Bruises

Medically Reviewed by Poonam Sachdev on May 23, 2024
Written by Lori M. King, PhD
17 min read

When you get an injury, blood may leak from the vessels (veins and capillaries) under your skin. The discoloration you see as a bruise on the surface of your skin is from blood that has pooled in or under your skin. On people with lighter skin tones, bruises may start out red or purple soon after the injury, then turn light brown, green, or yellow as they heal. On people with darker skin tones, bruises can look purple, dark brown, or black.

Ecchymosis vs. bruise

Ecchymosis (pronounced eh-kuh-mow-sis) is the medical term for a bruise. An ecchymosis is bigger around than 1 centimeter, which is about as big around as a triple-A battery. 

Hematoma vs. bruise

A hematoma is a large pool of blood that may come from a serious injury, such as a major fall or a car accident. Hematomas are usually painful and may make the skin over it feel raised, spongy, rubbery, and/or lumpy. Hematomas are more serious than ecchymoses, and they generally need medical attention. 

Purpura vs. bruise

Purpura are small patches of blood under the skin. These are between about 4 millimeters (about as big around as a tablet of aspirin) and 10 millimeters (about as big around as triple-A battery), so they're smaller than an ecchymosis, but larger than petechiae. They may look reddish-purple on lighter skin tones and brownish-black on darker skin tones.

Petechiae vs. bruises

Petechiae (pronounced puh-tee-kee-uh) are very small areas (pinpoint, or less than 2 millimeters around) of blood under the skin or in your mucous membranes (such as in your mouth or on your eyelids). These look a little like a rash with purple, red, or brown dots of blood, but they aren't raised or bumpy. They don't itch and they generally aren't painful. 

Bruises happen when blood leaks out of your veins and capillaries and pools under your skin because there isn't an opening for the blood to get out of your body. Blood cells called platelets stop your bleeding, but the pool of blood under your skin can change your skin color and cause swelling, pain, and tenderness. 

Your blood vessels may seep blood under your skin for a few reasons:

  • You were injured or had physical trauma (most common).
  • You have aging skin.
  • You have a medical condition that changes your blood platelet count, such as an autoimmune disease, hemophilia, or leukemia.
  • You take a medicine that reduces or prevents blood clotting, like anticoagulants (such as heparin or warfarin), antiplatelets (such as clopidogrel), aspirin, or steroids.

Is it normal to bruise after a tattoo?

Yes, it's fairly common to bruise after a tattoo. Right after a tattoo, it's normal for your skin around your tattoo to be red, irritated, swollen, warm, and sometimes bruised. These skin reactions are part of the healing process and usually last about 3-7 days.

 

Here are some conditions that may cause you to bruise easily:

Getting older

As you age, your skin gets thinner and you lose some of the layer of fat that cushions your blood vessels and protects you from injury. Also, your blood vessels become more fragile. Both of these things mean you may get more bruises, even from a minor bump.

Certain medicines

Blood thinners such as warfarin, heparin, and aspirin can cause you to bleed and get bruises more often. Steroids and some cancer drugs (chemotherapy and targeted therapy) may also lower your platelet levels, which can cause you to bleed and get bruises more than you usually do.

Vitamin deficiencies

Your body uses vitamin C to make collagen, a protein that is the substructure of your blood vessels. It's rare to have extremely low levels of vitamin C, but when you do, your blood vessels may be weaker. One of the signs of this is easy bruising. 

Your body uses vitamin K to help your blood form clots to stop bleeding. People with low levels of vitamin K may notice easy bruising.

It runs in your family

If you, your mom, and your sister all turn black and blue from the tiniest bump, it may be a family thing. Some people just have more fragile blood vessels, and that makes them more likely to bruise, especially on their upper arms, thighs, or butt. 

Heavy drinking and liver cirrhosis

We don't mean you woke up with a black-and-blue mark because you bumped into something after one too many cocktails. But if you often drink a lot of alcohol and you tend to get a lot of bruises, it may mean you've got liver problems.

The liver makes proteins that the blood needs for clotting, so if it's not doing its job, you may bleed or bruise more easily. It could be a sign that you've got a condition called cirrhosis, which is scarring of the liver. It's a serious illness, so see your doctor.

Bleeding disorders

Some conditions can make it harder for your blood to clot, which may increase your chance of bruising and bleeding. Examples include von Willebrand disease and hemophilia. People with von Willebrand disease (about 1%-2% of the population have this) make little or no von Willebrand protein, which is important for blood clotting. 

People with hemophilia don't make much of several blood clotting factors, such as factor VIII and factor IX. These disorders are rare, but they can be life-threatening if you don't treat them. If you're having nosebleeds for no reason, if your gums bleed a lot after you brush or floss, or if small cuts or scrapes seem to bleed heavily, call your doctor.

Vasculitis

Vasculitis is swelling in your blood vessels. People with vasculitis may get purpura regularly, and this can be a sign of conditions such as giant cell arteritis, Kawasaki disease, microscopic polyangiitis, granulomatosis with polyangiitis, and Behçet's. These conditions can cause organ damage, so if you suspect you have vasculitis, you should go see your doctor.

Rarely, some types of cancer

It's not likely, but it's possible that your bruises are a sign of blood cancer, such as leukemia. If you also feel tired, achy, and weak all the time, or lose weight without trying to, give your doctor a call.

Depending on your skin tone, bruises change color as your body heals. These color changes show that your body is breaking down the blood cells that are pooled in your skin. It's part of how your body repairs itself.

The typical stages of a bruise are based on the color changes that happen in people with lighter skin tones. These stages include:

  • At the time of injury or soon after, you will have a bump that looks red or purple. You may have swelling and your skin will likely be tender.
  • After a couple of days, your bruise may look blue or black.
  • After 5-10 days, your bruise may turn green or yellow.
  • After 10-14 days, your bruise may look light brown, and it will continue to get lighter and lighter until it fades away to your natural skin tone. 

On darker skin tones, you may not notice redness at the time of injury. Instead, you may feel a bump under your skin and it may be tender. As the bruise develops, the skin over your bruise may look dark brown or black. In general, people with darker skin and hair will have darker-colored bruises. People with medium skin tones may see more red and yellow color in their bruises than people with lighter or darker skin tones.

Yellow bruise

One study showed that the development of a yellow color was the most noticeable change in a bruise over time. The development of a yellow color happened much faster in people who are younger than 65 years old. This study also showed that yellow bruises were generally older than 18 hours.

Three types of bruises are:

  • Subcutaneous, which is a bruise just underneath your skin
  • Intramuscular, which is a bruise within a muscle under your skin
  • Periosteal, which is a bruise in your bone

Bruised ribs

Bruised or broken ribs may be caused by a fall, an injury to the chest, or a severe coughing fit. You may be able to tell if you have bruised ribs if you:

  • Have a strong pain in your chest, especially when you breathe in
  • Have swelling or tenderness in your ribs
  • See a bruise on the skin over your ribs

Bruised ribs will usually get better by themselves in 3-6 weeks. Doctors will usually leave bruised ribs to heal on their own because there's no easy way to splint bruised or broken ribs. You can support your own healing in the following ways:

  • Breathe normally and cough when you need to because it helps clear mucus from your lungs, which will help prevent chest infections, like pneumonia.
  • Hold a pillow against your chest when you cough to support your ribs.
  • Walk around and move your shoulders every once in a while to help you clear mucus from your lungs.
  • Once an hour, take 10 slow, deep breaths.
  • The first few nights, try to prop yourself up when you sleep because it will ease your pain and allow you to breathe more normally.
  • Don't smoke.
  • Don't bind your ribs, because that may prevent your lungs from fully expanding.
  • Don't lie down or stay still for a long time.
  • Don't strain yourself or lift heavy objects.

Bruises on legs and arms

Your legs and arms are the most common places to get bruises. You may get them if you had a fall, got hurt playing sports, or bumped into a piece of furniture. People over 65 years old and those assigned female at birth (AFAB) are more likely to get bruises than others because these groups generally have thinner skin and smaller blood vessels.

If you have a bruise on your arm or leg and signs of a blood clot in the same limb, call your doctor. Signs of a blood clot include redness and swelling that gets worse over time and pain in the limb. For instance, if you have a blood clot in your leg, you may have pain in your calf, behind your knee, or in your thigh or groin.

Bruise under a nail

Doctors call this a subungual hematoma. You may get it if you hit your thumb with a hammer or stub your toe, but you may also get it from wearing tight shoes or training for a marathon. At the time of injury, your nail may feel sore or tender, but the pressure that builds up under your nail as the blood pools can cause severe pain. Your nail may lift off your finger or toe, and the color of your nail may change. You should go see your doctor if you're bleeding and it won't stop, the pain is too intense, or you see a lot of damage to the base of your nail. 

If necessary, your doctor can pierce your nail to drain the blood and fluid built up underneath. This usually resolves the pain. Don't do this yourself because you could hurt yourself further, cause an infection, and slow your healing process. 

It usually takes about 6-9 months for a new nail to grow in. But if the cells that regrow your nail (called the nail matrix) are damaged, it may grow in incorrectly or you may not regrow your nail at all.

Bruised tailbone

The medical name for your tailbone is the coccyx (pronounced kak-siks), so your doctor may call this a coccyx injury. You may get a bruise on your tailbone if you fall backward onto a hard surface; for instance, if you slip on a wet floor or a patch of ice. Symptoms of a tailbone injury include:

  • Pain or tenderness in your lower back
  • Pain at the top of your butt
  • Pain or numbness when you sit
  • A bruise or swelling on the skin around the base of your spine

Tailbone injuries can be very painful. They can also take up to 4 weeks to heal. You can help speed your recovery if you use a cushion or gel doughnut when you sit down because this takes the pressure off your tailbone. Also, sleep on your stomach instead of your back. Going to the bathroom can be painful, so make sure you eat plenty of fiber and drink plenty of fluids to avoid a bout of constipation.

Bruise on the breast

You may get a bruise on your breast after you take a fall or if you are in a car crash where the seat belt catches you. It's rare, but some people may also get a hematoma from surgical procedures on the breast, such as breast reduction surgery, breast cancer surgery, or a biopsy. In this case, you can help yourself heal by following the general advice for a bruise: Use ice packs for the first 1-2 days, then use heat and take over-the-counter pain medication such as acetaminophen. 

It's also very rare, but sometimes, a bruise on your breast may be a sign of a breast infection (mastitis) or inflammatory breast cancer. If this is the case, you will likely also have other signs, such as a rapid increase in your breast size, feelings of heaviness, burning or tenderness in the breast, ridges or pitting in the skin, or an inward-turned nipple. You may also notice swollen lymph nodes in your armpit or near your collarbone on the same side as the bruised breast.

If you have a bruise on your breast and don't know how you got it or have other symptoms, go talk to your doctor.

Bruise on the bottom of the foot

People who run regularly may get something called a stone bruise (metatarsalgia). This is swelling and tenderness where your toe bones connect on the bottom of your foot. You may or may not have skin discoloration, too. With a stone bruise, you may notice pain or tenderness when you press on that point on your foot, pull up on your toes, or flex your foot upward. It can be caused by wearing old or worn-out shoes while you train, running or walking on hard surfaces like concrete, or training for too long.

If you have a stone bruise, take a break from running, don't walk around barefoot, and follow the general advice for treating a bruise: Use ice packs for the first 1-2 days, then use heat and take over-the-counter pain medication. If it happens regularly, you may want to try a different type of running shoe or use a cushioning insole when you run. It may be helpful to talk to a sports doctor who can help you figure out what to do to prevent them.

Bone bruise

A bone bruise is sometimes called a microfracture. It's less serious than a bone break, but the injury has damaged some part of the inside structure of your bone. Any type of bone in your body can be bruised, but if so, you'll usually also have damage in nearby structures of your skeleton, such as your ligaments (tissues that connect your bones and joints). You may get bone bruises from sports injuries, car crashes, falls from a height, joint sprains, or medical conditions like arthritis.

Bone bruises usually last longer (1-2 months) than soft tissue bruises, and they're more painful, but most will heal with rest and the same home care as for other types of bruises. Your doctor will likely suggest you use a brace or crutches for bone bruises in your legs and feet. Rarely, if your bone bruise is very large, you may not recover blood flow in that area. This may cause that part of your bone to die. Call your doctor if your symptoms don't start to get better in a few days or if you have any symptoms of an infection, such as a high fever.

Go see your doctor if you have:

  • A black eye with vision problems
  • A bruise that lasts for more than 2 weeks
  • Large bruises that happen often
  • A lump in the bruised area (hematoma)
  • Painful swelling
  • Pain that lasts for days after the injury
  • A bruise that keeps coming back in the same area
  • Unexplained bruising
  • Unusual bleeding, like a nosebleed or blood in your pee or poop

Go to the ER right away if you get a bruise (sometimes called a "goose egg") on your head and can't remember what happened or think you've got a concussion. Symptoms of a concussion include a headache that won't stop or gets worse, loss of balance, vomiting, blood or clear fluid coming out of your ears and nose, memory loss or confusion, and mood changes, such as crankiness. 

If you bruise or bleed easily, you should also see your doctor if you:

  • Have symptoms of serious blood loss, including sweating, weakness, nausea, or feeling faint, dizzy, or very thirsty
  • Are pregnant or recently gave birth
  • Have signs of an infection, such as a fever, chills, or diarrhea, or you feel generally unwell
  • Have a headache, confusion, or other sudden symptoms of brain or nervous system problems

Your doctor will ask about your symptoms and medical history and then do a physical exam. They may be able to figure out what caused your bruise just from that. But if not, your doctor will likely do some blood tests, such as:

  • A complete blood count, including a platelet count
  • Peripheral blood smear (where a technician examines a sample of your blood under a microscope to see if your blood cells are damaged, abnormal, or immature) 
  • Prothrombin time and partial thromboplastin time tests, which show how well your blood clotting factors are working

If any of these tests show that your blood clotting system isn't working the way it should, your doctor will likely do other tests to find out why. For instance, if your doctor suspects you have:

  • A bleeding disorder, they may do imaging tests, such as a computed tomography (CT) scan of your head or belly or an X-ray of your arms and legs
  • A bone marrow disorder, they may do a bone marrow biopsy
  • A vitamin deficiency, vasculitis, or another medical condition, they may do other blood tests

 

Most bruises don't need treatment because they heal on their own. This usually takes about 2 weeks, but many will heal sooner than that. Talk to your doctor if you have a bruise that lasts longer than 2 weeks.

In the meantime, here are a few things you can do to help your bruise heal faster:

After your injury, put an ice pack on it every once in a while for the first 24-48 hours. Wrap the ice pack before you put it on so you don't freeze your skin, and don't leave it on for more than 15 minutes at a time.

Rest and raise the area above your heart. This will help keep swelling down and soothe the pain.

After the first 48 hours, put a heating pad or warm compress on the bruise every once in a while.

Take an over-the-counter pain medicine, such as acetaminophen. Check with your doctor before using nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin or ibuprofen, because these can make bleeding and bruising worse.

Best ways to cover a bruise

If you are concerned about covering a bruise because you are in a situation where you are being abused, please seek out help.

To cover a bruise on your face:

  1. If you use moisturizer, give it at least 10 minutes to absorb before you apply makeup. You want the foundation to stay put, and swelling can dry your skin out.
  2. Apply a layer of concealer that is a shade lighter than your natural skin tone over the entire bruise. If your bruise is blue, look for a concealer with a yellow base color to help offset the color of the bruise. Likewise, if your bruise is green, try a concealer with a red base color. If your bruise is yellow, look for a concealer with lavender base color.
  3. Apply a layer of foundation over your face. Pat – don't rub – to blend.
  4. Dust translucent powder over your face.

Doctors have no special treatment for bruises other than the techniques described above: ice packs and later heat, over-the-counter pain medication, and elevation of the bruised area, if possible.

If your doctor suspects domestic abuse, you may be referred to a social worker.

If you bruise easily because of a medical condition, your doctor will treat that condition. For instance, if you:

  • Are taking a medicine that causes bruising, your doctor may switch you to another
  • Have a vitamin deficiency, your doctor may prescribe vitamin supplements
  • Have an infection, an autoimmune condition, or cancer, your doctor will treat you or refer you to a specialist for treatment
  • Have liver disease, your doctor may give you vitamin K or a plasma transfusion

To prevent a bruise:

  • Wear protective gear (like shin guards) while playing contact sports such as soccer.
  • Place furniture away from doorways and common walking paths within your home.
  • Keep phone and electrical cords away from open areas where you may trip and fall.
  • Make sure your floors are kept dry and that your rugs are slip resistant.
  • Keep floors free of clutter.
  • Plug in a small night light or use a flashlight if you need to walk through a dimly lit room.
  • If your doctor has prescribed blood-thinning drugs, be sure to have regular monitoring and adjust medications as necessary.
  • Eat a well-balanced diet with plenty of vitamins and minerals.

A bruise is a discolored mark on your skin that forms when blood vessels under your skin break and leak. They can be caused by several things, such as an injury, certain disorders, or certain medicines. Most bruises don't need treatment because they heal on their own, usually within about 2 weeks.

How long does it take a bruise to disappear?

Bruises typically heal on their own in about 2 weeks, depending on how bad your injury was. For instance, a hematoma is more serious than a regular bruise and may take more than a month to heal. If you have a bruise that lasts longer than about 2 weeks, talk to your doctor. 

What color is a serious bruise?

It's tough to judge the seriousness of a bruise using the color. How a bruise looks depends on a lot of things, including your natural skin tone, how bad the injury that caused it was, and how long you've had it. You will likely see some discolored skin until the bruise completely heals. But a serious bruise is more likely to be large, painful, swollen, or lumpy.

What do leukemia bruises look like?

People with leukemia may have low platelet counts, which is why they bruise easily. These will likely look like other bruises, but some things that suggest a leukemia bruise include:

  • A bruise that shows up in a place on your body that you wouldn't expect, such as your back, chest, or face
  • Having several bruises at once and not being sure how you got them
  • Having bruises that take more than 2 weeks to heal
  • Having petechiae (small pinpoints of blood under the skin).

Do bruises spread?

Yes, they can spread down your body in the direction of gravity.

Can bruises leave a permanent mark?

No, not really. In some cases, you may have a bruise that seems like it doesn't go away, but that is likely because you have a repeated injury in the same area, a blood clotting disorder that means you get bruises one after the other, or have another skin condition. In this case, you should go see your doctor to find out what's going on.

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