Ecchymoses

Alternative names
Bleeding into the skin; Skin spots - red; Pinpoint red spots on the skin; Petechiae

Definition

Aside from the common bruise, bleeding into the skin or mucous membranes is a very significant sign and should always be evaluated. Bleeding that consists of pinpoint dots of blood is called petechiae. Larger flat areas where blood has collected under the tissue, up to a centimeter in diameter, are called purpura. A very large area is called an ecchymosis.

Considerations
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

     
  • Injury or trauma  
  • Allergic reaction  
  • Autoimmune disorders  
  • Viral infection or illness affecting blood coagulation  
  • Thrombocytopenia  
  • 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       o Anticoagulants such as warfarin or heparin (ecchymosis)       o Aspirin (ecchymosis)       o Steroids (ecchymosis)  
  • Septicemia (petechiae, purpura, ecchymosis)

Home Care

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 your health care provider if

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

What to expect at your health care provider’s office
Your doctor will perform a physical examination and ask questions about the bleeding, such as:

     
  • Has there been a recent injury or accident?  
  • Have you been ill lately?  
  • Have you had radiation therapy or chemotherapy?  
  • What other medical treatments have you had?  
  • Do you take aspirin more than once a week?  
  • Do you take Coumadin, heparin, or other “blood thinners” (anticoagulants)?  
  • Has it occurred repeatedly?  
  • 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?

The following diagnostic tests may be performed:

     
  • Coagulation tests including INR and prothrombin time  
  • CBC with platelet count and blood differential  
  • Bone marrow biopsy

 

Johns Hopkins patient information

Last revised: December 5, 2012
by Potos A. Aagen, M.D.

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