Bruises

---

Bruises

Erase the Black and Blues

Most bruises occur in either of two ways: You hit something hard--a desk, a coffee table or a chair. Or, something hard--a cyclist, a falling carton or a toppling bookshelf--hits you.

"In the process, you break blood vessels, which leak blood into areas under your skin, causing swelling, discoloration and soreness," says Wilma Bergfeld, M.D., head of clinical research in the Department of Dermatology at the Cleveland Clinic Foundation.

Almost a taboo topic, "fingerprint" bruises are also common in women, along their shoulders, wrists, hips or thighs--a result of rough handling by a boyfriend or husband, either during moments of too-rough intimacy or unfortunately, during physical abuse, says Dr. Bergfeld.

Bruises are also common in older women whose skin is thinning with aging, because collagen--the connective tissue that cushions skin--breaks down, leaving underlying blood vessels more vulnerable, says Dr. Bergfeld. Long-term sun damage can also make women's skin more susceptible to repeat bruising. And older women who take multiple medications for diseases, including blood thinners like aspirin, also have an increased risk of bruising.

THE GEOGRAPHY OF BRUISES

Women doctors say that a common bruise should heal on its own within a few weeks. As it progresses through the stages of healing, the bruise evolves through a horrid rainbow of colors--reddish-blue, then purplish-black, then yellowish-green, says Dr. Bergfeld.

As a general rule, bruises tend to heal more slowly as you go down the body, says dermatologist Karen E. Burke, M.D., Ph.D., an attending physician at Cabrini Medical Center in New York City and at Greensboro Specialty Surgical Center in North Carolina. "They heal fastest on your face (usually within a week), slower on your trunk (in one to two weeks) and even slower on your legs. Don't be disconcerted if a leg bruise doesn't completely heal for up to a month."

When To See A Doctor Women doctors say that you should see a physician if: * You have a large bruise from a collision or injury of some kind (a fall or car accident, for example), especially if the bruise is painful and limits movement in a joint. * You tend to bruise a lot for no apparent reason. * You bruise easily and rely heavily on aspirin or other over-the-counter painkillers, such as ibuprofen or acetaminophen, for chronic conditions such as arthritis. * You develop a large bruiselike clot of blood that is swollen and very painful (known as a hematoma) after surgery. Return to your surgeon, who will be able to treat it so that it will heal faster.

Bruises on the legs are usually the worst, because there is more blood pressure in leg vessels, so they bleed more than blood vessels in the arms, for example, explains Dr. Bergfeld.

BRUISE CONTROL

The next time you bruise yourself, women doctors suggest that you take these measures to help minimize pain and ugliness.

Ice on, ice off. If you apply ice right after you bump your skin, you can limit the size and severity of a bruise and relieve pain, says Sheryl Clark, M.D., assistant clinical professor of dermatology at Cornell Medical Center and an assistant attending physician in medicine at the New York Hospital, both in New York City. "The coldness clamps blood vessels shut so that less blood escapes into surrounding tissue."

Using ice wrapped in cloth, or a cold pack, ice the bruise for 10 to 20 minutes, then take a break. Repeat every two hours. "Try keeping a cold pack in the refrigerator instead of the freezer," Dr. Clark suggests. "It still gets good and cold, but instead of freezing solid, it stays flexible so that you can conform it to your body."

Wrap it. Wrap an elastic bandage around the bruised area immediately (especially if it's on your leg) to apply mild pressure to broken blood vessels. The support might prevent vessels from leaking as much blood, minimizing the severity of the bruise, says Dr. Bergfeld.

Bring in the heat. After 24 hours, when the bruise has fully developed, it's safe to apply heat. "At that point heat actually helps open up the surrounding blood vessels so that they can sweep away fluids and blood cells much more quickly," says Dr. Clark. Soak in a hot bath or apply a heating pad or a washcloth soaked in hot water, for 20 minutes, three times a day, until the bruise resorbs. But don't apply heat immediately.

"Heat causes tissues to swell, and at that early stage it can actually cause more bleeding and make the bruise worse," cautions Dr. Bergfeld.

Knock out a bruise with vitamin K. Look for a brand-name bruise-diminishing cream containing vitamin K, such as Vitamin K Formula Clarifying Cream, at drugstores. "The cream penetrates your skin and provides vitamin K at the bruise site, which your body needs to break down blood and resorb it," says Dr. Clark.

"I've found that vitamin K cream helps resolve bruises faster. A lot of my patients really like it," she says. Rub vitamin K cream into a bruise right away and reapply twice a day until the bruise is dissolved. (Eating foods rich in vitamin K doesn't seem to provide high enough concentrations of the vitamin at the bruise site to be effective.)

Try cosmetic cover-up creams. You can camouflage a bruise with special yellow-tinted cover-up makeups, says Dr. Clark. "Since bruises are a mixture of blue and red, if you apply yellow--the opposite color on the primary color wheel--that cancels out the bruise so that it appears neutral."

"You can usually buy this at the cosmetic counter of a major department store," she says. Estee Lauder, for example, makes Under Cover Tint in yellow. And a company called Physician's Formula sells a less expensive version at drugstores. Look for a waterproof formula so that it won't wash or sweat off.

Boost bruise immunity with vitamin C. Bruises occur more frequently in people who don't get enough vitamin C. So if you notice that you bruise regularly, up your vitamin C intake. "Eating lots of fresh fruits and vegetables should give you all the vitamin C you need, but if you think that you're not getting enough, try a multivitamin," says Dr. Clark.

High doses of vitamin C could increase your risk for kidney stones. To prevent this, make sure that you drink plenty of water if you take extra vitamin C, advises Dr. Bergfeld.

Build collagen with vitamin C cream. As a long-term bruise preventative, try daily applications of vitamin C creams and lotions (available at drugstores or through your dermatologist). "The vitamin C is absorbed into the skin and, over time, helps rebuild collagen, which cushions and supports blood vessels, making bruising less likely," says Dr. Bergfeld.