During daily life, redness and bruising on the skin can appear as a result of minor or major accidents, different illnesses, or for no apparent reason. These red or bruised areas, often called contusions or bruises, can indicate serious health problems when they appear without a known cause. If the redness is due to a trauma-related injury resulting in blood pooling, it is known as ecchymosis.
While ecchymosis can occur at any age, it is more common in children and the elderly. This is due to their more fragile physical structures and a higher likelihood of falls or accidents. Ecchymosis can also result from simple causes like bumping into furniture at home.
It is most frequently seen on the arms and legs. Most cases of ecchymosis cause only mild discomfort at the site and heal on their own. Since the redness and bruising are visually unappealing, creams can be used to speed up the healing process.
What is Ecchymosis?
Ecchymosis is a type of bleeding seen under the skin due to damage to the capillaries. Blood that leaks under the skin accumulates in a specific area, creating a contusion-like bruise with a red or purple color. Over time, the color fades, changing from blue to green, brown, and yellow before disappearing. The size and shape of the ecchymosis vary depending on the intensity of the impact and the type of object causing the injury.
Bleeding from damaged capillaries can spread to surrounding tissues, favoring softer tissues over more rigid ones. In ecchymosis, the bleeding does not rise to the skin’s surface and does not cause swelling.
If there is swelling on the skin, it is called a hematoma, not ecchymosis. While a hematoma is a deep accumulation of blood, ecchymosis occurs just under the skin. In ecchymosis, red blood cells that escape from the damaged vessel accumulate under the skin while platelets gather around them, causing the ecchymosis to expand. Platelets help the clotting process, gather at the injured area, complete clotting, and repair the damage. This stops the blood leak, and over time, the ecchymosis heals, fades, and disappears.
What Are the Causes of Ecchymosis?
The most common cause of ecchymosis is trauma, but it can also occur for many other reasons. Various diseases, infections, injuries, or any condition that disrupts tissue integrity can cause ecchymosis. The causes can be categorized into individual factors and environmental factors. Some individual factors that lead to ecchymosis include:
- Platelet Count: When a person’s platelet count is lower than normal, blood leakage lasts longer, causing ecchymosis.
- Medications: Long-term use of anticoagulant medications can make a person more prone to bleeding because the blood thins. Since anticoagulant drugs slow down clotting, bleeding lasts longer and causes ecchymosis.
- Clotting Disorders: If there is a clotting disorder, the damaged vessel will not close quickly, resulting in more bleeding and ecchymosis. The primary cause of clotting disorders is a deficiency in clotting factors.
- Activated Partial Thromboplastin Time (APTT): Normally, the APTT value should be between 25-35 seconds. If it exceeds 100 seconds, bleeding is very likely.
- Carelessness: Carelessness is another individual factor that can lead to ecchymosis. Frequently bumping into things or falling due to carelessness may result in ecchymosis.
Environmental factors, like accidents or medical procedures, can also lead to ecchymosis. Here are some reasons why medical interventions might cause ecchymosis:
- Injection Site: Different injection types require specific injection sites. An inappropriate injection site can cause ecchymosis.
- Injection Needle: The needle must move correctly within the tissue at the right angle. Otherwise, it can damage tissues and cause bleeding.
- Medication Injection: Ecchymosis may occur during medication injections for various reasons, depending on the type of medication and the person administering it.
- Airlock Technique: When irritating medications are used, the airlock technique can minimize irritation. This reduces tissue damage, preventing ecchymosis.
- Aspiration Application: If aspiration is applied, the needle may move and damage tissues, causing ecchymosis.
- Administered Medication: The type of medication and the duration of administration can influence the formation of ecchymosis.
What Are the Types of Ecchymosis?
Types of ecchymosis vary based on size, shape, and location. Depending on where it appears, there are migratory or stationary types of ecchymosis. In migratory ecchymosis, if the injured area is on a firm or taut tissue, the blood leak moves towards surrounding soft tissues. A common example is when a blow to the forehead results in bruising under the eyes.
Because the area under the eyes is rich in capillaries and is a soft tissue, bleeding accumulates there, creating migratory ecchymosis. Stationary ecchymosis, on the other hand, refers to bleeding and color change at the site of trauma.
Subcutaneous injections, which are injections administered under the skin, are a typical example of stationary ecchymosis. Hematomas or ecchymosis are common during subcutaneous injections because if the procedure is not performed gently or the needle does not move correctly, it can damage the blood vessels and cause bleeding.
Types of ecchymosis can also be classified based on the extent of blood spread. These include:
- Petechiae: 1-2 mm pinpoint-sized bleedings, known as petechiae.
- Purpura: 3-5 mm bleedings under the tissue, called purpura.
- Ecchymosis: When the bleeding area is about 1-2 cm, it is classified as ecchymosis.
Thus, purpura and petechiae are types classified based on the size of the ecchymosis. Another type is based on the shape of the bruise, which varies according to the type of instrument causing the trauma. Injuries from cutting, piercing, or crushing tools create different shapes of ecchymosis, making it an essential clue in forensic cases. It provides information on what type of object was used during an attack and when the incident occurred.
What is the Difference Between Hematoma and Ecchymosis?
Hematoma and ecchymosis are often confused. The similarity between them lies in the color change seen on the skin’s surface due to bleeding. They differ in their locations and the appearance caused by the impact.
Ecchymosis is a condition that appears just under the skin, while a hematoma is deeper and can even occur inside organs. In ecchymosis, the damaged tissue forms a smooth patch, while in a hematoma, the patch can be larger and swollen. Therefore, while there is no swelling in surface-level ecchymosis, a hematoma will often cause redness and swelling on the skin’s surface.
If you notice an unexplained bruise or redness on your body, it may indicate a significant health problem, so you should not neglect to see a doctor. The doctor will determine the cause through examination, tests, and analyses, and apply the appropriate treatment.