Senile Purpura / Solar Purpura / Easy Bruising

Thin Skin is In

Lots of people ask me why they bruise so easily and I don't feel like I ever have a satisfying answer.

A bruise happens when you get blood that seeps out of a blood vessel into the skin and tissue around it and the hemoglobin as it gets broken down leads to staining. Over time as the skin fixes itself, it changes color from bright red all the way to purple or black, and usually clears up within a few weeks.

One tricky part that worries most people is when bruising develops and starts moving after they get injured. But for most people who get bruised on the arms or legs, gravity causes the bruising to be farther down than where they were injured as blood breakdown products trickle downwards. Many people will get bruising around the foot or ankle after leg injury higher up. Totally normal. Same reason people will get black eyes - the blood pools down under the eyes just because of the way the skull and skin fit together.

I also hear many people say that they bruise too easily without even doing anything. This really comes down to a combination of 3 factors

- medications that cause you to bleed more easily, including the blood thinners you know about (aspirin, warfarin, Plavix (clopidogrel) to name a few) as well as other medications you wouldn't think of (ibuprofen, naproxen, SSRI antidepressants, topical or systemic steroids). These usually don't cause any harm, but do make people more likely to bruise and bleed.

- thinner skin. About 10% of people over 50 have what's called senile or Bateman purpura or purpuric dermatoses which is due to thinner skin leading to less cushioning of the blood vessels and most commonly seen in the forearms with minimal trauma. Again, totally harmless, but the bruises take forever to go away. Sun damaged skin tends to develop this more easily than skin that's been protected for a long time.

- rare things. This is typically the first stuff that comes up when you search for "why do I bruise easily" and the answer usually involves some kind of cancer or blood disorder, which again are rare. It is very uncommon to find easy bruising as the first sign of anything horrendous but if it does come on pretty suddenly and substantially, we'll usually do some lab work which can pretty easily show when something is off.

NSAIDs

Advil and Motrin are ibuprofen, then you have Aleve (naproxen). Those are the over-the-counter ones. Prescriptions are Mobic (meloxicam), nabumetone, indomethacin, Toradol (ketorolac), diclofenac, Lodine, and the list goes on. All of these medications are in a class called non-steroidal anti-inflammatory drugs (NSAIDs). I'm giving you this list because there is mounting evidence that these medications a) don't work as well as we'd thought and b) have some very serious long term side effects we're finding out more about. NSAID's act by reducing the amount of prostaglandins you make in order to reduce inflammation. However, prostaglandins have a ton of other effects and are involved in the maintenance of just about AIDs and also stronger if they are taken every day and/or around-the-clock. every other organ system that you have. The effect is stronger with higher doses of NS NSAID's work best and are best indicated for times when something is r...

Kidney Stones

I've written about this previously , but it's often hard to explain to people what a 10 is on the "1-10" pain scale if they haven't been in that spot before. For women who have had children, they generally know what a 10 is, but for men it's a little harder. When I was a medical student on my psychiatry rotation, we had a patient calmly sitting there saying his pain level was at a 10 and our resident, who was an ex-military sniper with a large skull tattoo on his forearm and a crosshair through the eye, calmly leaned forward and asked, "so if I lit you on fire and ran you over with my truck, you could not be in more pain than you are now, correct?" The patient changed his answer. Getting to the point, a kidney stone is about the close I can come to describing a 10/10 pain to people who haven't gone through childbirth. The fundamental issue is similar - your body is trying to move a big solid thing through an opening that was not really desig...

Pain

Sorry to be a pain I would say about 90% of the comments I hear from people about their pain threshold is that they think they have a high pain tolerance. Which is statistically impossible unless I just attract people who have a high pain tolerance. We traditionally ask people to rate their pain on a 1-10/10 scale and while we hear a lot of 9's and 10's, I would say that, having been present for a number of them, a 10/10 would be giving birth to a first child. For those who haven't experienced that, my old psychiatry resident described it as "so if I lit you on fire and ran you over with my truck, you would not be in any more pain than you are now" (he was also a former Marine sniper which might explain that). But this is pretty pervasive throughout the medical system and got me wondering as to how people's understanding of what their pain threshold was matched up to what it really was. Fortunately, there were researchers who had a yen to poke peopl...

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