Bleeding into the skin

Answer 1

Definition

Bleeding under the skin can occur from broken blood vessels that form tiny pinpoint red dots (called petechiae). Blood also can collect under the tissue in larger flat areas (called purpura), or in a very large bruised area (called an ecchymosis).

Alternative Names

Ecchymoses; Skin spots - red; Pinpoint red spots on the skin; Petechiae

Considerations

Aside from the common bruise, bleeding into the skin or mucous membranes is a very significant sign and should always be checked out. Redness of the skin (erythema) should not be mistaken for bleeding. Petechiae, purpura, and ecchymosis do not become pale(blanch) with pressure. The redness of erythema decreases and then returns when you apply and then release pressure to it.

Common Causes

• Injury or trauma
• Allergic reaction
• Autoimmune disorders
• Viral infection or illness affecting blood coagulation
• Thrombocytopenia
• Medical treatment, including radiation and chemotherapy
• Antiplatelet medications such as clopidogrel (Plavix)
• 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
  • Anticoagulants such as warfarin or heparin (ecchymosis)
  • Aspirin (ecchymosis)
  • Steroids (ecchymosis)
• Septicemia(petechiae, purpura, ecchymosis)

Home Care

Protect aging skin. Avoid trauma such as bumping or pulling on skin areas. For a cut or scrape, use direct pressure to stop the bleeding.

If you have a drug reaction, ask your health care provider about stopping the drug. Otherwise, follow your prescribed therapy to treat the underlying cause of the problem.

Call your health care provider if

Contact your health care provider if:

• You have sudden bleeding into the skin for no apparent reason
• You notice unexplained bruising that does not go away

What to expect at your health care provider's office

Your doctor will examine you and ask questions about the bleeding, such as:

• Have you recently had an 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 the bleeding occurred repeatedly?
• Have you always had a tendency to bleed into the skin?
• Did the bleeding start in infancy (for example, with circumcision)?
• Did it start with surgery or when you had a tooth pulled?

The following diagnostic tests may be performed:

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

References

Schafer AI. Approach to the patient with bleeding and thrombosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 178.

Answer 2

Definition

Bleeding under the skin can occur from broken blood vessels that form tiny pinpoint red dots (called petechiae). Blood also can collect under the tissue in larger flat areas (called purpura), or in a very large bruised area (called an ecchymosis).

Alternative Names

Ecchymoses; Skin spots - red; Pinpoint red spots on the skin; Petechiae

Considerations

Aside from the common bruise, bleeding into the skin or mucous membranes is a very significant sign and should always be checked out by a health care provider.

Redness of the skin (erythema) should not be mistaken for bleeding. Areas of bleeding under the skin do not become pale (blanch) when you press on the area. The redness of erythema decreases when you apply pressure to it and returns when release the pressure.

Common Causes

• Injury or trauma
• Allergic reaction
• Autoimmune disorders
• Viral infection or illness affecting blood coagulation
• Thrombocytopenia
• Medical treatment, including radiation and chemotherapy
• Antiplatelet medications such as clopidogrel (Plavix)
• 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
  • Anticoagulants such as warfarin or heparin (ecchymosis)
  • Aspirin (ecchymosis)
  • Steroids (ecchymosis)
• Septicemia(petechiae, purpura, ecchymosis)

Home Care

Protect aging skin. Avoid trauma such as bumping or pulling on skin areas. For a cut or scrape, use direct pressure to stop the bleeding.

If you have a drug reaction, ask your health care provider about stopping the drug. Otherwise, follow your prescribed therapy to treat the underlying cause of the problem.

Call your health care provider if

Contact your health care provider if:

• You have sudden bleeding into the skin for no apparent reason
• You notice unexplained bruising that does not go away

What to expect at your health care provider's office

The health care provider will examine you and ask questions about the bleeding, such as:

• Have you recently had an 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 the bleeding occurred repeatedly?
• Have you always had a tendency to bleed into the skin?
• Did the bleeding start in infancy (for example, with circumcision)?
• Did it start with surgery or when you had a tooth pulled?

The following diagnostic tests may be performed:

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

References

Ballas M, Kraut EH. Bleeding and bruising: a diagnostic work-up. Am Fam Physician. 2008 Apr 15;77(8):1117-24.

Coller BS, Schneiderman PI. Clinical evaluation of hemorrhagic disorders: The bleeding history and differential diagnosis of purpura. In: Hoffman R, Benz EJ, Shattil SS, et al, eds. Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 121.

Reviewed By

Review Date: 05/01/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.