What Is A Bruise?

A bruise is a lesion that manifests on the skin as if it were a bruise. It has great importance in legal and judicial medicine. We will tell here how it forms and what its causes may be.
What is a bruise?

Ecchymosis is one of the basic and elementary skin lesions. Along with other dermatological manifestations, it forms the basis for the clinical presentations of other diseases.

In other words, it can be said that ecchymosis  is a blood deposit located in the subcutaneous tissue. The skin above this deposit is free from bruises or any other accompanying injury. In short, this accumulated blood comes from the rupture of blood vessels.

When blood leaves the blood vessels, what is called extravasation occurs. The bruise comes from an extravasation that occurs under intact skin. Blood vessels rupture because a blow opens them, because an infection tears them apart from the inside, or because the muscles in the area get torn apart.

Although we said earlier that bruises are a dermatological lesion, we are not just referring to the external skin. This lesion can manifest itself under a mucous membrane  as well, for example, in the inner region of the oral cavity.

Causes of bruise

There are different factors that can cause bruises. The end result is the rupture of vessels and the extravasation of blood into the subcutaneous space, however, this can be caused by:

  • Trauma:  a blow to the skin that does not open it, ie, performed with a blunt object. Always keep in mind that to speak of bruises there should be no sores on the superficial skin.
  • Sports practice:  bruises are common among athletes. Sometimes they are produced by trauma and other times by the exaggerated effort of training that damages the muscles.
  • Vitamin K Deficit:  Vitamin K is an essential substance for blood clotting to be correct. Therefore, when there is a lack of this vitamin in the body, bruises can form more easily.
  • Infections:  Certain infectious processes are prone to weaken blood vessels and break them from the inside, without damaging the skin. Sometimes bruises are an early sign of an infection. This can happen before the fever starts.
  • Clotting Disorders:  As with vitamin K deficiency, if a person suffers from clotting disorders such as Von Willebrand’s disease, they are more likely to develop bruises. Also, the clotting disorder may be secondary to another condition, such as cancers.
  • Use of anticoagulants:  there are diseases that require the use of anticoagulants for their treatment. The use of these drugs has as an adverse effect the formation of spontaneous ecchymosis or small trauma, which under normal conditions, would not break the blood vessels.
coagulation process

The training process

Ecchymosis, as we define it, is an accumulation of blood in the subcutaneous space under intact skin. The process is self-limiting and, after a certain period of time, the blood is reabsorbed  by the body itself.

During resorption, which can take weeks,  the skin color in the affected area changes. The same color changes indicate parts of the bruise resolution process.

Blood has a red color when it is inside the vessels. Once it leaves them and locates in the subcutaneous space, it is taken over by defense cells that are known as macrophages. Inside macrophages,  hemoglobin loses the oxygen it carries and its color becomes darker.

The dark red of oxygen-free hemoglobin is seen on the outside of the skin as purple  or violet. This is usually the typical color of the bruise; in short, it is the color of the bruises.

As the days go by, hemoglobin turns into pigments due to its decomposition. The color that continues after the violet is green. This is because hemoglobin turns into biliverdin.

Days later, biliverdin will turn into bilirubin. At this point,  the skin color turns from green to yellow. Bilirubin then converts to hemosiderin, which is reflected on the outside as a pale brown color.

The last step of the bruise is the complete reabsorption of the blood debris. Again, it is the macrophages that intervene, digesting all the remaining hemosiderin. At this point, the skin returns to its usual coloration.

Arm bruise

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Classification of bruises

Although it is common to use the words ecchymosis, bruise and petechia as if they were synonymous, in fact, it is not like that. In dermatology, each of these forms of presentation has its particular characteristics.

If we are strict about naming them,  a bruise is a bruise that goes beyond the skin. That is, if it remains at the height of the skin in the affected region, it is not possible to speak of a bruise.

On the other hand, petechiae are identified more with the size of the bruise. Lesions of up to two millimeters would be petechiae,  and they would be bruises when they exceeded that size.

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