How to Heal a Bruise

A bruise forms when blood vessels are damaged by trauma, allowing blood to seep into the surrounding tissues. Blood contains hemoglobin and iron that is visible under the skin. It can take awhile for the body to reabsorb the hemoglobin and it's byproducts.

Patients ages 60+ with a history of a lot of sun exposure or prednisone use often complain of "bruise -like spots on the skin that aren't bruises" on their arms. These are known as senile purpura, actinic purpura, or solar purpura which translates as "bruises in elderly people caused by excessive sun exposure". These purple spots occur because of loss of supportive collagen around tiny capillary blood vessels makes them fragile and easily broken with friction.  So senile purpura is bruises caused by broken capillaries due to friction, twisting motions, or force.

Senile purpura and bruises are treated the same way but senile purpura has a much better chance of coming back the next time that the skin in that area is subjected to another force.

The color of a bruise changes as your body breaks down and reabsorbs the blood. Initially, a bruise appears red because of the fresh, oxygen-rich blood under the skin. Over time, it turns purple or blue due to the deoxygenation of the blood.

As the blood cells break down, they release hemoglobin, which is further degraded into pigments such as hemosiderin , biliverdin , and bilirubin. Hemosiderin is responsible for the purple color, while biliverdin gives a green hue, and bilirubin leads to a yellow coloration as the bruise heals. Each of these colors indicates a different stage of healing.

Different bruise treatment creams should be used whether you are trying to prevent bruises or treat bruises. For example, arnica is used to prevent bruises and is used in the early stages when the bruise is purple. Vitamin K may be more effective as a preventative treatment. Bromelain is more effective at clearing bruises and may actually increase the risk of bruising if used before a procedure or injury.

The Alastin Inhance and the Dermend Moisturizing Bruise Formula can be used together for additive results. Use the Dermend to prevent bruises twice a day and the Alastin Inhace to treat bruises you already have.

To strengthen the skin to help prevent senile purpura, also use the following products on your arms or other affected areas with the goal of increasing collagen to strengthen the skin and capillary walls:

• Glycolic Acid
• Retinoids like retinol
• Vitamin C Serums

Don't forget that sun caused a lot of these issues in the first place, so wear SPF and sun protective clothing- especially on your arms.

Here is an intensive body routine that may help senile purpura. Keep in mind that this skin problem is very difficult to treat- so have realistic expectations that it may get better but will not be cured.

AM:

1. Apply Vitamin C Serum to entire area (Not just the bruise)

2. Apply Alastin Inhance to any bruises

3. Cover entire are with DerMend Moisturizing Bruise Formula. This helps the other two penetrate better.

PM:

1. Apply Vitamin C Serum to entire area (Not just the bruise)

2. Apply Alastin Inhance to any bruises

3. Apply a retinoid to entire area. Use a high strength retinol or a prescription tretinoin or tazarotene

4. Cover entire are with DerMend Moisturizing Bruise Formula. This helps the other two penetrate better.

Also take oral Vitamin C supplements 500mg twice a day.

All of these are aimed at restoring collagen and strengthening the skin. The following collection of products has other types products that can be alternated with the Vitamin C serum to try and increase collagen such as growth factors and exosomes.

Several ingredients have been shown to help treat bruises, either by reducing inflammation, promoting blood clotting, or enhancing the body's ability to break down and remove the components of the leaked blood, such as hemosiderin. Here’s a closer look at how each ingredient works:

Arnica is a herb derived from the Arnica montana plant and is commonly used in topical treatments for bruises. The active compounds in arnica, primarily sesquiterpene lactones, have potent anti-inflammatory and analgesic properties. These compounds inhibit the production of pro-inflammatory cytokines and enzymes, reducing inflammation and swelling in the bruised area. Arnica is also thought to improve blood circulation, which helps to speed up the reabsorption of the blood that has leaked into the tissues, thereby reducing the discoloration and size of the bruise more quickly.

Arnica can be used before or after procedures to help decrease swelling and bruising.

Bromelain is a mixture of proteolytic enzymes found in the stem and fruit of pineapples. These enzymes have anti-inflammatory, antithrombotic, and fibrinolytic properties. Bromelain works by breaking down fibrin, a protein involved in blood clotting, which helps to reduce the severity of a bruise. Additionally, bromelain can reduce inflammation and swelling by inhibiting the production of pro-inflammatory prostaglandins and reducing the aggregation of blood platelets. This makes bromelain particularly useful in the treatment of bruises following surgery or trauma, where inflammation and clotting need to be carefully managed. It’s important to note that bromelain is most effective when used after a procedure, not before, as taking it beforehand may increase the risk of bruising. Also, the stem or center part of the pineapple, which contains the highest concentration of bromelain, is often discarded. If you are eating pineapple for its bromelain content, make sure to consume the center part to maximize its benefits.

Vitamin C, also known as ascorbic acid, is a powerful antioxidant that plays a key role in collagen synthesis, which is vital for maintaining the strength and integrity of blood vessels. In the context of bruising, vitamin C helps to strengthen the walls of the capillaries, reducing the likelihood of further bleeding into the tissues. Additionally, vitamin C's antioxidant properties protect the skin from oxidative stress, which can further damage tissues and slow down the healing process. By promoting collagen production and protecting against oxidative damage, vitamin C aids in the faster healing of bruises and helps to prevent the formation of new ones.

Vitamin K is essential for blood clotting as it enables the synthesis of key clotting factors, including prothrombin and Factors VII, IX, and X, which work together to stop bleeding. After intake, it takes about 10 days for vitamin K to fully increase these clotting factors because the body needs time to synthesize and release these proteins into the bloodstream. In the context of bruising, while topical vitamin K is often used to reduce discoloration by enhancing clot formation and promoting the clearance of hemosiderin (the iron-storage complex responsible for the brownish color of older bruises), it's important to note that applying vitamin K after a bruise has already formed may not be very effective. To make a significant difference in bruise prevention and healing, vitamin K should be used at least 10 days prior to any skin injury or procedure, allowing time for it to build up the necessary clotting factors in the body.

I have noticed over the years that certain steps to prevent bruises can really make a difference in outcomes after injections like fillers and toxins. Avoid alcohol, especially red wine, and salmon for two days prior to injections. Also, avoid all the foods and supplements on the list, especially ibuprofen, aspirin, Vitamin E, and fish oil, as those seem to make people bruise the most. After getting injections, stay in a cool environment—do not take hot baths or showers, drink hot beverages, exercise, or get upset for at least 24 hours; 48 hours is even better. Getting upset raises blood pressure, which makes you more likely to bruise, so if you stay literally and figuratively calm and cool, you should bruise less.

This is the advice I give my cosmetic dermatology patients before getting fillers or botulinum toxins to prevent bruising.

To minimize the risk of bruising, it's essential to avoid certain substances that can thin the blood, affect platelet function, or increase bleeding. 

Avoid ingesting these for 10 days prior to any procedure:

• Chamomile
• Coumadin
• Fish Oil
• Garlic
• Ginger
• Ginkgo
• Ginseng
• Green Tea
• Horse Chestnut
• Omega 3 Fatty Acids
• Salmon
• NSAIDs (Aspirin, Advil, Aleve, Motrin, Ibuprofen)
• St. John’s Wort
• Vitamin E
• Warfarin

Avoid these for at least 10 days before your procedure. 

Additionally, avoid alcohol, especially red wine, for 24 hours before the procedure.

Before the procedure : Take arnica as directed for 1-2 days prior.

After the procedure : Take arnica and bromelain as directed. Avoid heat, exercise, getting upset which raises blood pressure, facials, body massages, alcohol, and spicy foods for 48 hours after the procedure to prevent vasodilation, which can worsen bruising.

The bottom line is stay cool and calm and you will bruise less.  This is one reason that cosmetic dermatologists keep their offices so cold.

By following these steps and using the appropriate products and ingredients, you can significantly reduce the appearance and duration of bruises, helping you recover faster and get back to your daily routine.