You don’t remember bumping into any furniture and you certainly haven’t gone for cupping therapy or injections lately. But there it is: A purplish-blue patch on your arm or leg that has seemingly come out of nowhere. Should you be worried about that bruise?
Bruises are basically what happens when blood vessels burst just underneath one’s skin, which consists of three layers.
While the outermost layer (epidermis) isn’t as easily damaged, the other two (dermis and subcutaneous tissues) are, explained Dr Adeline Yong, an associate consultant with National University Hospital's Division of Dermatology.
"When we develop a bruise, blood escapes from the ruptured capillaries and small veins, and spread into the surrounding tissue," she said. "It is the capillaries of the subcutaneous tissues that make the greatest contribution to bruising."
According to Dr Edwin Chng, the medical director of Parkway Shenton, most bruises heal in one to two weeks’ time, although some may take longer than that. “They start off red, then turn blue or purple. As they heal, bruises can turn green and yellow”.
It is the capillaries of the subcutaneous tissues that make the greatest contribution to bruising.
WHY YOU GET BRUISES – AND WHEN TO SEE A DOCTOR
So why do you get them when you think the furniture’s innocent?
Age could be a factor that makes you bruise as easily as a tomato, said Dr Yong. Ageing could cause your skin and subcutaneous tissue to thin, and your capillaries to weaken – all of which can increase your chances of bruising.
However, if you bruise "spontaneously without trauma", you should be concerned, cautioned Dr Yong, as it could be a sign of "an underlying bleeding disorder" that affects your blood platelet number and the way your blood coagulates.
Although rare, such disorders include haemophilia; factor II, V, VII, X, or XII deficiencies; von Willebrand disease; connective tissue disorders such as Ehlers Danlos syndrome; endocrine disorders such as Cushing’s syndrome and hypothyroidism; and blood cancers such as leukaemia and lymphoma, she said.
Take note if five or more bruises occur simultaneously – each bigger than 1cm in size – and found not only on your limbs, but also your trunk and other areas, said Dr Yong.
Such blue-black marks can also be caused by taking blood-thinning medication to prevent blood clots as well as deficiencies in protein and Vitamins C and K, said Dr Chng. To rule out concerns, see a doctor if your bruises are accompanied by these signs, he said:
- Bruises developing for no reason
- Bruises accompanied by fever
- Difficulty moving or walking because of the bruise
- Swelling of the joint caused by the bruise
- Unusual bleeding such as from the gums or in the urine
Age could be a factor that makes you bruise as easily as a tomato.
WHEN IT’S NOT JUST A BRUISE BUT A HAEMATOMA
Sometimes, a bruise isn’t just a bruise, especially if you’ve had a major fall or injury such as a car accident. What can result is a haematoma, which is a swollen, raised and painful bump (bruises are usually flat), according to Cleveland Clinic’s website.
Haematomas may require medical attention as the body may not heal them as easily as a minor injury, noted Medical News Today. “As a result, a haematoma stays the same colour, firmness and causes the same level of pain even after several days.”
Pain aside, another reason why you should let a doctor check your haematoma is because it could be a sign of injury to the internal organs if the bruise occurs with no known cause on the abdomen, head or trunk, according to Medical News Today. Get medical attention if your haematoma causes the following:
- Numbness in the arm or leg
- Loss of function of the joint, limb or muscle
- Keeps growing in size
- Recurs in the same spot or lasts longer than two weeks
- Happens alongside a broken bone
- Occurs on the head or neck
- Causes vision impairment
WHAT CAN HEAL BRUISES FAST?
Say you have a bruise despite your best effort to stay bump-free. What’s the best tip to help it heal fast?
If you’re thinking about rubbing a hard-boiled egg on it, Dr Yong pointed out that it “has not been shown to be effective in treating bruises.”
Dr Chng agreed – especially for the initial few days. "In the first few days, rubbing a hard-boiled egg over a bruise may actually worsen it," he said.
That's because the heat from the egg encourages blood flow to the area, causing even more internal bleeding, he said. On the other hand, an ice pack or cold pad would slow down the flow of blood leaking out and pooling underneath your skin.
If you want to use the egg method, massage the bruise only after 48 hours. "This works because the egg holds heat, which can help to open up the blood vessels to disperse the red blood cells from the bruise," he said.
As for arnica, a herb believed to treat bruises because of its anti-inflammatory and pain-relieving properties, Dr Yong said that "studies have shown that it is no more effective than placebo in treating bruising, pain and swelling".
What about hirudoid creams or gels? According to Dr Yong, they contain mucopolysaccharide polysulphate (MPS), which has been used for treating bruising, sports injuries and inflammation. "Existing data suggests that it is unclear if it is efficacious in relieving bruising," she said.
As for Vitamin K, which has been associated with helping blood to coagulate, Dr Yong is also not convinced that popping supplements would help your bruises to heal faster.
Applying an ice pack and elevating the affected limb can "reduce swelling and soothe pain" but it is "unclear if it helps in allowing bruises to heal faster", she said.
HOW AND WHEN TO ICE
If you are game to give cold therapy a go, consider putting a cold gel pack or a bag of ice on the bruise for 15 minutes every one to two hours, recommended Dr Chng. Repeat several times a day for a day or two as needed. “A thin towel should be used between your skin and the ice or other cold object,” he added.
The cold helps to slow down the flow of blood leaking out and pooling underneath your skin. On the other hand, a warm pack or heating pad would have the opposite effect as the heat encourages blood flow to the area.
“Raising the bruised area above the level of the heart also helps to reduce swelling,” said Dr Chng. If you wish, you can also take paracetamol or ibuprofen to reduce the pain and swelling, he added.
If you’ve been hit or punched in the face, apply an ice bag or cold gel pack as soon as possible to limit the swelling, recommended Healthline website. Hold the pack on the area for at least 10 minutes and no more than 30 minutes. Then, remove the pack for 15 minutes and repeat for about three hours.