Dear Doctor Column, November 3, 2003

Easy Bruising Usually Not Serious Sign

Question:

It seems as though every day I have a new bruise somewhere on my body. I don’t remember bumping into anything or being hit. I can be asleep and awake with a new bruise. What could be causing this to happen? Could it be a deficiency of some kind?

Answer:

An increased tendency to bruise sometimes reflects an abnormality of blood vessels, a deficiency in blood-clotting factors, or an abnormality of blood elements called platelets that stick together to plug leaking blood vessels. For most people, however, easy bruising does not indicate a serious medical problem; they simply have an increased tendency to bruise. And being fair skinned does not help, since bruising tends to look more intense on pale skin.

Skin is composed of several layers — the paper-thin outer layer called the epidermis; the middle layer called the dermis, which contains a network of tiny blood vessels; and a fatty layer that contains larger blood vessels and acts as a shock absorber between the skin, muscle, and bones. The thinner these layers are, the more likely you are to bruise. That is why women generally bruise more easily than men — their skin is thinner than a man's. It also explains the increased bruising as we age.

When you bump into something like a table with enough force, you crush blood vessels in the skin. Blood from the vessels seeps into the surrounding tissue, resulting in a bruise. The more blood that leaks, the darker and larger the area becomes.

Certain medications can contribute to excessive bruising, or worsen the situation for anyone prone to the problem. For example, aspirin interferes with the blood's ability to clot, increasing the risk of bruising. Certain dietary supplements, including fish oil, vitamin E, garlic, ginger, and Ginkgo biloba, also can contribute to easy bruising, especially if you are taking a blood thinner.

Other factors that can lead to frequent bruising include: steroids — often taken to help asthma, arthritis, or adrenal gland problems; aging and sun exposure — both decrease the skin's elasticity and increase the chance of damaging blood vessels; and deficiencies of vitamins C and K. Although uncommon, vitamin K deficiencies can result from antibiotic use of a month or longer. If you need to use antibiotics for an extended period, increase the amount of green leafy vegetables in your diet. To boost vitamin C levels, eat citrus fruits, kiwi, cantaloupe, and vegetables such as broccoli, cabbage, and green peppers.

Anyone who has a severe tendency to bruise or has a history of frequent or prolonged bleeding from other areas of the body, such as from the nose, mouth, gums, or rectum, should call their physician without delay for a thorough evaluation. Bruises on areas of the body that normally do not get bumped, such as the chest or the middle of the back, or bruises that are accompanied by other symptoms, such as fatigue, fever, or enlarged lymph nodes, or even cuts and scrapes that continue to bleed despite pressure, may be signs of an underlying problem that needs prompt medical attention.

If you are concerned about your bruising or think it is becoming worse, see your doctor. You can limit some of the discoloration of a bruise by immediately applying ice to the injured area for 15 to 20 minutes. Light pressure over the area and elevating your injured arm or leg also can slow bleeding and limit the extent of a bruise. Wearing long-sleeved shirts and pants may offer a layer of protection for your skin and help minimize your risk for bruising. Protecting your skin from sun damage is also helpful.