From the Guidelines
Superficial bruising can be managed with the RICE method and over-the-counter pain relievers, but it is essential to seek medical attention if bruising is extensive, extremely painful, occurs without injury, or is accompanied by significant swelling. The RICE method involves Resting the affected area, applying Ice for 15-20 minutes several times daily for the first 48 hours, using Compression with an elastic bandage if appropriate, and Elevating the bruised area above heart level when possible 1. Over-the-counter pain relievers like acetaminophen (Tylenol) at 325-650mg every 4-6 hours as needed can help manage pain, but avoid aspirin or ibuprofen initially as they may increase bleeding.
Key Considerations
- Most superficial bruises heal within 2-4 weeks as the body reabsorbs the blood that has leaked into tissues.
- The characteristic color changes from red-purple to green-yellow indicate normal healing progression.
- People who bruise easily may benefit from increasing vitamin C and K intake, which support blood vessel health and clotting function respectively.
- It is crucial to differentiate between accidental and abusive bruising, especially in children, and to consider the possibility of underlying bleeding disorders 1.
Evaluation for Bleeding Disorders
- Children with bruising that is suspicious for abuse may require an evaluation for bleeding disorders, including coagulation factor deficiencies, von Willebrand disease, and platelet disorders 1.
- The presence of a bleeding disorder does not rule out abuse as the etiology for bruising or bleeding, and the presence of a history of trauma does not exclude the presence of a bleeding disorder or other medical condition 1.
When to Seek Medical Attention
- Seek medical attention if bruising is extensive, extremely painful, occurs without injury, or is accompanied by significant swelling.
- Medical attention is also necessary if there are signs of abusive bruising, such as patterned bruises or bruises in areas that are not typical for accidental injury 1.
From the Research
Superficial Bruising
- Superficial bruising is a common symptom that can be caused by various factors, including trauma, medication, and underlying medical conditions 2, 3.
- The evaluation of superficial bruising in primary care involves a comprehensive history, physical examination, and laboratory testing to determine the underlying cause 2, 3.
- A bleeding assessment tool, such as the one developed by the International Society on Thrombosis and Hemostasis, can be used to indicate possible pathology 2.
- Laboratory testing, including a complete blood count, peripheral blood smear, prothrombin time (PT), and partial thromboplastin time (PTT), can help identify disorders of the coagulation pathway 2, 3.
- A normal PT and PTT may indicate a platelet disorder, while a normal PT with a prolonged PTT may indicate a disorder of the intrinsic coagulation pathway 2, 3.
- Consultation with a hematologist is recommended when initial evaluation indicates a bleeding disorder or when suspicion remains high despite a normal laboratory workup result 2, 3.
- There is no direct evidence to suggest that Arnica, which has been traditionally used to treat inflammation and pain, is effective in treating superficial bruising 4.
- The complete blood count, which includes components such as red blood cell count, hemoglobin, and platelet count, can provide valuable information in the evaluation of superficial bruising 5.