Bruises and Blood Spots Under the Skin

Topic Overview

Bruises

Bruises develop when small blood vessels under the skin tear or rupture, most often from a bump or fall. Blood leaks into tissues under the skin and causes the black-and-blue color. As bruises (contusions) heal, usually within 2 to 4 weeks, they often turn colors, including purplish black, reddish blue, or yellowish green. Sometimes the area of the bruise spreads down the body in the direction of gravity. A bruise on a leg usually will take longer to heal than a bruise on the face or arms.

Most bruises are not a cause for concern and will go away on their own. Home treatment may speed healing and relieve the swelling and soreness that often accompany bruises that are caused by injury. However, severe bruising, swelling, and pain that begin within 30 minutes of an injury may mean a more serious problem, such as a severe sprain or fracture.

If you bruise easily, you may not even remember what caused a bruise. Bruising easily does not mean you have a serious health problem, especially if bruising is minimal or only shows up once in a while.

• Older adults often bruise easily from minor injuries, especially injuries to the forearms, hands, legs, and feet. As a person ages, the skin becomes less flexible and thinner because there is less fat under the skin. The cushioning effect of the skin decreases as the fat under the skin decreases. These changes, along with skin damage from exposure to the sun, cause blood vessels to break easily. When blood vessels break, bruising occurs.
• Women bruise more easily than men, especially from minor injuries on the thighs, buttocks, and upper arms.
• A tendency to bruise easily sometimes runs in families.

Occasionally after an injury, blood collects and pools under the skin (hematoma), giving the skin a spongy, rubbery, lumpy feel. A regular bruise is more spread out and may not feel like a firm lump. A hematoma usually is not a cause for concern. It is not the same thing as a blood clot in a vein, and it does not cause blood clots.

Bruises that do not appear to be caused by an accidental injury may be caused by abuse. It is important to consider this possibility, especially if the bruises cannot be explained or if the explanations change or do not match the injury. Report this type of bruising and seek help to prevent further abuse.

Blood spots

Blood spots under the skin may be either purpura or petechiae. Purpura might look like bruises, but they are not caused by an injury as most regular bruises are. Petechiae don't look like bruises. They are tiny, flat, red or purple spots in the skin, but they are different than the tiny, flat, red spots or birthmarks (hemangiomas) that are present all the time.

Sudden unexplained bruising or blood spots under the skin or a sudden increase in the frequency of bruising may be caused by:

• A medicine, such as aspirin or blood thinners (anticoagulants).
• Infection that causes the buildup of toxin in the blood or tissues (sepsis).
• A bleeding or clotting disorder, such as hemophilia, von Willebrand's disease, thrombocytopenia, or another less common bleeding or clotting disorder.
• Other diseases that affect clotting. Examples include:
  • Chronic inflammatory diseases, such as lupus.
  • Liver disease, such as cirrhosis.
  • Some types of cancer, such as Hodgkin's disease, leukemia, or multiple myeloma.
• Inflammation of a blood vessel (vasculitis).
• Malnutrition, such as deficiencies of vitamins B12, C, or K, or folic acid.

Medical treatment for abnormal bruising or blood spots focuses on preventing or stopping bleeding, changing or adjusting a medicine that may be causing the bruising, or treating the medical problem that is causing the bruising.

Review the Emergencies and Check Your Symptoms sections to help you decide if and when you need to see a health professional.

Emergencies

• Signs of shock:
  • In children
  • In adults and older children
• A significant decrease in level of consciousness:
  • In children
  • In adults and older children

Check Your Symptoms

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• Bruises on the head or face after a head injury: Go to the topic Head Injury, Age 3 and Younger or Head Injury, Age 4 and Older.
• Bruises on the abdomen after an injury to the abdomen: Go to the topic Abdominal Pain, Age 11 and Younger or Abdominal Pain, Age 12 and Older.
• Bruises on the chest after an injury to the chest: Go to the topic Chest Pain.
• A bruise or blood spot under a fingernail: Go to the topic Nail Problems and Injuries.
• Bleeding: Go to the topic Cuts or Puncture Wounds.
• Blood in your eye after an injury to the eye: Go to the topic Eye Injuries.
• Bruises and moderate to severe pain and swelling after an injury: Go to the most closely related topic listed below:
  • Arm Injuries
  • Facial Injuries
  • Finger, Hand, and Wrist Injuries
  • Hip Problems and Injuries, Age 11 and Younger
  • Hip Problems and Injuries, Age 12 and Older
  • Knee Problems and Injuries
  • Leg Injuries
  • Nose Injuries
  • Shoulder Problems and Injuries
  • Toe, Foot, and Ankle Injuries
  • Male Genital Problems and Injuries
• A scrape, puncture, cut, burn, or bite: Go to the topic Scrapes, Puncture Wounds, Cuts, Burns, or Animal and Human Bites.

	Yes	Do you have bruises or blood spots under the skin and other signs of abnormal bleeding? When to See a Doctor See significance of bruises or blood spots under the skin and abnormal bleeding if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Have you had a nosebleed in the past 12 hours? Yes Have you had abnormal vaginal bleeding in the past 12 hours? Yes Have you had rectal bleeding in the past 12 hours? Yes Have you had blood in your urine in the past 12 hours? Yes Have your gums bled easily in the past 12 hours? Call your health professional today if you answer "Yes" to any of the following questions. Yes Have you had a nosebleed in the past few days? Yes Have you had abnormal vaginal bleeding in the past few days? Yes Have you had rectal bleeding in the past few days? Yes Have you had blood in your urine in the past few days? Yes Have your gums bled easily in the past few days? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you have an unexplained increase in the number or size of bruises or red blood spots under the skin? When to See a Doctor See significance of bruises or red blood spots under the skin if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Does a child age 3 or younger have a bulging soft spot on his or her head when he or she is not crying? Yes Is a child age 3 or younger crying or having other signs of pain after 30 minutes of home treatment? Yes Do you know or think you have a fever? Yes Do you have a severe stiff neck? Yes Are you extremely sleepy or having a hard time waking up? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had a gradual increase in the number or size of bruises or blood spots over the past 72 hours, but you do not have any other symptoms? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had a gradual increase in the number or size of bruises or blood spots in the past few weeks, but you do not have any other symptoms? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you think your bruises are caused by a medicine? When to See a Doctor See significance of medicines causing bruises if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you answer "Yes" to one of the questions below: Call the health professional who prescribed the medicine today. He or she can determine whether you should stop taking the medicine or take a different one. An appointment may or may not be needed. If you are taking nonprescription medicine, stop taking the medicine. Call your health professional if you feel you need to keep taking the medicine or if you need help to control your symptoms after you stop taking the medicine. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you take a blood-thinning medicine or a nonsteroidal anti-inflammatory drug, such as aspirin or ibuprofen, and you have new bruising or bleeding? Call your health professional today if you answer "Yes" to the following question. Yes Do you think a medicine may be causing your symptoms? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you think bruises may have been caused by abuse? When to See a Doctor See significance of bruises caused by abuse if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have a bruise because someone hurt you? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you think you have a skin infection? When to See a Doctor See significance of a skin infection if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have diabetes? Yes Do you have peripheral arterial disease? Yes Do you have a disease or take a medicine that causes problems with your immune system? Yes Do red streaks extend away from the bruise? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have increased swelling, redness, or warmth around a bruise? Yes Do you have discharge of pus from a bruise? Yes Do you know or think you have a fever? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had mild pain and swelling with redness less than 1 in. (2.5 cm) around the bruise for 24 hours or longer? Yes Have you had swollen lymph nodes near a bruise for 24 hours or longer? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Did a large bruise develop within 30 minutes of an injury? When to See a Doctor See significance of a large bruise that develops within 30 minutes of an injury if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Did a large, painful, swollen bruise develop within 30 minutes of an injury? Note: A large bruise is the size of the injured person's palm. If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you bruise easily, or do your bruises seem to last a long time? When to See a Doctor See significance of bruising easily or bruising that lasts a long time if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Are you worried about how easily you bruise? Yes Have bruises from an injury lasted longer than 2 weeks? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Emergencies

• Signs of shock:
  • In children
  • In adults and older children
• A significant decrease in level of consciousness:
  • In children
  • In adults and older children

Check Your Symptoms

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• Bruises on the head or face after a head injury: Go to the topic Head Injury, Age 3 and Younger or Head Injury, Age 4 and Older.
• Bruises on the abdomen after an injury to the abdomen: Go to the topic Abdominal Pain, Age 11 and Younger or Abdominal Pain, Age 12 and Older.
• Bruises on the chest after an injury to the chest: Go to the topic Chest Pain.
• A bruise or blood spot under a fingernail: Go to the topic Nail Problems and Injuries.
• Bleeding: Go to the topic Cuts or Puncture Wounds.
• Blood in your eye after an injury to the eye: Go to the topic Eye Injuries.
• Bruises and moderate to severe pain and swelling after an injury: Go to the most closely related topic listed below:
  • Arm Injuries
  • Facial Injuries
  • Finger, Hand, and Wrist Injuries
  • Hip Problems and Injuries, Age 11 and Younger
  • Hip Problems and Injuries, Age 12 and Older
  • Knee Problems and Injuries
  • Leg Injuries
  • Nose Injuries
  • Shoulder Problems and Injuries
  • Toe, Foot, and Ankle Injuries
  • Male Genital Problems and Injuries
• A scrape, puncture, cut, burn, or bite: Go to the topic Scrapes, Puncture Wounds, Cuts, Burns, or Animal and Human Bites.

	Yes	Do you have bruises or blood spots under the skin and other signs of abnormal bleeding? When to See a Doctor See significance of bruises or blood spots under the skin and abnormal bleeding if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Have you had a nosebleed in the past 12 hours? Yes Have you had abnormal vaginal bleeding in the past 12 hours? Yes Have you had rectal bleeding in the past 12 hours? Yes Have you had blood in your urine in the past 12 hours? Yes Have your gums bled easily in the past 12 hours? Call your health professional today if you answer "Yes" to any of the following questions. Yes Have you had a nosebleed in the past few days? Yes Have you had abnormal vaginal bleeding in the past few days? Yes Have you had rectal bleeding in the past few days? Yes Have you had blood in your urine in the past few days? Yes Have your gums bled easily in the past few days? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you have an unexplained increase in the number or size of bruises or red blood spots under the skin? When to See a Doctor See significance of bruises or red blood spots under the skin if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Does a child age 3 or younger have a bulging soft spot on his or her head when he or she is not crying? Yes Is a child age 3 or younger crying or having other signs of pain after 30 minutes of home treatment? Yes Do you know or think you have a fever? Yes Do you have a severe stiff neck? Yes Are you extremely sleepy or having a hard time waking up? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had a gradual increase in the number or size of bruises or blood spots over the past 72 hours, but you do not have any other symptoms? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had a gradual increase in the number or size of bruises or blood spots in the past few weeks, but you do not have any other symptoms? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you think your bruises are caused by a medicine? When to See a Doctor See significance of medicines causing bruises if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you answer "Yes" to one of the questions below: Call the health professional who prescribed the medicine today. He or she can determine whether you should stop taking the medicine or take a different one. An appointment may or may not be needed. If you are taking nonprescription medicine, stop taking the medicine. Call your health professional if you feel you need to keep taking the medicine or if you need help to control your symptoms after you stop taking the medicine. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you take a blood-thinning medicine or a nonsteroidal anti-inflammatory drug, such as aspirin or ibuprofen, and you have new bruising or bleeding? Call your health professional today if you answer "Yes" to the following question. Yes Do you think a medicine may be causing your symptoms? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you think bruises may have been caused by abuse? When to See a Doctor See significance of bruises caused by abuse if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have a bruise because someone hurt you? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you think you have a skin infection? When to See a Doctor See significance of a skin infection if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have diabetes? Yes Do you have peripheral arterial disease? Yes Do you have a disease or take a medicine that causes problems with your immune system? Yes Do red streaks extend away from the bruise? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have increased swelling, redness, or warmth around a bruise? Yes Do you have discharge of pus from a bruise? Yes Do you know or think you have a fever? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had mild pain and swelling with redness less than 1 in. (2.5 cm) around the bruise for 24 hours or longer? Yes Have you had swollen lymph nodes near a bruise for 24 hours or longer? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Did a large bruise develop within 30 minutes of an injury? When to See a Doctor See significance of a large bruise that develops within 30 minutes of an injury if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Did a large, painful, swollen bruise develop within 30 minutes of an injury? Note: A large bruise is the size of the injured person's palm. If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
	Yes	Do you bruise easily, or do your bruises seem to last a long time? When to See a Doctor See significance of bruising easily or bruising that lasts a long time if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Are you worried about how easily you bruise? Yes Have bruises from an injury lasted longer than 2 weeks? If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home Treatment

If your bruise does not require an evaluation by a health professional, you may be able to use home treatment to help relieve pain, swelling, and stiffness.

• Rest and protect a bruised area.
• Ice will reduce pain and swelling. Apply ice or cold packs immediately to prevent or minimize swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day.
  • For the first 48 hours after an injury, avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages.
  • After 48 to 72 hours, if swelling is gone, apply heat and begin gentle exercise with the aid of moist heat to help restore and maintain flexibility. Some experts recommend alternating between hot and cold treatments.
• Compression, or wrapping the bruised area with an elastic bandage (such as an Ace wrap), will help decrease swelling. Don't wrap it too tightly, as this can cause more swelling below the affected area. Loosen the bandage if it gets too tight. Signs that the bandage is too tight include numbness, tingling, increased pain, coolness, or swelling in the area below the bandage. Talk to your health professional if you think you need to use a wrap for longer than 48 to 72 hours; a more serious problem may be present.
• Elevate the bruised area on pillows while applying ice and anytime you are sitting or lying down. Try to keep the area at or above the level of your heart to help minimize swelling.
• Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage the bruised area if it causes pain.
• If desired, apply a natural product directly to the bruise.
  • Witch hazel may help heal damaged veins.
  • Arnica may stimulate healing.
• Do not smoke or use other tobacco products. Smoking slows healing because it decreases blood supply and delays tissue repair. For more information, see the topic Quitting Tobacco Use.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• A bruise lasts longer than 4 weeks.
• Signs of skin infection develop.
• Symptoms become more severe or frequent.
• New symptoms develop.

Prevention

You cannot always prevent bruises, but most of the time bruises are not a cause for concern.

• If you take aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), or blood-thinning medicines (anticoagulants), keep regular appointments with your health professional so that he or she can monitor your medicine dosages and make any necessary changes or adjustments.
• Eat a variety of foods to avoid dietary deficiencies. Nutritional deficiencies of vitamins C, K, or B12, or folic acid can affect blood clotting. Include a daily selection of:
  • Whole-grain and enriched breads, cereals, and grain products.
  • Vegetables.
  • Fruits.
  • Milk, cheese, and yogurt.
  • Meats, poultry, fish, eggs, dried beans and peas, and tofu.
• Do not take dietary supplements that may increase bruising, particularly if you take a blood-thinning medicine. Dietary supplements that may increase bruising include fish oil, vitamin E, garlic, ginger, and ginkgo biloba.

Bruises are often the first sign of abuse. You may be able to prevent further abuse by reporting it and seeking help.

• Call your local child or adult protective agency, police, or clergy or a health professional (such as a doctor, nurse, or counselor) if you suspect abuse.
• Seek help if you or someone you know is a victim of domestic violence.
• Seek help if you have trouble controlling your anger with a child in your care. Resources are available.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your health professional diagnose and treat your condition by being prepared to answer the following questions:

• Do you have a personal or family history of bleeding disorders or bruising easily?
• Are you taking any prescription or nonprescription medicines? Bring a complete list of your medicines with you to your appointment.
• Do you take any vitamins or dietary supplements? Describe your diet.
• Have you had any recent injuries or blood transfusions?
• Have you had any nosebleeds, bleeding gums, blood in the urine, unusual or unexpected heavy menstrual flow, or fever?
• Have you had any recent illness or changes in your health?
• Have you recently traveled outside the country or to a rural area?
• Do you have any health risks?

Related Information

• Abdominal Pain, Age 11 and Younger
• Abdominal Pain, Age 12 and Older
• Abnormal Vaginal Bleeding
• Arm Injuries
• Burns
• Chest Pain
• Child Abuse and Neglect
• Cuts
• Eye Injuries
• Facial Injuries
• Finger, Hand, and Wrist Injuries
• Head Injury, Age 3 and Younger
• Head Injury, Age 4 and Older
• Healthy Eating
• Hemophilia
• Hip Problems, Age 11 and Younger
• Hip Problems, Age 12 and Older
• Knee Problems and Injuries
• Male Genital Problems and Injuries
• Nail Problems and Injuries
• Nose Injuries
• Nosebleeds
• Physical Abuse
• Puncture Wounds
• Rectal Problems
• Scrapes
• Shoulder Problems and Injuries
• Toe, Foot, and Ankle Injuries
• Von Willebrand's Disease

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