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Bruising of Hands and Arms in Elderly – Actinic Purpura

Bruising of the hands and arms may result from a condition called actinic purpura, also known as Bateman purpura. It involves flat, purple blotches that darken before gradually fading. Actinic purpura occurs due to sun damage that weakens the blood vessels and appears most often in elderly and light-skinned individuals.

Although this condition closely resembles standard bruising, there are a few key differences. For example, bruises associated with actinic purpura do not usually result from a significant known injury to the skin. Rather, they may occur from trauma so slight that the patient is not even aware of it. The bruises of actinic purpura are not typically tender and do not display the normal color changes of bruises over time. Instead they tend to remain purplish until they gradually fade away, leaving an area of depigmentation or a whitish scar. Finally, the bruises of actinic purpura tend to last longer than standard bruises and may be present for up to a few weeks after they first appear.

With actinic purpura, bruising usually appears on the back of the hands and forearms but may also affect the face and neck. The skin appears sun-damaged, thin and wrinkled. In most cases, the bruising is relatively harmless and will disappear on its own. However, in some cases the bruising may indicate a serious, underlying condition, such as low levels or abnormal function of platelets, which help the blood clot following an injury. Patients who experience bruising of the hands and arms due to actinic purpura are likely to continue to have them throughout their lifetime.

In most cases, bruising that is characteristic of actinic purpura can be identified through a visual examination by a physician, which may include a physical examination. However, in some cases additional testing may be performed to confirm the diagnosis and rule out other conditions. Such tests may include blood tests, such as coagulation studies, complete blood count and platelet count, liver function tests, stool guaiac test and urine tests.

Common Causes of Bruising of Hands and Arms

Bruises typically form when the impact of a blow or injury causes small blood vessels (capillaries) near the skin surface (epidermis) to rupture. The blood then leaks out of the vessel and appears as a reddish-purple mark. Eventually, the body reabsorbs the blood and the mark slowly fades.

Bruising of the hands and arms associated with actinic purpura is usually due to the aging process. The skin becomes thinner as a person ages and loses some of the layers that cushion blood vessels against injury. In addition, aging causes the tissues that support capillaries to weaken, leaving capillary walls more vulnerable to rupture. Although the incidence of actinic purpura increases with age, it can also occur in younger patients.

Excessive exposure to the sun is also a major contributor to actinic purpura. Years of sun exposure damages the skin and weakens the blood vessel walls.

Bruising of the hands and arms can be made worse by use of anticoagulants (medications that stop blood from clotting, including aspirin), alcohol (which thins the blood) and corticosteroids (which may thin the skin). Dietary supplements, such as ginkgo, ginseng, fish oil, ginger and garlic, also may have a blood-thinning effect that leads to increased bruising.

Treatment and Prevention of Bruising of Hands and Arms

Bruising itself usually cannot be treated and should be allowed to disappear on its own as the body reabsorbs the blood. A cold compress can help reduce any swelling associated with the bruising. As swelling subsides, a warm compress can be used to help speed reabsorption of the blood. Makeup is available to help cosmetically camouflage bruises and is excellent at covering bruises. Alpha-hydroxy acid and tretinoin creams are sometimes prescribed to help increase skin thickness in those with thin skin. Some women can also use lotions containing the hormone progesterone to help thicken skin.

Avoiding prolonged exposure to the sun, particularly during peak hours of the day, is the most important step in preventing new damage to the skin and capillaries. Protective clothing, such as long-sleeved shirts, should be worn in the sun to help avoid damage. Use of sunscreens can also help prevent new damage but cannot reverse damage that has already occurred. Lifelong protection from sun exposure can prevent the development of actinic purpura in susceptible individuals during their senior years.