Bruising and bleeding both occur because of damage to blood vessels. When a
vein, artery, or capillary is torn or cut, blood flows out into the vessels
surroundings; if the escaped blood is contained within the tissues directly
under the skin, we see a bruise.
While all of us bruise from time to time, some people bruise particularly
easily. A number of factors, besides being accident-prone, can make this occur.
One factor contributing to easy bruising is thinning skin, caused by aging or by
medications such as corticosteroids. Easy bruising can also be due to fragile
blood vessel walls. Finally, difficulties with blood clotting, including
problems with platelets or clotting factors, can also increase bruising. For
this reason, strong blood-thinning drugs such as heparin and warfarin (Coumadin)
can lead to excessive bruising.
Warning: if you’re taking these or other anticoagulant drugs and notice
increased bruising, contact your doctor, as this situation could be dangerous.
Aspirin or even natural remedies such as high-dose vitamin E, ginkgo, and garlic
may also thin the blood, possibly raising the risk of bruising and other
bleeding problems; and if you combine two blood-thinning substances, these
effects might multiply. Rarely, severe bruising from minor or unnoticed injuries
can be a sign of leukemia or another serious health problem. Especially if this
is a new development, discuss your symptoms with a doctor.
However, in most cases, there is no identifiable medical cause for easy
bruising, and no conventional treatment. Furthermore, once you have a bruise,
there is no conventional therapy to help speed its resolution.
Treatment
Principal Proposed Treatments for Easy Bruising:
A number of natural substances might be helpful for easy bruising, including
citrus bioflavonoids, the related substances OPCs and bilberry, and vitamin C.
In addition, if you already are bruised, you may find some help with a
combination of two proteolytic enzymes, trypsin and chymotrypsin or a topical
preparation of escin (an extract of horse chestnut).
Citrus Bioflavonoids and Related Substances
Bioflavonoids (or flavonoids) are plant substances that bring color to many
fruits and vegetables. Citrus fruits are a rich source of bioflavonoids,
including diosmin, hesperidin, rutin, and naringen; studies have found that
bioflavonoids contained in citrus fruits can help decrease bruising. Two types
of natural compounds related to bioflavonoids, OPCs (oligomeric
proanthocyanidins) and anthocyanosides, may also be able to decrease bruising.
What Is the Scientific Evidence for Citrus Bioflavonoids?
A double-blind study of 96 people with fragile capillaries found that a
combination of the bioflavonoids diosmin and hesperidin decreased the tendency
to bruise. Participants took 2 tablets daily of these bioflavonoids or placebo
for 6 weeks, while researchers used a suction cup to measure their capillaries
tendency to rupture and also looked for spontaneous bruising and other symptoms
of fragile capillaries. Those individuals who received bioflavonoids had
significantly greater improvements in both capillary strength and symptoms
compared to those taking placebo.
Two rather poorly designed studies from the 1960s found benefits with a
combination of vitamin C and citrus bioflavonoids for decreasing bruising in
collegiate athletes. In a single-blind study of 27 wrestlers, 71% of those
taking placebo were injured, with bruises making up more than half their
injuries; in contrast, only 38% of those taking the supplement were injured,
none of whom sustained bruises. In a follow-up double-blind study of 40 football
players, the treated group received fewer severe bruises than the group taking
placebo.
Test tube studies have found that OPCs protect collagen, partly by inhibiting an
enzyme that breaks it down. One rather poorly designed double-blind study of 37
people—most of whom had fragile capillaries—found that OPCs were more effective
than placebo in decreasing capillary fragility; however, the authors of this
study left many questions unanswered in their report, making it hard to
determine how seriously to take their results.
Anthocyanosides, which are present in high concentrations in bilberry, may also
strengthen capillaries through their effects on collagen. Some European
physicians believe that these vessel-stabilizing properties make bilberry useful
as a treatment for easy bruising, but the evidence as yet is only suggestive.
For more information, including dosage and safety issues, see the full articles
on citrus bioflavonoids, OPCs, and bilberry.
Vitamin C
Vitamin C is essential for healthy collagen; severe vitamin C deficiency, called
scurvy, can lead to easy bruising. Fortunately, scurvy is extremely rare in
Western countries today—but marginal vitamin C deficiency is not rare, and might
lead to increased risk of bruising.
A 2-month double-blind study of 94 elderly people with marginal vitamin C
deficiency found that vitamin C supplements decreased their tendency to bruise.
If your diet is low in fresh fruits and vegetables, you may wish to supplement
it with vitamin C. In the study mentioned above, bruising in elderly people
decreased significantly with 1 g of oral vitamin C given daily for 2 months.
For more information, including dosage and safety issues, see the full vitamin C
article.
Trypsin and Chymotrypsin
Trypsin and chymotrypsin, naturally produced in the body to help digest protein,
are often called proteolytic enzymes. (Bromelain, discussed below, is a
proteolytic enzyme from a plant source.) It is theorized that trypsin and
chymotrypsin reduce swelling by breaking down protein fibers that trap fluids in
the tissues after an injury, thereby restoring normal circulation in the area.
Three small double-blind studies, involving a total of about 80 athletes, found
that treatment with proteolytic enzymes significantly speeded healing of bruises
and other mild athletic injuries as compared to placebo.
For more information, including dosage and safety issues, see the full
proteolytic enzymes article.
Escin
An extract of horse chestnut called escin may also help with bruising. Horse
chestnut has been traditionally used to treat varicose veins and other problems
involving blood vessels and swelling. One double-blind study of 70 people found
that about 10 g of 2% escin gel, applied externally to bruises in a single dose
5 minutes after they were induced, reduced bruise tenderness.
For more information, including dosage and safety issues, see the full horse
chestnut article.
Other Proposed Treatments for Easy Bruising:
Bromelain
Like trypsin and chymotrypsin, bromelain is thought to decrease bruising by
breaking down proteins that trap fluids in the tissues after an injury, and it
is sometimes used in Europe to speed recovery from injuries. However,
better-quality studies are needed before bromelain can be said to be effective.
In one controlled study, 74 boxers with bruises on their faces and upper bodies
were given bromelain until all signs of bruising had disappeared; another 72
boxers were given placebo. Fifty-eight of the group taking bromelain had lost
all signs of bruising within 4 days, compared to only 10 taking placebo.
Unfortunately, this study was apparently not double-blind, meaning that some of
its results may have been due to the power of suggestion.
Another study—this one without any type of control group—found that bromelain
reduced swelling, pain at rest, and tenderness among 59 patients with blunt
injuries, including bruising.
For more information, including dosage and safety issues, see the full bromelain
article.
Other Herbs Used for Bruising
The herbs comfrey, arnica, and sweet clover are widely used externally on
bruises and other minor injuries, but despite this traditional use, there is no
real scientific evidence that they work. A homeopathic preparation of arnica,
quite distinct from the herb arnica, is also popular for treating bruises.
Note: There are various safety concerns involved in using comfrey,
arnica, and sweet clover internally. For the treatment of bruising, they are
used as topical ointments and salves.