Lupus bruises can look different from person to person. However, there are some common characteristics that help identify bruises caused by lupus. Lupus bruises often appear on areas of the body that are frequently exposed to sunlight, such as the face, arms, and hands. They may start out reddish or purple in color when they first develop, then turn bluish-purple or brownish as they resolve. The size of lupus bruises can vary from small petechiae to larger patches. They are usually raised slightly from the skin and may be tender or itchy. Identifying and understanding the typical appearance of lupus bruising allows individuals with lupus to distinguish them from bruises caused by other conditions or injuries.
What Causes Bruising in Lupus?
Lupus bruises are caused by inflammation of small blood vessels under the skin known as vasculitis. This inflammation leads to leakage of blood compounds into the surrounding tissue, resulting in discoloration. Several factors contribute to this vasculitis and bruising in lupus:
– Autoantibodies: Lupus involves the production of autoantibodies that target and damage healthy cells and tissues. These autoantibodies can attack blood vessel walls.
– Blood clotting: Lupus may cause abnormalities in blood clotting that lead to excessive clotting or bleeding under the skin.
– Medications: Corticosteroids like prednisone used to treat lupus can make the skin more fragile and prone to bruising.
– Sunlight exposure: UV light exacerbates lupus and can damage blood vessels in areas exposed to the sun.
Characteristics of Lupus Bruises
Here are the most common distinguishing features of bruises that occur in people with lupus:
Location
Lupus bruises frequently occur on skin that is often exposed to the sun, including:
– Face – across the cheeks, bridge of the nose, forehead
– Ears
– Arms – especially on the extensor surfaces
– Hands – tops of hands and fingers
– Chest
– Legs – shins
This distribution reflects the role UV light plays in vessel inflammation. Areas covered by clothing are less often affected.
Shape and Size
The shape of lupus bruises can vary:
– Small petechiae – pinpoint round spots 1-2 mm
– Larger patches – ranging from dime-sized to several inches wide
– Irregular shapes following the contours of sun exposure on the face or arms
Color
The color of lupus bruises evolves over time:
– Bright red to purple initially
– Turning bluish-purple, greenish, or brownish in 1-2 weeks
– Yellowish once resolving
This reflects the breakdown of hemoglobin from leaked blood.
Texture
The texture and elevation of lupus bruises include:
– Slightly raised above the skin surface, palpable
– Soft, spongy feel
– Warm to touch
Number and Recurrence
Some key facts about the number and recurrence of lupus bruises:
– Varying numbers at any given time
– New bruises appear as old ones fade
– Crops of bruises come and go with lupus flares
– Often recurrent in the same vulnerable areas
Itching and Tenderness
Lupus bruises are often:
– Itchy, may want to scratch
– Sensitive or painful to touch
This reflects inflammation of the skin and blood vessels.
How Lupus Bruises Differ from Normal Bruises
Lupus bruises have some distinct differences compared to regular bruises:
| Lupus Bruises | Normal Bruises |
| Occur without trauma or injury | Caused by injury that impacts the skin |
| Appear on sun-exposed areas | Can occur anywhere on the body |
| Recur over time | Are one-time isolated bruises |
| Last several weeks | Fade within 1-2 weeks |
| Tend to be raised and warm | Lie flat on the skin |
| Often itch | Not usually itchy |
Being aware of these differences allows people with lupus to identify bruises caused by their disease and distinguish them from regular bruising.
Lupus Conditions that Can Cause Bruising
Certain lupus-related conditions that cause inflammation and blood vessel abnormalities result in easy bruising:
Vasculitis
Inflammation of small blood vessels (vasculitis) under the skin is a primary cause of lupus bruising. The immune system attacks the vessels, causing them to become damaged and leak blood compounds.
Clotting Disorders
Antiphospholipid antibody syndrome (APS) is a disorder involving autoantibodies against proteins needed for normal blood clotting. It causes excessive clotting or bleeding under the skin that appears as bruises.
Medications
Corticosteroids like prednisone impair collagen synthesis and cause the skin to become thin and fragile. This side effect makes the skin prone to easy bruising from minor bumps or pressure.
Low Platelets
Some lupus patients develop low platelet counts, which impairs the blood’s clotting ability. This allows bleeding underneath the skin, leading to purplish bruises.
When to See a Doctor
In most cases, bruises caused by lupus do not require emergency care. However, it’s a good idea to see a doctor for lupus bruising in certain situations:
– Severe bruising that causes significant pain or interference with daily activities
– Bruises accompanied by rash, fever, or joint pain indicating a lupus flare
– Bruises that seem to appear spontaneously without any preceding injury
– Bruising that increases dramatically in amount or frequency
– Bruises that do not fade normally over 2-3 weeks
– Development of bruises easily from minimal bumps or pressure
Pregnant women with lupus should specifically call their doctor about new onset of bruising, as this could indicate a pregnancy complication like preeclampsia.
Getting lupus bruising evaluated promptly can help identify any associated conditions requiring treatment, such as vasculitis, low platelets, or blood clotting disorders. The doctor can provide suggestions for alleviating this bothersome lupus symptom.
Treatments for Lupus Bruising
While bruising often cannot be completely prevented in lupus, the following treatments may help reduce occurrence and severity:
Avoiding Sun Exposure
Use sunblock, protective clothing, and hats to minimize UV light reaching the skin. This helps prevent inflammation and damage to blood vessels that lead to bruising.
Medications
Corticosteroids, antimalarial drugs, and immunosuppressants can reduce immune system flare ups and vasculitis. Blood thinners like aspirin help prevent excessive clotting under the skin.
Compression
Applying pressure by wrapping or taping an elastic bandage around vulnerable areas may help prevent bruising from everyday impacts.
Vitamin Supplements
Vitamin C, vitamin K, zinc, and bioflavonoids improve structural integrity of blood vessels. Talk to your doctor before starting any new supplements.
Protecting the Skin
Avoiding bumps, knocks, and tight clothing friction on vulnerable areas can help prevent bruising episodes. Soft padding on furniture edges also helps.
Cold Compresses
Applying cold packs to new bruises constricts blood vessels to reduce leakage and inflammation in the area. Do not apply ice directly on the skin.
When Bruising Should Raise Concern
While some lupus bruising is normal, certain circumstances should prompt medical evaluation:
– Bruises increasing dramatically in number or size
– Bruises without an apparent cause like injury or sun exposure
– Bruises accompanied by bleeding gums, nosebleeds, heavy periods
– Severe or painful bruising interfering with daily activities
– New onset of bruises during pregnancy
sudden or worsening bruising in lupus can signal problems like vasculitis flare ups, low platelet counts, blood disorders, or medication side effects. It is important to get unusual bruising checked out.
Coping with Lupus Bruising
Bruising can be upsetting and frustrating for individuals dealing with lupus. Some tips for coping include:
– Cover up bruises with clothing, makeup, or jewelry if self-conscious
– Avoid picking at or scratching bruises so they don’t worsen
– Use vitamin K cream to help speed healing
– Apply cool compresses to relieve pain and itching
– Keep a symptom journal to identify triggers for your doctor
– Join a lupus support group to share tips on managing bruises
– Talk to your doctor about emotional struggles with changes to appearance
– Focus on positive aspects of yourself unrelated to bruises
While bruises cannot always be fully prevented, adopting self-care methods allows individuals with lupus to minimize their impact on wellbeing.
Conclusion
Lupus bruises have some typical characteristics and locations that help distinguish them from regular bruising, such as appearing on sun-exposed areas and lasting longer. Vasculitis, certain lupus-related conditions, and some medications make the blood vessels more vulnerable to leakage under the skin. While often benign, new onset or worsening bruising should be evaluated to rule out potential complications. Preventing lupus flares, protecting the skin, avoiding blood thinners, and prompt bruise treatment can help reduce this bothersome symptom’s occurrence and impact. Being aware of the common appearance of lupus bruising allows individuals with the disease to identify them and take steps to manage them appropriately.
