What Is Ecchymosis?

Medically Reviewed By Cynthia Taylor Chavoustie, MPAS, PA-C
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Ecchymosis refers to blood pooled under the skin. This is what causes the purple coloration of bruising. An injury that breaks the blood vessels near the skin’s surface is the usual cause of ecchymosis. Sometimes, however, a bruise may appear for an unknown reason. This may cause concern. 

This article goes over what ecchymosis is and what other symptoms it can cause. You can also learn about the different causes and when you should reach out to your doctor about your bruising. This article also covers the treatment options available for ecchymosis.

What is ecchymosis?

A bruised knee
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Ecchymosis is an injury that damages the tissues under the top layer of skin but does not break the skin. Small blood vessels under the skin break and bleed into the connective tissue. There is also some swelling from the body’s inflammatory response to the injury. 

There are several different types of bleeding under the skin. These are as follows: 

  • Petechiae are tiny red dots under the skin from broken blood vessels. These are less than 4 millimeters (mm) in diameter. 
  • Purpura is a collection of blood under the skin or mucous membranes in the mouth. It is 4–10 mm in diameter.
  • Ecchymosis is an even more extensive blood collection under the skin. It is greater than 10 mm in diameter.

Ecchymosis vs. bruising

Ecchymosis and bruising almost mean the same thing. Both refer to the presence of blood pooled under the skin. 

The cause of a bruise is an injury. Sometimes, the cause of ecchymosis is not known. However, random ecchymosis appearing on the skin can cause concern. 

Ecchymosis only occurs under the skin, whereas bruising can also happen in the muscles and bones. 

What are the symptoms of ecchymosis?

The main symptom of ecchymosis is purple discoloration of the skin. It can also cause tenderness and swelling. 

Ecchymosis typically begins as a pinkish-red color that may be tender to the touch. Then, it becomes a deep purple. Then, as the body heals the area and breaks down the blood, it turns bluish, then green and yellow. Finally, the skin returns to its regular coloring. 

Visit our hub to read about injuries and wounds.

What causes ecchymosis?

Many things can cause you to develop ecchymosis, such as trauma, medications, and genetic disorders. The sections below look at some causes in more detail.

Injuries

Any bump to your body that is hard enough to break the tiny blood vessels under your skin can cause bruising. These include:

  • minor injuries
  • falls
  • getting hit by an object
  • small collisions

Lupus

Lupus is an autoimmune disorder that causes widespread inflammation in the body and can affect blood clotting. Genetics, the environment, and hormonal factors are possible factors driving lupus.

The condition can range from mild to severe, and treatment should come from a team of healthcare professionals who specialize in lupus. There is currently no cure.

Altered coagulation

Your body’s design is to stop bleeding when it gets injured. This keeps us from bleeding out at the slightest injury.

However, some people are born with clotting disorders. The most common bleeding disorders are:

  • Hemophilia A: This is a genetic disorder affecting 1 in 5,000 male births.
  • Hemophilia B: This is a genetic disorder affecting 1 in 30,000 male births.
  • von Willebrand’s disease: This disease affects 1% of the general population.

Usually, the diagnosis is made at birth, but mild to moderate cases may go undiagnosed until a significant trauma or surgery makes the condition apparent.

With medical treatment, people born with coagulation disorders can live full lives.

Vitamin K deficiency

Vitamin K is a vitamin you get from the food you eat. It helps your blood clot and stops bleeding.

Vitamin K deficiency is often a problem for newborns, and this is why they typically receive a vitamin K shot at birth. However, there are times when it can affect adults as well. It happens to individuals who have difficulty absorbing the vitamin K from their diet and those who are taking medications that interfere with vitamin K absorption. 

Thrombocytopenia

Thrombocytopenia is when your body has low platelets. Platelets are made in the bone marrow to form blood clots and stop bleeding.

When your body has low platelets, it can bleed more easily. As a result, even the smallest of bumps against your skin can cause a large bruise. 

Chemotherapy and radiation therapy

Bleeding is a common issue for people going through cancer treatments. It might appear as bruises, petechiae, nosebleeds, or other presentations.

Sometimes, your doctor will need to adjust your medications if the bleeding becomes too severe. 

Anticoagulant use

Anticoagulant medications, also called blood thinners, can help prevent blood clots. They do not actually make your blood thinner, but they prevent your blood from clotting too quickly.

There are injectable blood thinners such as Lovenox and heparin, and some come in pill form, such as warfarin. While taking these medications, your doctor will need to closely monitor your blood work to ensure that the dosage is correct for you. 

Leukemia

Leukemia is a cancer of the blood and bone marrow. It most often affects adults over the age of 55 years but can also affect children. This type of cancer can cause low platelets, leading to easy bruising and bleeding.

Treatment is typically chemotherapy.

Learn more about easy bruising here.

When should you contact a doctor for ecchymosis?

Contact your doctor if you have:

  • bleeding under the skin for no known reason
  • bruising that does not go away
  • extreme pressure under the skin where the ecchymosis is
  • increased bruising while taking a blood-thinning medication

What are the treatment options for ecchymosis?

After an injury, place ice on the bruising area to reduce swelling and speed up recovery. Wrap the ice pack in a towel and do not place it directly on the skin.

Ice the area for 10–15 minutes about two to three times on the first day. After the first day and when the bruising is healing, applying a warm compress will increase circulation, helping your body reabsorb the blood and make the bruise go away faster.

Try to rest the bruised area and take acetaminophen (Tylenol) if needed for pain

If your ecchymosis is not due to an injury, your doctor may need to run some tests to determine the underlying cause. 

If you take anticoagulant medications, your doctor may need to adjust the dosage.

Other treatments depend on the underlying cause. 

Summary

Ecchymosis is very similar to bruising. It is a blood collection under the skin, usually as a result of breaking blood vessels from trauma.

Bruising not due to trauma is sometimes due to medications or clotting disorders.

Carefully treat your bruises. Ice them initially to help your blood clot, then apply heat to improve circulation and help the bruise go away faster.

If you notice bruising for no known reason, let your doctor know.  

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Medical Reviewer: Cynthia Taylor Chavoustie, MPAS, PA-C
Last Review Date: 2022 May 17
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