Bruises

WHEN TO SEE YOUR DOCTOR

* Bruises appear easily and frequently.

* Bruises typically take longer than a week to disappear.

* You're suddenly getting more unexplained bruises than usual.

What Your Symptom Is Telling You

Ice skating with your niece was loads of fun—you only took one spill. But it was a doozy. The next day, the bluish purple marks on your shins and hip made you look like you tumbled down two flights of stairs.

Unless you live in a bubble, you're bound to bump into something—whether it's an ice-covered rink or the edge of a desk—or something is bound to bump into you. When a blow occurs, blood vessels rupture under your skin and blood spills into the surrounding area. The spilled blood shows through the skin as a darkened bruise.

Once the vessels are ruptured, the area swells as scavenger cells flood in to cart off injured cells. The swelling cuts off oxygen, making the hemoglobin in the blood turn blue. Later, as the hemoglobin breaks down, the bruise turns yellowish green and then brown.

"The size and shape of your bruise depends on the force of the blow as well as where your body is hit," says Jerome Z. Litt, M.D., assistant clinical professor of dermatology at Case Western Reserve University School of Medicine in Cleveland. If you lightly bump your forearm on a doorknob, he says, a minor number of blood vessels may be damaged and the resulting bruise is barely noticeable. On the other hand, if the furniture mover knocks into your hip full-force with a 50-pound table, many blood vessels will be crushed. You'll wind up with a nasty bruise the size of a hockey puck.

And if a blow occurs over a bone where the skin is thinner—around your eye, for instance—the bruise and swelling are likely to be more even prominent.

Women generally have skin that is more easily bruised than men. One reason is that their skin is thinner, possibly because the female hormone estrogen softens the blood vessels and affects the supporting network of collagen beneath the skin.

Another reason may be that one in ten women has a mild platelet defect (platelets are blood cells that play a role in clotting). "This doesn't pose a noticeable problem unless they take an aspirin-containing product," says Sandor Shapiro, M.D., director of hematology at Jefferson Medical College of Thomas Jefferson University in Philadelphia. "Aspirin interferes with platelet function for several days. This means that if you take one aspirin today, it can still interfere with clotting five to six days later."

Bumping into a desk corner during that time can make you look like you got in the way of a champion kick-boxer. Aspirin may also contribute to bruising in men.

Both sexes are more prone to bruising once they hit middle age, when the protective tissue and supporting fibers of the blood vessels beneath the skin naturally begin to break down. Plus, a lifetime exposure to the penetrating rays of the sun weakens the collagen and other elastic fibers. This makes the vessels in the upper skin layers vulnerable, especially in sun-exposed areas such as the backs of the hands and arms. The vessels in these areas can rupture at the slightest tap.

Easy bruising may also be a side effect of birth control pills, arthritis medications and some diuretics (medications that flush excess water from the body). Corticosteroids (cortisone-like drugs) may also contribute to easy bruising. These powerful anti-inflammatory agents relieve swelling in asthma, rheumatoid arthritis and itchy skin rashes.

In rare cases, unexplained bruising can signal a clotting disorder or immune problem.

Symptom Relief

Here's how to minimize the bumps and bruises you're bound to get along the road of life.

Apply icy pressure, pronto. If you've just bumped into something and you know it's going to cause a bruise, immediately press the area with ice wrapped in a washcloth for seven minutes or so. "This keeps blood from leaking out of vessels and will minimize the black-and-blue marks," says Robert E. Clark, M.D., Ph.D., director of the Dermatologic Surgery and Cutaneous Oncology Unit at Duke University Medical Center in Durham, North Carolina. Ice also helps deaden the pain, he adds.

Give a lift to a just-bumped limb. Raising a bruised arm or leg above the level of your heart will keep blood from pooling in the injured area.

Try warm compresses. Applying a warm washcloth a day or two after an injury helps disperse the extra red blood cells into the tissues. Hold the warm cloth in place for about 20 minutes. The dark area may fade more quickly, says Dr. Litt.

Apply a dab of zinc oxide. "Never bandage a bruise," says Dr. Litt. But covering the bruise with a coating of zinc oxide—a common ingredient in many first-aid creams—before going to bed provides a protective shield and may nudge healing in some way, he says. Both topical and oral zinc play an important role in wound healing.

Try a little arnica. The American Indians knew what they were doing when they smeared the juice of the arnica bush on bruises, according to Varro E. Tyler, Ph.D., a plant-drug specialist and professor of pharmacognosy at Purdue University in West Lafayette, Indiana. "Several years ago, a German study found two substances in this herb that produce anti-inflammatory and painkilling effects," says Dr. Tyler. Health food stores sell ready-made arnica ointments such as Antiflora, which may help bruises disappear. They should contain at least 10 percent arnica to be effective, says Dr. Tyler.

Reach for vitamin C skin cream. The latest "miracle" ingredient to show up in skin cosmetics is vitamin C. This one seems to have some merit. "Vitamin C penetrates the skin deeply and may help build up the skin's support structure of collagen," says Dr. Clark. "This may reduce your vulnerability to bruising."

Vitamin C also helps toughen up older skin, protecting against fragility and bruising. "Preliminary studies have shown that when vitamin C is applied to fresh bruises in older people, the discoloration is minimized," says Douglas Darr, Ph.D., assistant research professor at Duke University Medical Center. Dr. Darr's own research has found that topical vitamin C helps prevent damage from past overexposure to sunlight and inactivates harmful substances that corrode the cells and further age the skin. A few of these products are now available; ask your dermatologist.

Swallow vitamin C, too. "Taking 500 to 1,000 milligrams of vitamin C daily may help enhance skin collagen formation and make blood vessels less brittle," says Dr. Clark. Taking vitamin C may be especially important if you also take aspirin or corticosteroids for arthritis. During a study, British researchers observed that arthritis inflammation robs the body of vitamin C, and aspirin and steroids used to combat the disease also tend to drain the body of this nutrient, weakening the capillaries. When people were given 500 milligrams of vitamin C daily, their bruises showed rapid improvement. Before taking large doses of any vitamin, including vitamin C, you should get the consent of your doctor.

Become an oyster lover. Shellfish as well as beef and chicken is an excellent source of zinc. This mineral may help keep blood cells from leaking out of the blood vessels following injury, according to Joseph Bark, M.D., chairman of the Department of Dermatology at St. Joseph's Hospital in Lexington, Kentucky. You may also want to take a daily multivitamin/mineral supplement that contains zinc.

Switch to acetaminophen. Unlike aspirin and ibuprofen, this painkiller does not affect platelet function, says Dr. Shapiro.

Go easy on rash cream. If you are using an over-the-counter hydrocortisone cream for an itchy skin condition, don't use it for more than one to two weeks. "These products have the potential to thin the skin and make you more prone to bruising," says Dr. Clark. Be especially careful not to overuse these products in moist areas, such as the armpit and groin, where they can more easily penetrate the skin, he adds.

Check your medications. Make a list of all medications you're taking—both prescription and over-the-counter drugs—and show it to your doctor. Your doctor may be able to suggest changes that will help prevent excess bruising.