- 1 What is ecchymosis?
- 2 Is there a difference between ecchymosis and bruise?
- 3 What are the causes of ecchymosis?
- 4 What are the signs and symptoms of Ecchymosis?
- 5 What are the signs related to ecchymosis?
- 6 What is the difference between ecchymosis and hematoma?
- 7 What is the difference between ecchymosis and purpura?
- 8 How is ecchymosis treated?
What is ecchymosis?
Ecchymosis is the presence of a reddish or bluish discoloration of the skin which is more than one centimeter in diameter. Depending on the size of the lesion, different medical terms have been given. If the lesion is less than 3 mm, then it is called as petechiae. If the lesion is more than 3 mm in diameter but less than 10 mm, then it is called as purpura.
The bluish discoloration is due to the blood that escapes from the ruptured blood vessels. The blood escapes into the subcutaneous purpura and appears as a bluish or reddish discoloration on the skin.
Is there a difference between ecchymosis and bruise?
Most people use the terms ecchymosis and bruise interchangeably thinking that they are the same. But it is not. A bruise usually occurs when there is some kind of an injury or trauma to the body such as blunt trauma. As a result of this trauma, blood leaks out of the blood vessels or the capillaries thus giving rise to a bruise. For instance, if someone punches you, the blunt force exerted on your body will damage the blood vessels just under your skin and thus lead to the development of a bruise.
On the other hand, ecchymosis results not because of trauma or injury caused to the blood vessels, but due to an underlying condition or a medical disease which will lead to the spontaneous onset of ecchymosis. However, there are some medical conditions such as hemophilia A, where with the slightest injury to the body, ecchymosis results. This is also because there is an underlying medical condition which has led to the development of ecchymosis.
What are the causes of ecchymosis?
Ecchymosis usually occurs following trauma, especially blunt force trauma. When there is a blunt force trauma, the blood vessels get damaged causing blood to leak out of the vessels. This gives an appearance of a dark patch on the skin.
Ecchymosis can also occur with several medical conditions. Out of all, 2 common conditions include scurvy and idiopathic thrombocytopenia. Other medical causes of ecchymosis include:
- Cirrhosis of the liver
- Acute renal failure
- Acute pancreatitis
- Multiple myeloma
Scurvy is a condition that usually results from a deficiency of vitamin C. Vitamin C, also referred to as ascorbic acid, plays and important role in the body as it is necessary for the synthesis of collagen within the body. Collagens are a type of protein that is found in almost all our body tissues including the blood vessels, skin, bones and cartilage. Therefore when there is a deficiency of vitamin C, collagen is not produced properly. This leads to impaired wound healing, and abnormal synthesis of connective tissue and bone matrix protein.
In scurvy, the structures with the highest collagen content such as the blood vessels are most severely affected. Therefore, one of the earliest clinical features of vitamin C deficiency is therefore and increased propensity to hemorrhage. This is probably due to the increased fragility of the capillaries which occurs as a result of reduced collagen synthesis. In severe vitamin C deficiency, petechiae and ecchymosis due to rupture of blood vessels, bleeding gums and bleeding into nails and joints can occur.
Idiopathic thrombocytopenic purpura
Idiopathic thrombocytopenic purpura or immune thrombocytopenic purpura, also known as ITP in short, is a common condition where there is immune mediated platelet destruction. This leads to a reduction in the platelet count. Platelets play an important role in the coagulation cascade thus helping the blood to clot when needed thereby preventing excessive bleeding. In ITP, the platelet count is reduced and therefore increases the bleeding tendency as well as the fragility of the capillaries. This leads to purpura and sometimes ecchymosis.
Cirrhosis of the liver
The liver is another important organ which is involved in the synthesis of many proteins of the coagulation cascade. So, if there is cirrhosis of the liver, this synthesis will be affected thus resulting in an increase in the bleeding tendency. Therefore, patients with cirrhosis of the liver may also develop ecchymosis.
Leukemia is a malignancy where there is abnormal proliferation of the white blood cells in the bone marrow. Due to the abnormal proliferation of the white blood cells, the production of the other cell lines such as the red blood cells and the platelets will be reduced. Since the platelets reduce, this increases the bleeding tendency of these patients and therefore may present with purpura, ecchymosis or abnormal bleeding.
Acute renal failure
Acute renal failure means that the person’s kidneys fail to do their normal function that is they are no longer able to filter the blood and remove all the waste products from the blood as it used to do. This leads to an accumulation of waste products in the blood and this may lead to the appearance of ecchymosis.
Myelofibrosis is another type of malignancy where there is fibrosis of the bone marrow. The bone marrow is the house where all types of cells are synthesized. When there is fibrosis of the bone marrow, the cell production will be reduced and this results in a reduction of the red blood cells, white blood cells and the platelets. Since the platelet count is reduced, it results in an increased tendency to bleed and therefore causes ecchymosis.
Acute pancreatitis is a clinical syndrome which occurs when the pancreatic enzymes escape the duct system and enters the parenchyma. These enzyme destroys the pancreatic tissue as well as the extra pancreatic tissues thus leading to an acute inflammatory process. Acute pancreatitis is fairly common and is important medical emergency.
Acute pancreatitis leads to release of two important enzymes known as Trypsin and chymotrypsin. These two enzymes activate other enzymes including elastase and phospholipases. Elastase is what is important for us right now. Elastase contributes to injury of the blood vessels which will therefore lead to local hemorrhage. When this hemorrhage occurs in the flanks, ecchymosis results and this sign is known as the Grey turner’s sign. When the local hemorrhage occurs around the umbilicus, ecchymosis results and it is known as the Cullen’s sign.
Another name that refers to multiple myeloma is Plasmacytoma. With this name, you can figure out what this disease is. It is a malignancy of the plasma cells. Plasma cells are an important part of our immune system and are responsible for the production of antibodies. Antibodies are necessary to protect the body from dangerous pathogens. These antibodies are produced specific to the offending pathogen and targets those pathogens and destroys them thus protecting our body.
In multiple myeloma or plasmacytoma, there is uncontrollable production of the plasma cells and therefore leads to an elevated number of antibodies within the blood. Although antibodies are a good thing to have in our body, anything in excess is not good. Therefore this will lead to many symptoms such as bone pain, kidney failure and many other symptoms. Out of these many symptoms and signs, ecchymosis is one important sign that is usually seen.
What are the signs and symptoms of Ecchymosis?
Ecchymosis is a symptom. It is not a disease.
Usually there are no other symptoms associated with ecchymosis. The ecchymosis lesions are not painful and they usually occur following trauma.
- Racoon eye sign
Racoon eye sign is when there is ecchymosis around the eyes. It is most commonly seen following injury to the eyeball. Usually it occurs following trauma to the frontal area of the skull which results in rupture of the veins within the anterior cranial fossa. Therefore the blood will leak into the connective tissues around the eyes thus presenting with ecchymosis around the eyes. Due to this reason, Raccoon eye is considered as a reliable sign of basal skull fracture or any intracranial lesions. Raccoon eye sign is also known as Belpharohematoma.
The reason why ecchymosis is seen around the eyes most commonly is due to the fact that around the eyes, there is loose connective tissue between the skin and the underlying tissue. In comparison to other regions of the body, the ecchymosis around the eyes seems to be darker. This is because there is heavy pooling of blood in the connective tissues around the eye. Over time, the color of the ecchymosis patches around the eyes will change from purple to green and finally to yellow. This is due to degradation of the correct red blood cells around the eye. These lesions may persist for about 2 week’s duration until all the collected red blood cells are lysed.
- Battel sign
Battle sign is when there is blood collected around the ears or the mastoid process. This appears as ecchymosis around the ears and over the mastoid. If a patient develops this Battel sign, this indicated that there is a fracture at the base of the skull.
- Cullen sign
Cullen’s sign is when there is ecchymosis around the umbilicus. This sign is seen when there is blood collected beneath and around the umbilicus. Cullen’s sign will give a clue about the underlying condition. This can be caused by several disease and the they include:
- Acute pancreatitis
- Liver cirrhosis with portal hypertension
- Hemorrhagic ascites
- Ovarian cyst hemorrhage
- Intrauterine pregnancy associated with bilateral acute salpingitis
- Strangulated umbilical hernia
- Splenic rupture
- Ruptured abdominal aortic aneurysm
- Hypothyroid myopathy
- Ischemic and gangrenous bowel
- Perforated duodenal ulcer
- Renal sarcoma
- Hepatocellular carcinoma.
- Grey Turner sign
Grey Turner sign is when there is ecchymosis over the lateral abdominal wall. This is usually seen in patients with acute pancreatitis. However, it can be caused by other conditions as well and they include:
- Rectus sheath hematoma
- Ischemic and gangrenous bowel
- Retroperitoneal necrotizing fasciitis
- Sclerosing peritonitis
- Cardiac catheterization
- Crescent sign
This is the presence of ecchymosis over the malleolus either unilaterally and bilaterally. The reason for this crescent sign a synovial rupture of the knee and this leads to accumulation of blood within the knee joint – a condition known as haemarthrosis.
- Stabler sign
This sign is seen when there is bleeding under the tissues in the inguinal pubic area giving rise to ecchymosis patches over this area. Stabler sign can be seen in several conditions including acute hemorrhagic pancreatitis, abdominal aortic aneurysm rupture, ruptured ectopic pregnancy and neonatal adrenal hemorrhage.
- Seat belt sign
This sign is when there is ecchymosis due to an injury to the lumbar spine, abdominal or thoracic organs caused by a seat belt following a road traffic accident.
- Fox sign
This sign is when there is ecchymosis over the upper outer thigh. This can be a result of many different conditions including pulmonary infarction, abdominal aortic aneurysm, and acute suppurative pancreatitis. The fox sign can be seen following certain procedures as well, such as subcutaneous injections to the outer thigh, and insertions of instruments to the urethra such as catheterization.
- Blue scrotum sign of Bryant
As the name suggests, ecchymosis will be seen over the scrotum and this sign is seen usually following abdominal aortic aneurysms. An abdominal aortic aneurysm is when there is dilatation of the abdominal aorta. In such a case, the abdominal aortic wall will be so weak owing to the dilatation and therefore will lead to rupture at one point. When it ruptures, the blood can pass through the inguinal canal and the spermatic cord into the subcutaneous tissue in the scrotum. Blood within the subcutaneous tissue within the scrotum will give rise to ecchymosis over the scrotum and this sign is known as the Blue scrotum sign of Bryant.
What is the difference between ecchymosis and hematoma?
Hematoma is a collection of blood outside the blood vessels within a closed cavity and therefore they most often present as a swelling with a more 3 dimensional character to it, whereas ecchymosis is the is when the blood is accumulated under the skin following damage to the blood vessel and ecchymosis are usually flat. Another important difference between the two is that hematoma may be associated with pain and tenderness, whereas ecchymosis usually do not accompany these features.
Hematomas can occur in other organs as well not just on the skin like in ecchymosis.
What is the difference between ecchymosis and purpura?
Both ecchymosis and purpura indicate that there is bleeding underneath the skin. One of the main differences between ecchymosis and purpura is the size of the lesion. Purpura are smaller lesions whereas ecchymosis are larger compared to purpura. Purpura is usually 3mm to 10 mm in size and ecchymosis is larger than them. Both these lesions are seen prominently in the extremes of age.
Purpura can be caused by several conditions including platelet disorders, inflammatory disease of the blood vessels known as vasculitis, vitamin C deficiency, and chronic hypertension, meningitis, as a complication of radiation or following blood transfusions. Out of all the causes, the most important and the most common cause of purpura are platelet disorders. On the other hand, ecchymosis is usually due to blood coagulation disorders such as Hemophilia A.
Both ecchymosis and purpura are reddish purple or bluish discoloration that occurs beneath the skin occurs spontaneously without a traumatic cause. Both lesions are flat and cannot be palpated. Since in both these lesions, blood seeps out of the blood vessels, and therefore they do not blanch with pressure.
How is ecchymosis treated?
Ecchymosis is basically a collection of blood underneath the skin within the subcutaneous tissue. Therefore if you have ecchymosis, then you can follow these steps at home to hasten the healing process. However, ecchymosis is not something that you have to worry about and does not require immediate medical attention. Ecchymosis usually goes away on its own without any treatment. However, you can follow these measures to hasten the recovery process.
- Rest the area – If there is ecchymosis on the hand, and then avoid doing work with that hand. Resting is important as it will help to hasten the healing process of ecchymosis.
- Place an ice pack over the areas of ecchymosis – This will cause the blood vessels in that area to constrict thus reducing the blood flow to that area and therefore the bleeding will be reduced. This will therefore help to prevent the ecchymosis from extending to the surrounding areas.
- Keep the area elevated
- If it is painful, then take over the counter pain killers to relieve the pain. Pain killers such as Ibuprofen can be taken over the counter for pain relief.
You can also, carry out some light stretching exercises and also light massaging of the area to improve the tissue repairing process.
However, these measures are only temporary and the ecchymosis may come back, if the underlying cause is not treated. Therefore, if you have ecchymosis, then it is important that the underlying cause Is diagnosed and that cause is treated. Unless you do that, no matter what treatment you do to reduce the ecchymosis, it will continue to come back.
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