Easy Bruising (Ecchymosis); Symptoms, Causes, Diseases and Treatments

How to tell the difference

Bruising, hematoma, periorbital, contusion and petechiae are also subcutaneous hemorrhages. We look at how these skin conditions are different and similar to ecchymosis.

Ecchymosis vs. Hematoma

Ecchymosis vs. Hematoma

They are the accumulation of blood, which has left the blood vessels and can occur anywhere in the body and even in internal organs. They are blood effusions that occur in an organ, in the wall of a muscle or abdomen. They are therefore invisible at first but may appear on the surface of the skin over time.

In general, they are classified into two main types:

  • Superficial: if they appear on the skin or muscles.
  • Profound: when they are formed in the internal organs.

Superficial hematomas are the most frequent and obvious, due to their location, and can be: subcutaneous (under the skin), intramuscular or subungual (under the nails).

The main cause of hematomas is the blows (traumatisms), that break the blood vessels (arteries or veins). They can also be formed after procedures such as blood drawing or surgery.

In addition, they can appear spontaneously, that is, without having suffered a previous blow, as a result of various disorders or certain diseases that alter the normal mechanisms of blood coagulation, such as liver cirrhosis, leukemia, acute kidney failure, certain types of anemia (aplastic anemia) and multiple myeloma, among others.

Ecchymosis vs bruise

Bruises (ecchymotic purpura) are frequent and quite benign in 95% of all cases. Women are particularly prone to this because their skin is thinner and hormonal changes weaken the blood vessels. Older people also have more transparent skin.

Bruises may turn blue, green and yellow before disappearing completely. They may take several days to appear after a trauma. Trauma almost always causes a bruise. And if the blow was violent (like a baseball bat on one leg), the bleeding can occur both on the surface of the skin and inside the leg, causing a bruise and a hematoma.

Certain medications, called anticoagulants, also promote the appearance of bruising. In addition, people who take aspirin, anti-inflammatories, oral cortisone or inhaler are more likely to bruise. Why? Because these drugs interfere with the proper functioning of blood platelets.

With the years, cortisone thins the skin, making it more vulnerable to bruising.

Ecchymosis vs petechiae


Petechiae (petechial purpura) is used to refer to as very small red lesions (less than 3 mm), most of the time on an organ, which is caused by some bleeding under the skin.

There are two types of petechiae: those that are caused by a deficiency of platelets (important elements in the process of coagulation) and those that occur while the platelets are healthy.

Petechiae are rare and are more serious than ecchymosis, bruises or hematomas, as they almost always indicate a serious problem. They occur suddenly and in large numbers; appear mostly on the legs; do not whiten when pressed; bring no pain, swelling or itching and may disappear after a few days, leaving brown spots. Medicines that cause bruising can also cause petechiae (see above).

Contusion vs ecchymosis

Contusions are wounds like the bruise which appears like a bruise. The skins of the victims are not broken in this case. However, it is usual to have the patient’s blood vessels broken, followed by discoloration.

Periorbital ecchymosis

Periorbital ecchymosis, also known as raccoon eyes and panda eyes is a sign of a form of hematomal, a craniotomy, a certain rare cancer or a fracture at the skull’s base.

This occurs when the meninges are torn during an incident of damage from a facial fracture. This causes the blood from the skull fracture to go around the eyes’ soft tissues – hence, a periorbital ecchymosis is triggered.

This condition can be followed by the Battle’s sign or in some cases, an Ecchymosis may appear around the ear.

The racoon usually appears two to three days after such injury. Victims are advised not to cough vigorously, blow the nose, or strain, so as to prevent further damages.

This condition usually requires an urgent consultation of a doctor – whether for surgical or medical intervention – depending on the cause.

Ecchymosis and leukemia

Ecchymosis and leukemia
Leukemia bruises

Very often in the case of frequent, sudden and unexplained bruises, there are fears of being ill with leukemia. In reality, in 99% of cases, the fear is completely unjustified and the tendency towards the development of frequent ecchymoses can be explained by a marked capillary fragility.

In the case of leukemia, on the contrary, the drastic decrease of the platelets would cause the appearance of major bleeding, naturally accompanied by several other symptoms.

Written by Martin Davis