao with different penetration enhancers. J Ethnopharmacol. 2013 Jul 9;148(2):610-6. https://www.ncbi.nlm.nih.gov/pubmed/23702037
- Fraser IM, Dean M. Extensive bruising secondary to vitamin C deficiency. BMJ Case Rep. 2009;2009. pii: bcr08.2008.0750. doi: 10.1136/bcr.08.2008.0750. Epub 2009 Feb 26.https://www.ncbi.nlm.nih.gov/pubmed/21686649
- MacKay D, Miller AL. Nutritional support for wound healing. Altern Med Rev. 2003 Nov;8(4):359-77. https://www.ncbi.nlm.nih.gov/pubmed/14653765
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