Why Do I Bruise Easily? Understanding the Causes

You are not alone if you tend to bruise easily. Bruising easily is a common complaint healthcare providers see. It occurs in 12% to 55% of healthy people.

Sometimes, those black-and-blue marks pop up with little or no reason. Still, there's usually an explanation or a treatable underlying cause for bruising easily. Here are some common reasons and what to do about it.

Bruising Easily Symptoms

Generally, new bruises appear red before turning bluish-purple. As it heals, a bruise may turn greenish-yellow before fading.

Signs and symptoms of easy bruising include:

• Bruises that appear without a known cause
• Large bruises or several small bruises
• Bruises that do not go away or fade in color
• Bruising more frequently than normal
• Bruises that appear after starting a new medicine

What Causes Easy Bruising?

Bruises can appear for several reasons, such as falling or bumping into something. Upon impact, tiny blood vessels under your skin break. Blood pools under the skin at the site of the bruise. As a result, a reddish mark appears on the skin. As bruises heal, the body reabsorbs the trapped blood.

Sometimes, people easily bruise due to physical activity, age, sun damage, or underlying health conditions.

An Active Lifestyle

Whether you are a competitive soccer player or a weekend warrior, bumps and bruises can happen after contact with other athletes or gear at the gym. Bruises may result from minor injuries (e.g., sports injuries), falls, or collisions. 

A person might be more likely to sustain injuries during sports or exercise for a number of reasons, such as if they:

• Do not use exercise techniques correctly
• Run or jump on hard surfaces
• Change exercise intensity too fast

Of note, though bruising may occur with sports injuries, those injuries can happen to anyone active in some way (e.g., painters, gardeners).

Age

For older adults, a minor bump or touch on the arm may leave a bruise. That's partly because as the skin ages, it starts to lose strength and takes longer to heal after injuries or if the skin breaks.

"As we age, our skin and blood vessels become more fragile; we lose collagen, elastin, and some of the subcutaneous fat that cushions and protects our small blood vessels," Suzanne Friedler, MD, a dermatologist at Advanced Dermatology PC in New York, told Health.

Sun-Damaged Skin

Years of sun exposure can weaken blood vessel walls, contributing to bruising in older adults known as "actinic purpura." Actinic purpura causes purple patches on the backs of the hands and forearms without much of a bump or injury.

Blood Thinners or Painkillers

Taking the blood thinner warfarin or using nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen can lead to easy bruising.

NSAIDs and blood thinners block the normal function of platelets, or a part of the blood that binds to other clotting factors to stop bleeding, Margaret Ragni, MD, director of the Hemophilia Center of Western Pennsylvania, told Health.

Blood thinners might not cause a bruising problem. Still, long-term use could result in bruising easily. Be sure to consult a healthcare provider before stopping any medication.

Steroids

Taking corticosteroids may result in easy bruising. Some health conditions that use corticosteroids as a standard treatment include:

• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Eczema
• Rheumatoid arthritis (RA)

Whether someone is using an inhaler, taking pills, or applying a topical version of those powerful anti-inflammatory drugs, bruising is a common side effect. Long-term use may cause skin thinning.

Talk to a healthcare provider about sticking with your medication regimen or switching to another drug if bruising easily is an issue.

Low Blood Platelet Count

A rare platelet disorder may be to blame if bruises seem to appear for no reason. Immune thrombocytopenia (ITP) is a low platelet condition. Blood platelets are crucial because they help form clots to slow or halt bleeding.

"You can either have an insufficient number of platelets, or your platelets don't work normally," said Dr. Ragni. 

Tell-tale signs that a person may have ITP include purpura or petechiae, or red spots under the skin that are small and flat. Of note, although it's uncommon, thrombocytopenia can develop during pregnancy. One of the first signs can be a bruise.

"That's the sort of thing a hematologist could help you sort out," noted Dr. Ragni.

A Bleeding Disorder

Bruising in and of itself can be minor. When other symptoms, like nosebleeds, heavy periods, or excessive bleeding after surgery, accompany bruising, something more than an accident may be the issue.

"It's the company [bruising] keeps, the frequency that it occurs, even the severity by which it occurs," explained Dr. Ragni. A bleeding disorder might be at play if abnormal bleeding patterns show up alongside easy bruising.

A missing or defective clotting protein causes one of the most common bleeding disorders, von Willebrand disease. The genetic condition affects up to 1% of the population.

People with bleeding disorders require specialized treatment, beginning with a thorough evaluation by a hematologist.

Liver Damage

Many things can cause liver damage, from hepatitis C to alcohol-related liver disease. With liver damage and disease, fewer platelets may be circulating in your blood than you need for normal blood clotting. Easy bruising may occur as a result, said Dr. Ragni. Low levels of hepatic-thrombopoietin (TPO) may lead to fewer platelets in the blood than average.

Seeing a healthcare provider is essential since it's possible to have liver disease and bleeding disorders.

"You want to have a very thorough evaluation to make sure you're not just attributing [bruising] to drinking and liver disease when it may be something else entirely," said Dr. Ragni.

Blood Cancer

Although exceedingly rare, bruising easily is a common symptom among people with blood cancer, or leukemia. People develop bruises due to an absence of healthy blood cells in the bone marrow. The body does not produce enough platelets needed for clotting.

One telltale sign of cancer-related bruises: They tend to occur in unexpected places, like the back or hands. People often develop multiple unexplained bruises at a time. The bruises may take longer than a week to go away, with new bruises showing up for three days.

How Is Easily Bruising Diagnosed?

To pinpoint the underlying cause of easy bruising, a healthcare provider will likely ask about your health history. They may ask about your lifestyle and any medications you take. A healthcare provider may ask about your family health history, including people with bruising or bleeding problems. Sometimes, bruising is easily inherited.

Then, the healthcare provider may order tests based on your account, symptoms, and physical exam. Those tests can rule out or diagnose health conditions that cause easy bruising. For example, if you present with petechiae, the healthcare provider may order blood tests to check your platelet levels. A severely low platelet count may indicate ITP.

Treatments for Bruises

Minor bruises do not require treatment. In contrast, try the RICE method for significant bruising due to a fall, jam, or blow: rest, ice, compression, and elevation. 

In particular, you'll want to do the following:

• Apply ice for up to 15 minutes every hour.
• Keep the bruised area raised and rested.
• Take Tylenol (acetaminophen) to reduce the pain.

Of note, the RICE method is most beneficial for a fresh injury, said Dr. Friedler: "It may initially help a bruise from worsening, but it rarely has a benefit on a bruise after the first 24 hours. After that time, heat can sometimes help the bruise clear up faster."

Treatments for health conditions that cause easy bruising include:

• Sun-damaged skin: Daily application of alpha-hydroxy acid (AHA) or tretinoin cream may thicken the skin and help a bit. Wear long sleeves and avoid hand and arm trauma to help prevent actinic purpura.
• ITP: Prednisone and dexamethasone are medicines that help manage ITP symptoms like easy bruising. In severe cases, a healthcare provider may advise surgically removing the spleen. Some people with ITP see increased platelet counts after removing the spleen.
• Bleeding disorders: A healthcare provider may prescribe certain medicines to control bleeding disorders. Blood, platelet, or clotting factor transfusions can help, too.
• Liver damage: Treatment varies but focuses on reducing damage to the liver and preventing liver failure or cancer. In severe cases, you may require a liver transplant.
• Blood cancer: Treatment may include chemotherapy, radiation therapy, stem cell transplant, or other targeted therapies to get rid of and stop the growth of cancer cells.

A healthcare provider may advise stopping or adjusting the dose of certain medicines if they cause you to bruise easily.

How To Prevent Bruises

Preventing bruises may be tricky, depending on the cause. For example, health conditions like ITP or certain blood cancers are not entirely preventable. 

Still, you can take several steps to protect your skin. An SPF of at least 30 helps prevent sun damage that causes bruises. Keeping your home clear of mess and furniture you can easily bump into can avert bruises. Maintain good lighting in your home to avoid any areas where you can fall or bump into something.

Complications

Rarely do bruises cause severe complications. Bruises with other symptoms, like redness, oozing, and fever, may signal an infection.

Some underlying conditions that cause easy bruising may lead to complications. For example, ITP rarely causes hemorrhage, or bleeding in the brain. Hemorrhage happens due to the body's inability to clot.  

When To See a Healthcare Provider

You will want to seek medical attention for bruises in some health conditions, such as:

• Large or multiple small bruises without a known injury
• Bruising with signs of infection (e.g., oozing or a fever)
• Bruises that do not look like they are healing or fading
• Large or painful bruises following an injury
• Increased and more frequent bruising
• Bruises that appear following the use of a new medicine

Still, bruises usually go away on their own. Consult a healthcare provider if you are worried about them.

"If it bothers you—if it recurs or it occurs, and you can't explain it, and you're concerned, or you have a family history of a problem—then you should see somebody," advised Dr. Ragni.

A Quick Review

Bruising easily can result from several things, including being active, using certain treatments, or blood-related health conditions. You can treat minor bruises with home remedies like ice and rest. For more severe issues or changes with bruises, consult a healthcare provider to find out what treatments may be best.