Ecchymosis · What Is It, Causes, Symptoms, and More

Ecchymosis, commonly referred to as a bruise, is the discoloration of the skin resulting from the rupture of blood vessels beneath the skin’s surface. Ecchymoses are typically described as purpuric (i.e., purplish patches) and do not blanch (i.e., briefly become white or pale when pressure is applied). They are usually greater than one centimeter in size and take approximately one to three weeks to heal completely.  

Other conditions that may resemble ecchymosis include hematomas, petechiae, and purpura. Hematomas are typically larger, covering a broader area of the body, and appear raised, firm, and painful. On the other hand, petechiae are pinpoint spots on the skin, usually less than 0.3 centimeters in diameter. Therefore, ecchymoses are larger than petechiae but smaller than hematomas.  

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

Underlying diseases can also predispose individuals to ecchymoses. Aplastic anemia is a condition in which the bone marrow halts production of new blood cells due to autoimmune destruction of its stem cells, resulting in a reduced number of platelets – blood components essential for blood clotting – and increased risk of bruising and bleeding. Leukemia, acute renal failure, cirrhosis, clotting disorders (e.g., hemophilia, Von Willebrand disease), and vitamin K deficiency can also lead to ecchymosis.  

Ecchymoses surrounding the umbilical region, referred to as Cullen sign, might be indicative of underlying acute pancreatitis, ruptured ectopic pregnancy, and perforated duodenal ulcers, among others. Additionally, lateral abdominal wall bruising, known as Grey-Turner sign, should raise suspicion for a number of conditions including acute pancreatitis, ruptured abdominal aneurysm, ruptured spleen, bilateral salpingitis (i.e., inflammation of the fallopian tubes) in intrauterine pregnancies. In general, both Cullen and Grey-Turner sign indicate the presence of intraperitoneal or retroperitoneal (i.e., behind the peritoneum, the membrane lining the abdominal cavity) hemorrhage.  

Ecchymosis is typically diagnosed by physical examination. Once identified, the underlying cause should be investigated. Various blood tests, including platelet count and vitamin K levels, may be ordered to identify the underlying cause.  

Ecchymoses typically resolve spontaneously. However, treatments may depend on the underlying cause - e.g., vitamin K supplements may be used if vitamin K deficiency is present. Nonetheless, various conservative measures can be utilized to promote healing. If the ecchymosis is located in an area prone to movement, such as the lower extremities, rest can help with tissue repair and swelling reduction. Applying cold compresses as soon as possible after the injury, along with elevating the affected body part, can help constrict the damaged blood vessels and reduce the spread of bleeding into surrounding tissues. Over-the-counter medications, such as acetaminophen, can be used to relieve pain - provided the bleeding is not due to a more severe medical condition, such as liver cirrhosis.