There it is again. Another unsightly mark on your leg. You don't even remember bumping yourself! Why do we bruise, and how can we prevent it?A bruise occurs when tiny blood vessels are damaged or broken as the result of a blow to the skin. The raised and discolored area is the result of blood leaking from these injured blood vessels into the tissue, and from the inflammation that accompanies the injury. Bruises change in appearance over time. In fact, you can tell the age of a bruise by examining its appearance. When it first appears, a bruise will look reddish, reflecting the color of the blood just under the skin. Within one or two days, the reddish iron from the blood changes and the bruise appears blue or purple. By day six, the color will change to green. By day eight or nine, the bruise will appear yellowish-brown. Within two to three weeks, the healing process will be complete and the skin will look normal once more. When a bruise continues to get larger instead of going away, or becomes painful, it may be due to a large collection of blood forming under the skin or in the muscle. Instead of trying to clean up the area, the body may actually form a wall around the blood. This is called a hematoma, and it may require draining by your physician. What factors contribute to bruising? Age causes our skin to become thinner and lose some of the protective fatty layer that helps to cushion the blood vessels against injury. The capillary walls become weaker, and as they become increasingly fragile, they become more prone to rupture. Excessive exposure to the sun also accelerates this aging process. A number of medications may contribute to bruising. Blood thinning medications such as aspirin, warfarin (Coiumadin), clopidogrel (Plavix), ibuprofin (Motrin, Advil), naproxin (Aleve), or any other non-steroidal anti-inflammatory medication, can all increase the bleeding from capillaries. Bruising may be the result of getting too high a dose of one of these medications; check with your doctor regarding this possibility. Steroids cause your skin to thin, making it easier to bruise. Some dietary supplements such as fish oil, glucosamine chondroitin, Vitamin E, and ginkgo may increase bruising, as they have a blood thinning effect. When should you worry about a bruise? There are certain diseases that affect blood-clotting. Be more concerned about bruising if: •you have unusually large or painful bruises •they develop for no apparent reason •you are bruising easily and experiencing abnormal bleeding from other places, such as your nose and gums, or notice blood in your bowel movements •you have no previous history of bruising but are suddenly experiencing them. Any of these may indicate that you have low levels or abnormal functioning of platelets, or other components of blood clotting. Specific blood tests can help you and your doctor reach the correct diagnosis. Finally, let's not forget a tragic cause of bruising if they appear suddenly in a loved one: domestic violence. If you have a loved one who has suddenly developed bruising, especially around the eyes or face, or other areas of the body not likely to receive routine bumps, consider the possibility of abuse. Also, someone who repeatedly falls with subsequent bruising may have a drug or alcohol problem. After the bruise has occurred, time will heal it. But what can you do to avoid bruising? •If advisable, your doctor may wish to lower the dose of one of your medications. •If there is swelling at the site of an injury, apply ice compresses for 20 minutes at a time. Once the swelling is gone, warm compresses will speed removal of the pooled blood. •Safety-proof your home to help eliminate sources of bumps and falls. •Wear long-sleeved shirts and pants to help provide an extra layer of protection for your skin. •Avoid prolonged exposure to the sun, in order to slow the aging process of your skin. Finally, if you're unhappy about the appearance of a bruise, cover it up until it has healed. I wish good health - and caution - to you all. Dr. Alan Frischer is former chief of staff and current chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

********** Published: July 24, 2009 - Volume 8 - Issue 14