What is a bruise?
A bruise, or contusion, is skin discoloration from a skin or tissue injury. This injury damages blood vessels underneath the skin, causing them to leak.
When blood pools under the skin, it causes black, blue, purple, brown, or yellow discoloration. There’s no external bleeding unless the skin breaks open.
Who might get a bruise?
Everyone experiences bruising. Bruises can occur from a fall, accident, sports injury or medical procedure. Older people are more likely to bruise. There are some bleeding disorders that can lead to excessive bruising. There are also some medical conditions that may make you more prone to bruising.
You may be more prone to bruising if you:
- Have cancer or liver disease.
- Have family members who bruise easily.
- Take medications to thin blood or stop clotting, such as aspirin or blood thinners.
- Regularly take nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief, including ibuprofen (Advil®) or naproxen (Aleve®).
- Have a bleeding disorder such as hemophilia, von Willebrand disease or another blood clotting disorder.
- Experience a low blood platelet count (thrombocytopenia).
- Are deficient in vitamin C or vitamin K.
What are the types of bruises?
Your healthcare provider may refer to bruising by its medical term: ecchymosis (ech-e-moe-sis). Bruises are also called contusions. The different types of bruises include:
- Hematoma: Trauma, such as a car accident or major fall, can cause severe bruising and skin and tissue damage. A hematoma is a collection of blood outside the blood vessels that causes pain and swelling..
- Purpura: This type of bruising typically involves small bleeding that occurs under the skin.
- Petechiae: These are pinpoint areas (less than 2 mm) of reddish dots on the skin that do not turn white after applying gentle pressure.
- Senile purpura: As you age, your skin becomes thinner, dryer and more prone to tearing. Your skin also bruises more easily. This condition is known as senile purpura.
- Black eye: A blow to the head can cause a black eye (or two black eyes). Blood and fluids pool under the eye. This condition causes swelling and a bruise, or discolored ring, to form around the eye. A black eye can sometimes indicate a more serious eye injury, such as bleeding in the eye (hyphema), or a facial fracture.
Symptoms and Causes
What causes bruising?
After an internal blood vessel injury, blood pools under the skin causing the discolored, bruised look.
What are the signs of bruising?
Bruises are sometimes called black-and-blue marks. They may appear red or purplish at first. If you have darker skin, you may notice purple, dark brown or black bruising. As the area heals, the bruise may turn a lighter shade of brown, green or yellow. The bruised area and surrounding skin may also be tender to touch. A hematoma causes a swollen, raised, painful bump.
Diagnosis and Tests
How are bruises diagnosed?
You and your healthcare provider can identify a bruise by its distinct look and coloring. If you experience frequent or unexplained bruising, your provider may order tests to rule out possible causes. These tests include:
- X-rays to check for bone fractures.
- Blood tests to check for clotting disorders and vitamin deficiencies.
Management and Treatment
How is bruising managed or treated?
Most bruises fade away within two weeks without treatment. More severe bruising and hematomas may last a month or longer. These steps can help you heal faster:
- Rest and elevate the injured area to prevent swelling and relieve pain.
- Apply ice packs for the first 24 to 48 hours after injury. Wrap the ice pack in a towel and apply ice for no more than 15 minutes at a time. Repeat throughout the day.
- Apply a heating pad or warm compress to the injured area after two days. You can apply heat several times throughout the day.
- Take over-the-counter pain medication, such as acetaminophen (Tylenol®). Check with your doctor prior to using NSAIDs.
How can I prevent bruising?
Everyone experiences bruising. You can take these steps to lower your risk of injury and bruising:
- Keep floors and rooms clear of tripping hazards like throw rugs and shoes.
- Move furniture away from doorways and walkways to avoid bumping into hard surfaces.
- Turn on a light or flashlight when walking through poorly lit areas.
- Get enough vitamins in your diet.
- Wear protective gear like helmets and pads when playing contact sports, bicycling or riding a motorcycle.
Outlook / Prognosis
What is the prognosis (outlook) for people with bruising?
Bruises can be unsightly, but most bruises fade without treatment. Sometimes bruising is a sign of a more serious problem, so please talk to your doctor if you experience unexplained or large bruises. Certain types of bruises, such as hematomas and black eyes, may require medical attention.
When should I call the doctor?
You should call your healthcare provider if you experience:
- A black eye with vision problems.
- Bruising that lasts more than two weeks.
- Frequent large bruises.
- A lump in the bruised area (hematoma).
- Painful swelling.
- Pain that lingers days after the injury.
- A recurring bruise in the same location.
- Unexplained bruising.
- Unusual bleeding, such as nosebleeds, blood in the urine, or blood with bowel movements.
What questions should I ask my doctor?
You may want to ask your healthcare provider:
- What is causing the bruising?
- Why am I prone to bruising?
- Should I have blood tests to see if a condition is causing the bruises?
- What steps can I take to lower my risk of bruising?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Bruising is a common condition that affects everyone at some point. You should see your healthcare provider if you seem to bruise excessively or have unexplained bruising. Your provider will want to rule out certain conditions that may require treatment. Applying ice soon after an injury can minimize bruising. Most bruises go away without treatment within a couple of weeks.
Last reviewed by a Cleveland Clinic medical professional on 08/11/2020.