Alternate Names: Bruising; Ecchymoses; Skin spots - red; Pinpoint red spots on the skin; Hematomas; Petechiae

Considerations: Aside from the common bruise, bleeding into the skin or mucus membranes is a very significant sign and should always be evaluated. Bleeding that consists of pinpoint dots of blood is called petechiae. Larger areas of bleeding up to approximately a centimeter in diameter are called purpura, while a very large area is called an ecchymosis.

Redness of the skin (erythema) should not be mistaken for bleeding. Petechiae, purpura, and ecchymosis do not blanch (become pale) with pressure, while the redness of erythema decreases and then returns when pressure is applied and released.

Common Causes:

• local injury or trauma
• allergic reaction
• autoimmune disorders
• viral infection or illness affecting blood coagulation
• thrombocythemia
• medical treatment, including radiation and chemotherapy
• bruise (ecchymosis)
• birth (petechiae in the newborn)
• aging skin (ecchymosis)
• idiopathic thrombocytopenic purpura (petechiae and purpura)
• Henoch-Schonlein purpura (purpura)
• leukemia (purpura and ecchymosis)
• drugs
  • anticoagulants such as warfarin or heparin (ecchymosis)
  • aspirin (ecchymosis)
  • cortisone (ecchymosis)
• septicemia (petechiae, purpura, ecchymosis)
• violent vomiting or coughing (petechiae)

Home Care: Bruises (or purpuric lesions) are not permanent and will fade if the underlying cause can be treated successfully.

For a hematoma, apply pressure and cold compresses initially to help reduce bleeding and swelling. After the first day, apply hot compresses to help speed the absorption of blood.

For aging skin, protection of skin is recommended. Avoid trauma (such as bumping or pulling on skin areas).

For a cut or scrape, use direct pressure to stop the bleeding.

For a drug reaction, identify and consult the health care provider about discontinuing the drug.

Otherwise, follow prescribed therapy to treat the underlying cause.

Call If:

• there is sudden bleeding into the skin for no apparent reason.
• if there is persistent, unexplained bruising.

What To Expect: The medical history will be obtained and a physical examination performed.

Medical history questions documenting bleeding into the skin in detail may include:

• quality
  • Is the area flat?
  • Is the area raised or swollen?
• location
  • Where is the hematoma or purpura spot?
• aggravating factors
  • Has there been a recent injury or accident?
  • Have you been ill lately?
  • Have you had radiation therapy?
  • Have you had chemotherapy?
  • What other medical treatments have you had?
• medications
  • Do you take aspirin more than once a week?
  • Do you take Coumadin, heparin, or other "blood thinners" (anticoagulants)?
• time pattern
  • Did it begin recently?
  • Has it occurred repeatedly (recurrent)?
  • Has a tendency to bleed into the skin been present lifelong?
    • Did it start in infancy (for example, with circumcision)?
    • Did it start with surgery or a tooth extraction?
  • Has it occurred for the past several months? How many?
• associated conditions
  • What other symptoms are also present?

• bleeding time and coagulation test
• CBC with platelet count and blood differential
• bone marrow biopsy