Differential Diagnosis for Skin Bruises with No Pain in the Legs

Single Most Likely Diagnosis

• Easy Bruising: This is a common condition characterized by bruising easily, often due to minor trauma or even without any apparent cause. It can be due to various factors such as vitamin deficiencies (e.g., vitamin C or K), medications (e.g., anticoagulants), or mild platelet disorders. The lack of pain and the familial occurrence (in the wife and daughter) might suggest a genetic predisposition or a shared environmental factor.

Other Likely Diagnoses

• Vitamin Deficiency: Deficiencies in vitamins like vitamin C (scurvy) or vitamin K can lead to easy bruising. These vitamins are crucial for collagen synthesis and blood clotting, respectively.
• Medication Side Effects: Certain medications, such as anticoagulants (e.g., warfarin, aspirin), antiplatelet agents, or steroids, can increase the risk of bruising.
• Hormonal Changes: Hormonal fluctuations, especially in women, can affect blood vessels and make them more susceptible to bruising.

Do Not Miss Diagnoses

• Bleeding Disorders: Conditions like hemophilia or von Willebrand disease can cause easy bruising. Although less common in females due to their genetic nature (X-linked recessive for hemophilia), they can be carriers and exhibit mild symptoms.
• Leukemia or Lymphoma: These cancers can affect the blood and bone marrow, leading to bruising due to low platelet counts or abnormal platelet function.
• Liver Disease: Liver conditions, such as cirrhosis, can lead to coagulopathy and easy bruising due to decreased production of clotting factors.

Rare Diagnoses

• Ehlers-Danlos Syndrome: A group of genetic disorders that affect the body's connective tissue, leading to highly flexible joints and very stretchy, fragile skin that bruises easily.
• Pseudoxanthoma Elasticum (PXE): A rare genetic disorder that affects the elastic fibers present in the skin, retina, and cardiovascular system, leading to skin bruising among other symptoms.
• Amyloidosis: A condition characterized by the deposition of amyloid (a particular type of protein) in various tissues of the body, which can lead to bruising due to blood vessel fragility.

Each of these diagnoses should be considered and investigated based on the patient's full medical history, physical examination, and appropriate laboratory tests to determine the underlying cause of the skin bruising.