Bleeding under the skin can occur from broken blood vessels that form tiny pinpoint red dots (called petechiae). Blood also can collect under the tissue in larger flat areas (called purpura), or in a very large bruised area (called an ecchymosis).

Aside from the common bruise, bleeding into the skin or mucous membranes is a very significant sign and should always be checked out. Redness of the skin (erythema) should not be mistaken for bleeding. Petechiae, purpura, and ecchymosis do not become pale (blanch) with pressure. The redness of erythema decreases and then returns when you apply and then release pressure to it.

• Injury or trauma
• Allergic reaction
• Autoimmune disorders
• Viral infection or illness affecting blood coagulation
• Thrombocytopenia
• Medical treatment, including radiation and chemotherapy
• Antiplatelet medications such as clopidogrel (Plavix)
• Bruise (ecchymosis)
• Birth (petechiae in the newborn)
• Aging skin (ecchymosis)
• Idiopathic thrombocytopenic purpura (petechiae and purpura)
• Henoch-Schonlein purpura (purpura)
• Leukemia (purpura and ecchymosis)
• Drugs
  • Anticoagulants such as warfarin or heparin (ecchymosis)
  • Aspirin (ecchymosis)
  • Steroids (ecchymosis)
• Septicemia (petechiae, purpura, ecchymosis)

Protect aging skin. Avoid trauma such as bumping or pulling on skin areas.

For a cut or scrape, use direct pressure to stop the bleeding.

If you have a drug reaction, ask your health care provider about stopping the drug.

Otherwise, follow your prescribed therapy to treat the underlying cause of the problem.

Contact your health care provider if:

• You have sudden bleeding into the skin for no apparent reason
• You notice unexplained bruising that does not go away

Your doctor will examine you and ask questions about the bleeding, such as:

• Have you recently had an injury or accident?
• Have you been ill lately?
• Have you had radiation therapy or chemotherapy?
• What other medical treatments have you had?
• Do you take aspirin more than once a week?
• Do you take Coumadin, heparin, or other "blood thinners" (anticoagulants)?
• Has the bleeding occurred repeatedly?
• Have you always had a tendency to bleed into the skin?
• Did the bleeding start in infancy (for example, with circumcision)?
• Did it start with surgery or when you had a tooth pulled?

• Coagulation tests including INR and prothrombin time
• CBC with platelet count and blood differential
• Bone marrow biopsy

Schafer AI. Approach to the patient with bleeding and thrombosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 178.