What causes bleeding into the skin?
In this article, we look at what bleeding into the skin is and what can cause it. We also cover diagnosis, treatment, and when to see a doctor.
What is bleeding into the skin?
When hemorrhaging occurs below the skin, it causes the surrounding area to darken.
If a blood vessel ruptures, the blood inside can leak into nearby tissues and spaces. This is known as hemorrhaging.
When hemorrhaging occurs directly below the skin, the blood can escape into the surrounding skin and cause it to discolor. Typically, this skin discoloration is a mixed shade of red, blue, black, or purple.
The number and type of blood vessels that rupture will affect the size and appearance of the skin discoloration, as well as the extent of the bleeding.
Breaking only a few small blood vessels, or capillaries, tends to cause petechial lesions. These are small red dots less than 2 mm in width that appear on the surface of the skin.
If more than a few capillaries rupture in the same area, they can cause purpura. People with this condition have larger patches of reddish-purple discoloration, which are generally between 2 mm and 1 cm in width.
When large numbers of capillaries break close together, blood can pool under the surface of the skin to form an ecchymosis. This is a bluish-purple or black bruise that can vary in size.
Most bruises present in a reddish color, but take on a darker black-blue shade within a few hours. As bruises heal, they tend to appear purple for some time before fading to a greenish-yellow color. Bruised areas of skin are usually quite tender and may be slightly swollen.
Bruises vary in their healing time from a few days to several weeks, depending on how severe they are. A moderate bruise typically takes around two weeks to fade away entirely. Bruises in the lower legs can sometimes take longer to heal.
Bruising is more likely to occur in places where the blood can pool more efficiently, such as under the eyes or around the breasts.
Bruising that occurs deep in the body tissues or cavities is a hematoma, which is a more severe condition.
Playing contact sports is one of the most common causes of bleeding under the skin.
Most people experience some bleeding under the skin and bruising during their lifetime. Common causes include:
- playing contact sports
- bumping into objects
- falling or slipping
- wearing ill-fitting glasses, clothing, or shoes
- having an allergic reaction
- giving birth or being born
- using certain medical devices, such as braces, crutches, or casts
- straining from vomiting, coughing, or crying
Bleeding into the skin can also occur as a side-effect of:
Several health conditions and medications can also interfere with the body's ability to form blood clots. This can lead to excessive or spontaneous bleeding and bruising.
Conditions likely to increase the risk of bleeding and bruising include:
- systemic lupus erythematosus
- kidney or liver disease
- aplastic anemia
- disseminated intravascular coagulation
- thrombotic thrombocytopenic purpura
- hemolytic uremic syndrome
- vitamin C, K, B12, or folic acid deficiency
- strep throat
- blood infections
- scarlet fever
- infective endocarditis
- Marfan syndrome
- Ehlers-Danlos syndrome
- von Willebrand's disease
Common medications that can increase the risk of bleeding and bruising include:
- nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and diclofenac
- blood-thinning medications and anticoagulants such as aspirin, clopidogrel, apixaban, rivaroxaban, warfarin, and heparin
- systemic or topical corticosteroids
Other factors that also increase the risk of bleeding into the skin and bruising include:
- playing a lot of contact sports
- working in a job that involves physical labor, such as construction, landscaping, or building
- being over the age of 65
- consuming excessive quantities of alcohol
- smoking or using tobacco products
- taking specific health supplements, such as fish oils, high-dose vitamin E, gingko biloba, St. John's wort, and garlic
Doctors will usually carry out a physical exam when diagnosing bleeding into the skin and the resulting lesions.
The doctor may also review the person's medical history, asking questions about:
- potential causes of the lesions or bruises
- all symptoms, including symptoms that may seem unrelated
- medication use, especially blood-thinning drugs and NSAIDs
- previous injuries or surgery
- family medical history
- use of herbal supplements or natural medications
If a doctor sees someone with a lot of bruises or frequent bruising, they may also need to ask them some questions to rule out the possibility of physical abuse and violence.
If the doctor is unsure of the cause or thinks there could be an underlying medical condition, they might order some diagnostic tests. Possible tests include:
- complete blood count test
- platelet count test
- coagulation test
- urine analysis
- bone marrow biopsy
Treatment and home remedies
Applying an ice pack to the affected area for 10-15 minutes can help reduce bleeding into the skin.
There is no specific way to treat minor skin bleeding and bruising. However, some home remedies may help reduce the pain and swelling and promote healing.
Common home remedies for minor bleeding into the skin and bruising include:
- Applying an ice pack to the area for 10–15 minutes as soon as possible and then repeating this several times a day. Wrapping the icepack in a towel or cloth will prevent frostbite.
- Trying to keep the injured area elevated.
- Applying pressure to bleeding areas.
- Avoiding exposing the injury to heat from showers, hot tubs, or saunas for 2 days following the injury.
- Applying a heated compress to the area for up to 20 minutes at a time and repeating several times daily. Only do this after most pain and swelling has gone down, which is typically around 3 days after the injury.
- Massaging or rubbing the bruise and surrounding area gently several times a day once the pain and swelling have gone.
- Eating plenty of whole fruits and vegetables that are rich in antioxidants, such as vitamins A, C, D, and E.
- Avoiding smoking or using tobacco products.
- Abstaining from alcohol, especially for the first 2–3 days after developing the injury.
- Avoiding vigorous exercise for 24 hours.
- Applying herbal gels and creams such as arnica or vitamin K8 several times daily until the bruise heals.
- Taking 200–400 milligrams (mg) of bromelain three times a day.
Doctors do not recommend using NSAIDs to manage conditions relating to bleeding or bruising because they can worsen the bleeding.
For more severe cases of bleeding into the skin and bruising, or those resulting from an underlying medical condition, a doctor will put together a tailored treatment plan. Very large hematomas may need surgical removal.
When to see a doctor
Minor bleeding into the skin or bruising that happens from time to time is rarely cause for concern.
However, anyone who experiences bleeding into the skin with no apparent cause or bruising that lasts longer than two weeks should speak to a doctor. Individuals taking blood-thinning medications who experience frequent or severe bleeding or bruising should also seek medical attention.
It is also best to visit a doctor if any of the following symptoms accompany the bruising:
- extreme pain
- blood in the stool or urine
- bleeding gums
- swollen extremities
- darkening of the skin around the bruise over time
- nausea or vomiting
- a large lump
- dizziness or fainting
- joint or bone pain
For unexplainable bruising that is sudden or severe, it is best to seek immediate medical care.