How to know if a bruise is worrisome: A guide to distinguishing a normal bump from a serious medical issue

October 1, 2025 •

5 min read

While most bruises fade on their own within two weeks, approximately 10% of people over 50 experience a type of easy bruising called senile purpura, which happens due to natural thinning of the skin and increased fragility of blood vessels. Knowing the difference between these common, benign marks and more concerning symptoms is key to understanding how to know if a bruise is worrisome.

Quick Summary

A guide detailing the visual and symptomatic differences between a typical bruise and a more serious condition. Key indicators for seeking medical attention include unusual size or pain, prolonged healing, or associated systemic symptoms like fever or unexplained bleeding, along with the development of a firm lump or hematoma.

Key Points

Persistent Bruising: If a bruise lasts longer than two weeks or returns to the same spot, it may be a sign of a deeper issue.
Hematoma vs. Bruise: A hematoma is a larger, deeper pool of blood that creates a firm, painful lump and is more serious than a simple bruise.
Check for Systemic Symptoms: Worrisome bruises can be accompanied by fever, fatigue, unusual bleeding, or unexplained weight loss, which require medical evaluation.
Know When to Act Fast: Immediate medical care is needed for bruises with symptoms like severe headache after a head injury, or sudden swelling and pain in a limb.
Consider Underlying Causes: Easy bruising can result from age, medications, vitamin deficiencies, or blood disorders, which should be discussed with a healthcare provider.
Location Matters: Bruises appearing in unusual places like the torso or back, or that are unusually large, can be a sign of an internal problem.

The Anatomy of a Normal Bruise

Bruises, or contusions, are common occurrences resulting from trauma that causes small blood vessels under the skin to break. This leads to blood leaking into the surrounding tissue, causing the characteristic discoloration. The appearance of a bruise changes over time as the body breaks down and reabsorbs the pooled blood. A bruise typically starts as red or purplish, turning blue or black within a day or two. As it heals, it evolves into shades of green and yellow before fading completely. Most minor bruises resolve on their own within two weeks. Understanding this normal healing process is the first step toward recognizing when a bruise deviates from the norm and becomes potentially worrisome.

What Makes a Bruise Worrisome?

Not all bruises are created equal. Several factors can elevate a simple contusion from a minor annoyance to a cause for concern. Observing the bruise's characteristics and any accompanying symptoms can help determine its severity.

Persistent or Unexplained Bruising

One of the most significant red flags is a bruise that doesn't follow the normal healing timeline. If a bruise doesn't show signs of fading and disappearing after two weeks, or if it reappears in the same spot for no apparent reason, it warrants medical attention. Additionally, frequent, large bruises that occur without any known injury or with only minor trauma should be investigated, as this could indicate an underlying issue with blood clotting. Bruising in unusual places, such as the back, torso, or abdomen, where you are less likely to have bumped into something, can also be a sign of a deeper problem.

Accompanying Symptoms

Bruising is often accompanied by some tenderness, but severe pain or swelling can signal a more serious injury. Look out for any of the following symptoms in conjunction with a bruise:

Significant swelling: Especially if it is localized and creates a noticeable lump, which may indicate a hematoma—a more severe collection of blood.
Numbness or weakness: Any loss of sensation, tingling, or inability to move a limb or joint effectively suggests possible nerve or structural damage beneath the surface.
Signs of infection: Red streaks radiating from the bruise, warmth, pus, or fever are clear indicators of an infection that needs immediate medical evaluation.
Unusual bleeding: If easy bruising is accompanied by other bleeding—such as frequent nosebleeds, bleeding gums, or blood in your urine or stool—it may point to a more systemic bleeding disorder.
Systemic symptoms: Feeling unwell with symptoms like fatigue, unexplained weight loss, or fever alongside bruising can signal an underlying medical condition like leukemia.

Location and Size

The location and size of a bruise can also be a valuable clue. Bruises that are unusually large for the amount of trauma sustained, or those that appear with a very minor bump, may indicate an underlying issue. Bruises to the head, trunk, or abdomen require closer scrutiny, particularly if they are accompanied by other symptoms like severe headache, nausea, or vision problems.

Bruise, Hematoma, or Something More Serious?

While the terms are often used interchangeably, bruises and hematomas are different and understanding this distinction is crucial. A bruise is a more superficial collection of blood, while a hematoma is a larger, deeper pooling of blood that can form a firm, painful lump. In some cases, a hematoma can indicate a more significant injury or bleeding problem. Furthermore, a bruise should not be mistaken for a blood clot, such as deep vein thrombosis (DVT).


Feature	Normal Bruise (Contusion)	Hematoma	Blood Clot (DVT)	Petechiae/Purpura
Appearance	Flat area of skin discoloration. Changes color from red/purple to green/yellow.	Raised, lumpy, or spongy area under the skin. Can be very painful.	Swelling, warmth, redness, and tenderness in one limb. Pain may be persistent.	Tiny (petechiae) or large (purpura) purple/red spots that don't fade when pressed.
Sensation	Mild tenderness or pain that subsides over time.	Significant pain and tenderness, often much worse than a simple bruise.	Persistent pain, cramping, and warmth in the affected area.	Usually not painful or tender, but can be a sign of systemic issues.
Causes	Minor bump or impact that breaks small, surface-level capillaries.	More significant trauma that breaks larger blood vessels, or occurs with a bleeding disorder.	Often linked to prolonged immobility, surgery, or underlying clotting issues.	Underlying blood disorders, platelet problems, or vasculitis.
Severity	Generally harmless, heals naturally.	Can be more serious, especially internally, and may require medical attention.	Potentially life-threatening, requiring immediate medical care, especially if it travels to the lungs.	Can signal a serious underlying health problem, requiring medical diagnosis.

Underlying Causes of Easy Bruising

If you find yourself bruising more easily or more frequently than usual, it's worth considering the underlying causes, many of which can be identified by a doctor.

Aging: As mentioned, skin thins and blood vessels become more fragile with age.
Medications: Certain medications, including blood thinners (anticoagulants), NSAIDs (ibuprofen, naproxen), and some steroids, can increase your susceptibility to bruising.
Nutrient Deficiencies: Lack of essential vitamins like C and K, which are vital for blood clotting, can lead to easy bruising.
Blood Disorders: Conditions such as hemophilia, von Willebrand disease, or low platelet count (thrombocytopenia) can cause frequent and spontaneous bruising.
Liver Disease: Severe liver disease (cirrhosis) affects the production of proteins necessary for blood clotting.
Blood Cancers: In rare cases, conditions like leukemia can present with unexplained or widespread bruising.

When to Seek Immediate Medical Attention

While most bruises are harmless, certain signs should prompt a visit to the emergency room or an urgent care clinic immediately. This includes:

A bruise accompanied by symptoms of a concussion after a head injury.
Sudden, severe pain and swelling in a limb, particularly the leg, which could indicate a DVT.
Symptoms of internal bleeding, such as chest or abdominal pain.
Bruising that appears with a high fever, confusion, or severe headache.
Vision problems following a black eye.

Conclusion: When in Doubt, Check it Out

Bruises are an everyday part of life, but knowing the signs of a potentially serious problem is critical for your health. A bruise that lingers for weeks, appears without reason, or is accompanied by other worrying symptoms should not be ignored. Pay attention to your body and consult a healthcare provider if you have concerns about the severity or cause of a bruise. A prompt medical evaluation can provide peace of mind and address any underlying issues. For additional first aid information on bruises, consult reliable sources like the Mayo Clinic's guidance on bruise first aid.

Frequently Asked Questions

A bruise (contusion) is a collection of blood from small, broken capillaries near the skin's surface, while a hematoma is a larger, deeper pooling of blood that often forms a firm, painful lump.

Bruises change color as they heal, whereas a blood clot (like DVT) often causes persistent symptoms such as swelling, warmth, and localized pain that don't fade, and the area may feel hard or rope-like.

See a doctor if a bruise doesn't heal within two to three weeks, if you experience frequent or unexplained bruising, or if it is accompanied by significant swelling, pain, or other symptoms like fever or unusual bleeding.

On darker skin tones, bruises may appear dark brown or black and may not show the typical reddish or purplish color initially. The best indicators of a worrisome bruise are persistent pain, a lump, excessive swelling, or systemic symptoms.

Yes, medications such as blood thinners (anticoagulants), NSAIDs (like ibuprofen), and certain steroids can increase a person's tendency to bruise easily.

While uncommon, unexplained or frequent bruising can sometimes be a sign of an underlying health condition such as a blood disorder, liver disease, or, in rare cases, a blood cancer like leukemia.

Petechiae are tiny, pinpoint red or purple spots caused by broken capillaries. When they appear without a clear cause, they can be worrisome and may indicate an issue with platelet function or a serious medical condition, requiring evaluation.

Go to the emergency room for severe headaches after a head injury, signs of DVT (leg swelling, warmth, pain), chest or abdominal pain with bruising, or if you suspect a broken bone or severe internal bleeding.