Tiny pink dots around your eyelid. A small black-and-blue galaxy on your thigh. Purple splotches down your back. Bruises are just one symptom of immune thrombocytopenic purpura (ITP). Not only can they vary in appearance from person to person — your own bruises may look different depending on the day, your daily activity level, and the severity of your disease. If you’re living with ITP and develop a bruise, you may wonder whether they’re from the condition, a normal response to sustaining an injury, or something else.

In this article, we break down the different ways that ITP bruises can look and feel on your skin, how common they are in other people with ITP, what causes them, and what you can do to prevent them.

How Does ITP Cause Bruises?

ITP is a disease that lowers the amount of platelets in your blood. Platelets are cells that are responsible for blood clotting. Fewer platelets leads to a number of ITP symptoms, including poor wound healing, blood in your urine and stool, heavy menstrual bleeding, and of course, bruises.

When people with ITP partake in normal activities, such as cooking, cleaning, or going out with friends, they may notice that they bruise more easily and severely than the average person. Most of the time, they may not even remember anything that may have caused this internal bleeding.

It’s possible that an increased severity or amount of bruising could be a sign of worsening ITP due to a low platelet count. The lower your platelets, the worse your symptoms may be. However, it’s important to keep in mind that many factors can worsen bruising, including the location and underlying causes of the bruise and your body’s ability to heal. It’s important to monitor your symptoms and communicate any changes or concerns with your health care provider. The only way to know the severity of your ITP is through blood and other laboratory testing.

Sometimes, people develop ITP as a result of other conditions, such as systemic lupus erythematosus (SLE). Could coexisting diseases be the cause of your bruising? People with lupus may have a low number of platelets, causing bruising across the body. However, if you have an ITP diagnosis, your bruising is likely stemming from this disease.

You may be wondering if ITP treatment can also cause bruising. Common treatment methods include:

• Corticosteroids, which can protect platelets from your body’s own immune system
• Intravenous immunoglobulin (IVIG), which also protects platelets from the immune system
• Immunosuppressants, which can treat autoimmune ITP
• Rituximab, which prevents the body from destroying its own platelets
• Thrombopoietin receptor agonists (TPO-RAs), which help regenerate more platelets
• Platelet transfusion, which directly restores the amount of platelets in your body

None of these treatments are known to cause bruising as a side effect. However, some can cause skin symptoms that may appear like bruising. For example, adverse reactions to a platelet transfusion may include a rash, but this will be itchy, unlike a bruise. Also, IVIG may cause flushing in your skin, which may feel warm to the touch. Speak to your doctor if you experience side effects of your ITP treatment, or if you think that it’s not working well enough to control your symptoms.

Types of Bruises

There are many kinds of bruises that are commonly found in people with ITP. Did you know that bruises have different names based on their size and appearance? Learning the bruise lingo can help you communicate with your doctor about your symptoms over time.

Purpura

Purpura is a specific type of bruising that is commonly seen in people with ITP. Represented by the “P” in ITP, purpura is one of the diagnostic criteria for the condition. Purpura appears as purple bruises under the skin, and it is often one of the first symptoms that people with ITP notice. These bruises are caused by bleeding from small blood vessels in the skin, and they can range in size from small dots to larger patches.

Petechiae

Petechiae are another type of skin manifestation commonly seen in people with ITP. They appear as pinpoint-sized red or purple spots that are grouped together in close proximity, sometimes resembling a rash. They often appear on the skin or the mucous membranes, such as inside the mouth or on the eyelids, due to bleeding from tiny blood vessels. Petechiae can be more common in people with more severe cases of ITP, but they can occur at any stage of the condition.

Ecchymosis

Ecchymosis is the most common type of bruise among the general population — and it’s more likely to occur in people with ITP due to your increased risk of bleeding, especially after an injury. Ecchymoses are caused by bleeding under the skin, usually due to trauma. They appear as large, flat, blue or purple patches on the skin, and they may be painful or tender to the touch.

Bruising in Different Skin Tones

Keep in mind that bruising may look different depending on one’s skin stone. For example, ecchymoses may be harder to see on darker skin tones than lighter skin ones. Further, the color of petechiae may appear more pink on lighter skin and more purple or black on darker skin. These differences may potentially delay the diagnosis of ITP in people with darker skin tones. Pay attention to how bruises look on your body so you know how your ITP is being managed.

What Do Bruises Feel Like?

Bruising in ITP can feel different for each individual. In general, bruises caused by low platelet counts from ITP may feel tender or sore to the touch like other bruises. The amount of pain or discomfort associated with a bruise can vary depending on the location, size, and severity of the bruise.

In addition to bruising, people with ITP may experience other symptoms related to low platelet counts, such as nosebleeds, bleeding gums, and heavy menstrual bleeding. In severe cases, internal bleeding can occur, which can cause symptoms such as abdominal pain, black or tarry stools, or blood in the urine.

Ways To Manage ITP Bruising

To prevent bruising while living with ITP, you can take the following actions:

• Avoid injury by wearing protective equipment when participating in high-risk activities and avoiding substance use that could reduce your coordination.
• Avoid drugs like aspirin that are known to increase bleeding and bruising by affecting platelet function.
• Take treatments prescribed by your doctor to treat ITP. They usually help to reduce symptoms, including bruising.
• Speak to your doctor about your bruising if it increases in severity or persists over a long period of time.

If your symptoms are difficult to tolerate or are interrupting your life, talk to your doctor. There may be additional treatment options that could help reduce bruising and other symptoms. It’s important to communicate with your doctor about all potential symptoms and side effects.

Talk With Others Who Understand

On myITPcenter, the site for people with immune thrombocytopenia and their loved ones, people come together to gain a new understanding of ITP and share their stories with others who understand life with ITP.

What does ITP bruising look like for you? How do you manage this symptom of ITP? Share your advice in a comment below.