Bleeding into the skin

  • Definition
    • Bleeding into the skin can occur from broken blood vessels that form tiny 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 paler (blanch) when you press on the area, like the redness from erythema does.

  • Causes
  • 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 provider about stopping the drug. Otherwise, follow your prescribed therapy to treat the underlying cause of the problem.

  • When to Contact a Medical Professional
    • 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 Office Visit
    • Your 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:

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

      Hayward CPM. Clinical approach to the patient with bleeding or bruising. Hoffman R, Benz EJ Jr, Silberstein LE, Heslop HE, Weitz JI, eds. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 130.

      Piette WW. Purpura. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 22.