What is Ecchymosis (Ecchymosis definition)?
Ecchymosis is the discoloration of the skin or the change in color of the skin into reddish or bluish or purplish color. Ecchymosis occurs as a result of an underlying disease or medical condition. Due to certain diseases, the smallest blood vessels in the body called capillaries that facilitate the exchange of oxygen and nutrients between the tissue and blood vessels get ruptured. This rupture of capillaries occurs spontaneously.
This leaked or extravasated blood from the capillaries gets accumulated in the subcutaneous tissues. This accumulated blood makes the skin appear red, blue or purple in color. This is called ecchymosis. Ecchymosis is greater than 1 cm in size.
The difference between bruise and ecchymosis:
Many people get confused between a bruise and an ecchymosis. People often use both the terms interchangeably. Although bruise and ecchymosis are changes in skin color due to leakage of blood, they both are different. This difference is based on the mechanism of leakage of the blood.
A bruise occurs when there is any injury or trauma to the skin or any body part like blunt trauma. Due to the compressive forces exerted on the skin by the traumatic incident, the blood leaks from the blood vessels or capillaries and leads to the formation of a bruise. For example, if someone punches you in your face or eye, you develop a bruise.
But in ecchymosis, the bleeding from the blood vessels or capillaries occurs only due to an underlying disease or medical condition. If you happen to develop any abnormal discoloration on your skin without any trauma or injury, you need to think of ecchymosis and the causes of ecchymosis.
Different types of hematomas:
Just similar to a bruise, many people use the terms hematoma and ecchymosis interchangeably. But, the fact is that ecchymosis is a type of hematoma. There are two other types of hematomas. There are the petechiae and the purpura.
Hematomas are subdivided into these three types based on their size. If the skin bleeding is less than 2 mm in size, it is called as petechiae. If the skin bleeding or discoloration is between 2mm and 1 cm in size, it is called purpura.
If the bleeding into the skin is more than 1 cm in size and larger, this types of hematoma are referred to as ecchymosis. Based on whether a person has developed petechiae or purpura or ecchymosis, the doctors or physicians will be able to narrow down the causes of the hematoma or skin bleeding, as all the three types of hematomas are caused by different medical disorders.
Causes of ecchymosis:
When there is leakage of the blood from the capillaries, there is no cut or opening in the skin through which the blood can leak out through the skin. As the skin is tightly closed, the blood gets accumulated in the subcutaneous tissue leading to the reddish discoloration of the skin.
Later on, a type of white blood cell called macrophage tries to clean up the blood by engulfing it by a process called phagocytosis. Also, the “heme” part of the hemoglobin in the blood gets broken down into bilirubin. These changes like phagocytosis and breaking into bilirubin are responsible for the color changes occurring in the part undergoing ecchymosis.
There are many different causes of ecchymosis. These may range from minor problems or protective mechanisms of the body like swelling or inflammation to fatal conditions like cancers, leukemias, multiple myeloma, etc. Let us explore all about these causes in detail.
Multiple myeloma is also known as the plasmacytoma. It is a cancer of the plasma cells. Plasma cells are the cells of the immune system, and they are a type of white blood cells or leukocytes. There are mainly 2 types of white blood cells. They are the granulocytes and the agranulocytes. Granulocytes are further divided into acidophils, basophils, and neutrophils.
Agranulocytes are further divided into lymphocytes and monocytes. Lymphocytes are divided into T lymphocytes and B lymphocytes. These B-lymphocytes get activated into plasma cells and produce antibodies or immunoglobulins which are required to protect our body from the harmful pathogens.
In Multiple myeloma, the plasma cells divide in an uncontrolled manner and so produce excessive amounts of proteins or antibodies. They lead to many symptoms like kidney failure, bone pains, and also the formation of ecchymosis, or reddish discoloration in the skin. This disorder is mainly seen in elderly people.
Leukemia is the increased production of different types of white blood cells in rapid uncontrolled manner. It is the cancer of the white blood cells. There are many types of leukemia like the AML (Acute myeloblastic leukemia), ALL (Acute lymphoblastic leukemia), CML (Chronic myelocytic leukemia) and the CLL (Chronic lymphocytic leukemia).
Different types of leukemia occur in different age groups. But all these types of leukemia are associated with bleeding tendencies, like bleeding into the skin and also bleeding from the gums, etc. Due to leukemia, the bleeding into the skin appears like ecchymosis.
Acute renal failure:
Acute renal failure is the failure of the kidney to filter the blood and to produce urine. It leads to decreased production of urine called oliguria or if it’s very severe urine production stops completely. This is called anuria.
In acute renal failure, due to the inability of the kidneys to filter the waste products from the blood, these waste products like urea get accumulated in the blood. This leads to bleeding from the skin and the formation of ecchymosis.
Cirrhosis of liver:
The liver is a very important organ of the body which regulates various functions like detoxification of the body or getting rid of toxic substances accumulated in the body, maintaining or regulating the clotting factors and the proteins in the body, etc.
Cirrhosis of the liver can occur due to various reasons like viral infections and also due to excess alcohol consumption. In the condition, the liver is replaced by fibrous tissue. So, the functions of the liver are impaired in cirrhosis. Due to this, the clotting factors are not controlled properly and it leads to ecchymosis or bleeding into the skin.
“Myelo” means bone marrow. In myelofibrosis, the entire bone marrow is replaced by fibrous tissue. Bone marrow is the region where blood cells are produced. So, as the bone marrow is replaced by fibrous tissue, the count of platelets is reduced.
Platelets are the cells which help in stopping bleeding from the blood vessels. So, in myelofibrosis due to the decreased levels of platelets, ecchymosis can occur.
Grey turner syndrome:
This syndrome is seen in a condition called acute pancreatitis, in which the pancreas is inflamed or swollen acutely. In this disorder, there is grayish or bluish discoloration of the flank region.
Symptoms of ecchymosis:
You have seen the various reasons or causes of ecchymosis. Now, let us learn the exact symptoms of ecchymosis.
1. Skin discoloration or stages of ecchymosis:
There is skin discoloration in ecchymosis, which might range from bluish to reddish to green color. But, different colors appear at different stages in ecchymosis. Let us learn when these color changes occur exactly.
Initially, when ecchymosis occurs, the skin appears with slight reddish discoloration. Then there is appearance of reddish color patches after a few hours,
Bluish or purplish color:
After a few days after the initial appearance of the red colored patches, the skin with red discoloration turns into a bluish or purplish color.
Slowly, the skin with purplish color turns into green color after a few days. Then again, the skin changes color later on.
After few days of the appearance of green colored skin discoloration, the color of the affected area turns into yellow color. Yellow color appearance indicates that the person or the area affected with ecchymosis is about to recover or become normal again. It is a good sign of recovery.
After few days, the ecchymosis becomes brown in color and tries to match the skin color. Our body always tries to recover from any ailment or injury by various mechanisms.
Some people experience pain at the region of ecchymosis. But, there are many people who don’t experience any pain at all at the region of ecchymosis.
3. Non-Blanching rash:
Rashes or skin discolorations are categorized by the medical professionals on the basis of whether they blanch or not. Blanching means when you press over a rash or skin discoloration with your finger and then you remove your finger, the rash seems to disappear initially and then after a few seconds, the skin rash or discoloration comes back.
A non-blanching rash means that if you press over the rash or skin discoloration and then remove your finger, the rash or skin discoloration seems to be as it is without any changes.
In some people, there can be signs of inflammation like reddishness, swelling, pain or raise of temperature around the area affected with ecchymosis.
Treatment of ecchymosis:
The majority of ecchymosis can be managed by yourself at home if they are very small or affecting only a particular body part or region. But, if there are any other abnormal symptoms apart from skin discoloration or if the area affected by ecchymosis is very large, you will need to visit your healthcare professional or doctor for a detailed history, physical examination, tests, and diagnosis.
In order to get relieved from ecchymosis fast, you will need to take adequate rest. Avoid any strenuous activities and take rest for a few days until the ecchymosis resolves completely.
Application of ice over the area of ecchymosis helps in constriction of the blood vessels that are leaking. This helps in avoiding further leakage of the blood into the subcutaneous tissues.
Elevation of the affected area:
You need to elevate the affected limb or body part higher than other body parts. This prevents the pooling of blood in the area due to the effect of gravity. You can do this by using pillows.
If you experience pain in the area of skin discoloration, you can take the help of certain over the counter pain killers or analgesics like ibuprofen, or aceclofenac to curb the pain.
You have seen all the different causes, symptoms and also the treatment of ecchymosis. Hope you have understood everything about it. Be sure to visit your doctor if you experience any other abnormal symptoms apart from skin discoloration.