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Ecchymosis

What Is It, Causes, Symptoms, and More

Author: Lily Guo

Editors: Alyssa Haag,Jozia McGowan, DO

Illustrator: Jessica Reynolds, MS

Copyeditor: David G. Walker

Modified: 13 May 2022


What is ecchymosis?

Ecchymosis, commonly known as a bruise, refers to the discoloration of the skin due to the rupture of the blood vessels below the surface of the skin. Ecchymoses are typically described as purpuric (i.e., purplish patches) and do not blanch (i.e., briefly become white or pale in appearance) when pressure is applied. Generally, they are greater than one centimeter in size and take approximately one to three weeks to completely heal. 

Other conditions that may resemble ecchymosis include hematomas, petechiae, and purpura. Hematomas are typically larger in size; cover more of the body; and are raised, firm, and painful. Petechiae are pinpoint spots on the skin that are usually less than 0.3 centimeters in diameter, while purpura are smaller than ecchymoses but larger than petechiae

Back of a hand with purple bruising

What does ecchymosis mean?

Ecchymosis is derived from the Greek word ekkhumōsis which means “escape of blood.” In the case of ecchymosis, the blood “escapes” from the damaged blood vessels and seeps into the surrounding tissue, causing the characteristic blue-purple discoloration. 

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What causes ecchymosis?

Ecchymosis is caused by the leaking of blood from blood vessels into the subcutaneous tissue that underlies the skin. The most common cause is trauma (e.g., blunt force to the skin, leading to the rupture of capillaries) and it may affect various regions of the body. Ecchymosis of the eyes is also known as periorbital ecchymosis or raccoon eyes, which is indicative of a contusion or blunt injury that has caused a skull fracture. Periorbital ecchymosis can be associated with Battle sign, bruising in the mastoid region located behind the ear, and may suggest underlying brain trauma. Additionally, if someone is in a motor vehicle accident, they may develop an ecchymosis pattern in the distribution of a seatbelt across the abdomen, chest, and neck. 

Underlying diseases can also predispose someone to ecchymoses, including aplastic anemia, which is a condition where the bone marrow halts production of new blood cells due to autoimmune destruction of stem cells in the bone marrow. Leukemia, acute renal failure, cirrhosis, clotting disorders (e.g., hemophilia, Von Willebrand disease), and vitamin K deficiency can also lead to ecchymosis. If ecchymoses are present surrounding the umbilical region, they are referred to as Cullen sign and might suggest the presence of liver cirrhosis, pancreatitis, or a ruptured cyst within the abdominal cavity. Additionally, lateral abdominal wall bruising, known as Grey-Turner sign, raises suspicion for a ruptured abdominal aneurysm, ruptured spleen, an intrauterine pregnancy, bilateral salpingitis (i.e., inflammation of the fallopian tubes), or hemorrhagic pancreatitis. Both Cullen sign and Grey-Turner sign indicate the presence of retroperitoneal hemorrhage (i.e., bleeding stemming from the structures behind the peritoneum, which is the membranous covering of the abdominal cavity). 

What are the signs and symptoms of ecchymosis?

The signs and symptoms of ecchymosis include bluish-purple discoloration limited to the upper layer of the skin, with a characteristic flat appearance. They are typically one centimeter or larger, and the individual may experience occasional pain, inflammation, and subsequent swelling around the lesion. Additionally, the area may be tender to touch. As the ecchymosis progresses and heals, the color will typically turn from dark purple and blue to yellow or green in color due to the biochemical breakdown of hemoglobin (i.e., an oxygen-carrying molecule found in the blood). It is more common to see ecchymosis in active children who may bump into objects and fall frequently, as well as in older adults since the skin thins and capillary walls grow more fragile with increasing age. Finally, it is also more common for bruising to appear in areas where the skin is thinner, such as the eyelids or lips

How is ecchymosis diagnosed and treated?

Ecchymosis is typically diagnosed on close examination by a clinician. Once identified as an ecchymosis, the underlying cause should be investigated. Various blood tests, including a platelet count and vitamin K levels, may be ordered to identify an underlying cause. 

Typically, ecchymoses will resolve on their own. However, treatments may depend on the underlying cause (e.g., vitamin K supplements for vitamin K deficiency). Nonetheless, various conservative measures can be utilized to assist in healing. Resting the area can help with tissue repair and swelling reduction, particularly if the ecchymosis is located in an area prone to movement, such as the lower extremities. Applying cold compresses as soon as possible after the injury and elevating the affected body part can help to constrict the damaged blood vessels and prevent increased spreading of the blood. Over-the-counter medications, such as acetaminophen, can be used to relieve pain if the bleeding is not the result of a more severe medical condition, such as liver cirrhosis

What are the most important facts to know about ecchymosis?

Ecchymosis, also known as a bruise, refers to the blue or purple skin discoloration that occurs as a result of rupture of blood vessels under the skin. Oftentimes, pain and tenderness accompany the discoloration. Ecchymoses are frequently due to trauma but can also be a sign of underlying medical conditions, including aplastic anemia, liver cirrhosis, renal failure, and vitamin K deficiency. Most bruises begin as a purple-blue color and gradually turn green-yellow, are typically larger than one centimeter in size, and are commonly seen in active children and the elderly. Treatment depends on the underlying cause. Conservative measures include rest and cold compresses. Most mild bruises can be treated at home; however, one should seek medical attention if the cause of bruise is unknown as it can indicate an underlying health condition. 

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Related links

Coagulation disorders: Pathology review
Abdominal trauma: Clinical practice
Hemophilia
Bleeding disorders: Clinical practice
Platelet disorders: Pathology review

Resources for research and reference

Davis, C. P. (2020). Hematoma vs. ecchymosis: Differences and similarities. In eMedicineHealth. Retrieved January 27, 2022, from https://www.emedicinehealth.com/hematoma_v_ecchymosis/article_em.htm 

Ecchymosis. In ScienceDirect. Retrieved January 27, 2022, from https://www.sciencedirect.com/topics/medicine-and-dentistry/ecchymosis 

Lewin, J. (2018, May 27). What is ecchymosis?. In Medical News Today. Retrieved January 27, 2022, from https://www.medicalnewstoday.com/articles/321943#symptoms 

Mallidi, R. Q. (2017, August 23). Ecchymosis. In MedIndia. Retrieved January 27, 2022, from https://www.medindia.net/patientinfo/ecchymosis.htm