Persistent Bruising: Causes and Treatment Options

Bruises that do not fade?

Hello, Dr.
Yeh.
I have difficulty with bruises healing.
In March 2023, I underwent massage therapy, and a small bruise that had been present for over a year (which was not painful or swollen) became larger and swollen after the treatment.
I have been intermittently using topical treatments and applying heat.
As of July 2023, the bruise has not resolved, and it remains swollen and painful.
I have had blood tests for clotting factors and platelets, which all came back normal at Chang Gung Memorial Hospital.
The doctor advised me not to worry, and my local family medicine physician also said the results were normal and to continue with heat therapy.
However, I am still concerned about the persistent swelling and pain.
Additionally, I have diabetes with a hemoglobin A1c of 8.0.
I would like to inquire about any further tests or treatments I could pursue.

Zhang, 30~39 year old female. Ask Date: 2023/07/09

Dr. Ye Qianyu reply Family Medicine

Hello! It is recommended that you visit a dermatologist.
Additionally, you can discuss the target value for glycated hemoglobin with your primary physician to achieve it together.

Reply Date: 2023/07/09

More Info

Persistent bruising can be a concerning symptom, especially when it does not resolve over time or when it is accompanied by swelling and pain. It’s essential to understand the potential causes and treatment options available for this condition.

Bruising occurs when small blood vessels under the skin break, allowing blood to leak into the surrounding tissue. This can happen due to various reasons, including trauma, certain medical conditions, or even medications that affect blood clotting. In your case, you mentioned that the bruise became larger after receiving a massage, which could indicate that the pressure applied during the massage exacerbated the existing bruise or caused new microtrauma to the area.

Given that you have already undergone blood tests to check for clotting factors and platelet levels, and the results were normal, it is reassuring that there are no immediate concerns regarding your blood's ability to clot. However, persistent bruising can sometimes be linked to other underlying conditions, including:
1. Vascular Disorders: Conditions that affect blood vessels can lead to increased bruising. This includes conditions like vasculitis, which is inflammation of the blood vessels.

2. Connective Tissue Disorders: Disorders such as Ehlers-Danlos syndrome can lead to fragile blood vessels and increased bruising.

3. Medications: Certain medications, especially anticoagulants (blood thinners) and some anti-inflammatory drugs, can increase the likelihood of bruising.

4. Nutritional Deficiencies: Deficiencies in vitamins such as Vitamin C (scurvy) or Vitamin K can lead to easy bruising.

5. Chronic Conditions: Conditions like diabetes, which you mentioned having with a glycosylated hemoglobin (HbA1c) level of 8.0, can also affect circulation and healing, potentially leading to persistent bruising.

In terms of treatment, since you have already been advised to continue with heat therapy and topical treatments like "喜療瘀" (a topical bruise remedy), here are some additional steps you might consider:
- Consult a Specialist: If you haven’t already, consider seeing a hematologist or a vascular specialist. They can perform more specialized tests to rule out any underlying vascular or hematological issues.

- Imaging Studies: An ultrasound or MRI of the affected area may help visualize any underlying issues with blood vessels or soft tissue that could be contributing to the swelling and bruising.

- Dietary Adjustments: Ensure you are consuming a balanced diet rich in vitamins and minerals. Consider discussing with a nutritionist to ensure you are meeting your nutritional needs, particularly regarding Vitamin C and K.

- Monitor Blood Sugar Levels: Since you have diabetes, keeping your blood sugar levels well-controlled is crucial. Poorly controlled diabetes can lead to complications that may affect healing and circulation.

- Avoid Strenuous Activities: Until the bruise resolves, it may be wise to avoid activities that could lead to further trauma to the area.

- Follow-Up: Regular follow-ups with your healthcare provider are essential to monitor the bruise and any changes in your symptoms. If the bruise does not improve or if you develop new symptoms, further evaluation may be necessary.

In summary, while persistent bruising can be alarming, there are various potential causes and treatment options available. It is crucial to continue working closely with your healthcare providers to ensure that any underlying issues are addressed and to find an effective treatment plan tailored to your needs.

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