What Is An Ecchymosis And How Does It Occur?

Ecchymosis is a lesion of the skin, similar to a bruise, and it is very important in forensic medicine. Today we will tell you how it is formed and what the causes may be.
What is an ecchymosis and how does it occur?

An ecchymosis is one of the basic types of skin lesions. It is the basis of many other types of diseases and conditions, along with other dermatological symptoms.

You could say that ecchymosis is a subcutaneous blood clot. This is because there are no sores or associated lesions on the skin above it. This accumulated blood is therefore a result of damaged blood vessels.

When blood flows out of the blood vessels it is called extravasation. The ecchymosis comes from extravasation under intact skin. That is, there are broken, open blood vessels either caused by a stroke, an infection that destroys them from within, or due to torn muscles in this area.

Ecchymosis is a dermatological lesion, but it does not only affect the outer skin. This type of lesion can also develop under a mucous membrane – for example in the inner area of ​​the oral cavity.

Causes of an ecchymosis

There are several things that can cause eczema. Violation of the vessels and extravasation of blood in the subcutaneous space are the end result. However, the reasons may be:

  • A trauma, such as a blow to the skin that does not destroy it. That is, something caused by a non-sharp object. Remember that ecchymosis only occurs when there are no superficial skin ulcers.
  • Ecchymosis is common among athletes. Sometimes it is due to trauma and other times of the type of overexertion in exercise that can damage the muscles.
  • Vitamin K is an essential substance for proper coagulation. A deficiency of this vitamin in the body constitutes a perfect condition for ecchymosis to form in.
  • Certain infectious processes can weaken the blood vessels and break them from the inside, without damaging the skin. Sometimes ecchymosis is the first symptom of an infection. They can appear even before the fever begins.
  • As with vitamin K deficiency, a person with a coagulation disorder such as von Willebrand is more prone to developing ecchymosis. In addition, a coagulation disorder can also be a secondary symptom of another condition such as cancer.
  • There are diseases for which a person must take anticoagulants. Their use has the negative effect of forming spontaneous ecchymosis or small traumas, which under normal conditions would not destroy the blood vessels.
An illustration of platelets.

This is how it is formed

An ecchymosis, as defined above, is an accumulation of blood in the subcutaneous space under intact skin. The process is self-limiting and after a certain period the blood reabsorbs itself in the body.

During reabsorption, which can take several weeks, the skin color of the affected area changes. The color changes reveal the stages in the dissolution process of ecchymosis.

For example, the blood is red when it is inside the vessels. When it leaves them and enters the subcutaneous space, the defense cells or macrophages take over. In macrophages, the hemoglobin in the blood loses the oxygen it carries and becomes darker in color.

You can see the dark red of hemoglobin without oxygen from the outside of the body as purple. This is the typical color you can identify ecchymosis with, that is, the color of a common bruise.

As the days go by, hemoglobin is transformed into various pigments due to the degradation. Green is the color of an ecchymosis that follows violet, and it happens because hemoglobin is converted to biliverdin.

Days later, biliverdin is converted to bilirubin. At that time, the skin color goes from green to yellow. At least bilirubin becomes hemosiderin, which looks light brown on the outside.

The last step of ecchymosis is the total reabsorption of the remnants of blood. Again, the macrophages intervene and digest all the remaining hemosiderin. Eventually, the skin returns to its normal color at this point.

A person with a bruise.

Classification of an ecchymosis

The words ecchymosis, hematoma, bruise and petechiae are often used interchangeably, but they do not mean the same thing. In dermatology, each one has its own special characteristics.

In the strictest sense of the word, a hematoma is an ecchymosis that lifts the skin to the surface. That is, if the level of the skin in the affected area does not rise, it is not a hematoma.

On the other hand, petechiae are more identified with the size of an ecchymosis. For example, lesions of up to two millimeters are petechiae. However, they are classified as ecchymosis when they exceed this size.

Beyond all this, keep in mind that ecchymosis is usually transient and is mainly associated with trauma. Contact a doctor if you have bruises and do not know where they came from, as they should be able to make an accurate diagnosis.

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