Most bruising episodes are directly related to trauma, medication, or herbal supplements. When no no clear etiology is prsent, "spontaneous" bruising should be considered an urgent problem.
A 26-year-old woman was experiencing multiple, tender, large macular areas of discoloration on her extremities. She denied any trauma to affected sites. She was ingesting neither medications nor dietary supplements. Other than fatigue, she felt fine.
Key point: Excluding senile purpura, most bruising episodes are directly related to traumatic events. Many are associated with medication or herbal supplements (such as fish oil or gingko). However, when no clear cause is present, then “spontaneous” bruising should be considered an urgent medical problem. A blood dyscrasia or clotting disorder may be responsible.
Treatment: Any underlying hematological abnormality would be treated. Cold packs may help alleviate the discomfort associated with the bruises.
Note: This patient was subsequently found to have acute lymphocytic leukemia and was referred promptly to a hematologist/oncologist.