February 21, 2019
Knee Contusion (Bruised Knee)

Bruises: What to Do

by Berkeley Wellness  

A bruise is a discoloration of the skin that appears shortly after an impact injury caused by a blow or a fall, for example. Such an injury causes damage to blood vessels and subsequent bleeding into the skin. Bruises can also arise from minimal trauma in people taking certain medications that interfere with blood clotting (including aspirin and warfarin) or that “thin” the skin (like corticosteroids). Older people bruise more easily than younger people because their skin is thinner and less elastic, and they have less subcutaneous fat, so their small blood vessels are not as well cushioned; also, their small blood vessels become more fragile and thus more vulnerable to tearing or rupturing.

Bruises typically start out as reddish tinges, but change to black-and-blue or purplish hues before finally turning greenish-yellow as the body reabsorbs the blood. The discoloration that appears on the skin is actually blood that has settled in the area below the skin surface.

Immediate care for bruises

Most bruises will heal by themselves in a week or so. But you can speed healing and get some pain relief with the following measures.

  • Immediately after receiving an impact likely to cause a bruise, apply firm direct pressure to the area and hold for at least 5 minutes. This minimizes bleeding and thus the amount of bruising.
  • If there is significant swelling, elevate the area if possible and apply a cold pack every hour or so for about 15 minutes. Continue for a day or two.
  • Don’t massage a bruise, since that may increase the bleeding.
  • If you initially need a pain reliever, take acetaminophen, rather than aspirin, ibuprofen, or naproxen (these drugs, known as NSAIDs, impair the clotting of blood).
  • There’s little evidence to support using topical vitamin K or hydrogen peroxide on bruises. Though some people (and some plastic surgeons) swear by it, evidence for applying arnica is limited—and conflicting.

When to seek medical help

Get medical attention if there is extreme swelling or pain, or if the bruise doesn’t go away after three or four weeks. Bruises over a joint should be evaluated if you can’t move the joint, as should bruises that appear behind the ears or under your eye after a head trauma.

If you bruise frequently or for no apparent reason, talk to your doctor to discuss possible contributing factors and rule out a more serious underlying problem, such as leukemia, a clotting disorder, or aplastic anemia. You may be able to change medications or lower the dose if that is the cause.

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