What these colours tell you

Hematomas: how do bruises form?

A bruise is more than just a skin discolouration — it is the visible sign of a small internal injury. When a blow or bump applies pressure to the tissue, the fine blood vessels beneath the epidermis, known as capillaries, can tear. Blood leaks out and collects in the surrounding tissue. This process is called a hematoma. The typical bluish-violet colour appears when the blood is slowly broken down under the skin — a natural healing process during which the mark changes colour and eventually fades.

What causes bruises?

They most often occur as a result of trauma. Falls, knocks or blows can tear small blood vessels, allowing blood to leak into the surrounding tissue or even into neighbouring body areas such as joints. This collection of blood can spread quickly and discolour to varying degrees depending on the severity of the injury. Such bruises commonly occur with contusions, crush injuries or bone fractures.

Medical procedures like surgeries can also cause hematomas if vessels are damaged. In some cases, however, hematomas appear seemingly without an identifiable trigger — for example a bruise in the eye. These cases are described as having an “idiopathic” cause.

Why do bruises appear without an obvious injury?

Bruises without an apparent cause may seem puzzling at first, but they can have many origins — some harmless, others requiring attention.

A common explanation is the use of certain medications such as blood thinners or anticoagulants, which increase the risk of bleeding under the epidermis. A deficiency in key vitamins like vitamin C or K can also weaken vessels or disturb clotting — making even very small bruises visible.

Additionally, clotting disorders, liver disease or an enlarged spleen can lead to an increased tendency to bleed. In hereditary conditions such as haemophilia — a severe bleeding disorder — spontaneous hematomas are common because clotting is severely impaired. In older adults, thinning skin and fragile vessels also play a role. Less common conditions like leukaemia or the painful lipedema can also be associated with spontaneous bruising. Early medical assessment can help exclude more serious causes.

Which creams can help a bruise?

When a bruise is forming, acting quickly can make a big difference — and the right cream matters. Heparin cream is one of the best-established remedies for hematomas. The active ingredient promotes the breakdown of clotted blood and can accelerate the resorption of larger bruises. Ideally the cream is applied twice daily for a week — if there is no effect, stop the treatment.

The herbal arnica cream is valued for its anti-inflammatory and pain-relieving properties — especially for smaller bruises. Studies do not provide conclusive proof of effectiveness, but many users report positive effects. Again, two applications per day are sensible, for up to seven days.

Hirudoid cream, containing the active mucopolysaccharidopolysulfonic ester, not only supports the reduction of existing bruises but can also help prevent them — for example immediately after a bump. The cream is applied morning and evening and helps many people within a few days.

Voltaren-Emulgel & Doc-Salbe (diclofenac/ibuprofen) are pain-relieving and anti-inflammatory agents that do not directly break down the bruise but can reduce swelling around it. They are particularly useful for extensive swelling — provided there are no open wounds.

Another herbal classic is Traumeel cream. Although scientific evidence is lacking, many people report pleasant symptom relief. The cream can be applied several times a day and is a gentle alternative, especially for sensitive skin.

Cooling gels (e.g. menthol, ice gel) are particularly suitable in the first hours after the injury. The cooling effect relieves pain and may help reduce the extent of the bruise. After three days of use, cooling gels generally offer no additional benefit.

There are no clear studies on the effect of zinc ointment on hematomas, but the anti-inflammatory and skin-soothing properties of zinc oxide make it a possible support for the healing process, particularly if the skin is irritated.

Each skin reacts differently. If itching, redness or a rash occurs, the ointment should be removed immediately and the skin cleaned thoroughly. Allergic reactions are rare but possible — especially with products containing ibuprofen or diclofenac.

Why does the colour of a bruise change?

A bruise is like an artist painting on the skin — each colour tells something about the healing process. Once blood vessels under the epidermis tear, blood leaks into the connective tissue. The red blood pigment haemoglobin begins to break down — and this breakdown causes the fascinating colour change.

Initially the mark appears reddish or blue-violet — a sign of fresh, clotted blood. After a few days haemoglobin is broken down and biliverdin forms, giving the bruise a green colour. Shortly afterwards bilirubin follows, causing a yellow to brownish-yellow shade. Eventually the mark disappears completely once all degradation products have been removed by the body.

Which bruises are dangerous?

Not every bruise is harmless — in some cases it can be a warning sign. Be especially alert if a bruise is very large, grows quickly or appears without an obvious trigger. This may indicate a clotting disorder or injury to a larger blood vessel.

Bruises in the abdominal or chest area should also be taken seriously, as internal organs could be affected — especially if the pain is deep or very severe.

Bruises on the head are particularly delicate. If additional symptoms such as nausea, dizziness or unconsciousness appear after a fall, a concussion or even internal bleeding may be present — urgent medical assessment is required.

Be cautious with bruises around joints. If the affected joint swells, becomes immobile or is very painful, blood may have entered the joint space — a so-called haemarthrosis.

Bruises near the genitals can be harmless, e.g. after sport or sexual activity, but they can also signal infections such as herpes or syphilis. If unusually many bruises appear in a short time without injury, or if they do not disappear after a long time, consult a doctor.

When should I see a doctor for bruises?

There are situations where a medical visit is essential. If a hematoma becomes unusually large or continues to swell, this may indicate that bleeding in the tissue has not yet stopped. Visible swelling or movement restrictions also suggest that more than a simple bruise is present — for example deeper tissue damage or a possible muscle fibre tear.

Be particularly cautious if the affected area feels hard or tense. This may be a sign of a compartment syndrome — an emergency in which fluid in tightly confined tissue spaces presses on nerves and blood vessels. Numbness, tingling or even paralysis can result. Such symptoms require immediate medical evaluation, often with imaging methods such as ultrasound.

If a bruise forms without an obvious cause or if an unusually large number of hematomas occur at the same time, see your GP. Such changes may indicate clotting disorders, side effects of medications or serious illnesses.

Bruises: how to make them disappear faster

• React immediately with cold. As soon as you have been bumped, apply cold quickly. Cold causes blood vessels to constrict so less blood leaks into the subcutaneous tissue — the bruise often stays smaller. Place a cold pack or ice (always wrapped in a cloth) on the affected area for a maximum of five minutes.
• If no cooling is available, pressure helps. Press firmly on the spot with the flat of your hand or your thumb for at least one minute. This slows bleeding into the tissue and can significantly reduce the spread of the hematoma.
• Elevate the injured limb if possible. This slows blood flow, which counteracts the formation of a large bruise. The principle is similar to swelling of the foot: less circulation = less spread.
• From the second or third day of treatment, heat helps more than cold. Warm compresses promote circulation and help the body transport the blood that has entered the tissue away more quickly. Do not start heat treatment too early — otherwise you may worsen the bleeding.
• Rely on proven ointments. Arnica, heparin or calendula promote healing. They reduce swelling, are anti-inflammatory and relieve pain. Gently massage the affected area to bring the active ingredients deeper into the tissue.
• Try herbal home remedies. Home remedies such as arnica tincture compresses, cold cabbage leaves or quark compresses can also help. Cabbage contains, for example, anti-inflammatory substances and also cools. Apply home remedies only to intact, closed skin.
• Pay attention to a vitamin-rich diet. Good supply of vitamin C, K and iron strengthens your blood vessels. This helps prevent bruises and speeds up their healing. Regularly include green vegetables, citrus fruits and wholegrain products in your diet.
• If you cannot hide the bruise, special concealer makeup helps. Use colour-correcting concealers (e.g. yellow for blue bruises), then a skin-coloured foundation. Apply makeup in good daylight to avoid visible edges.
• Many bruises result from carelessness — for example bumping into table corners. Being mindful in everyday life, especially in tight or busy situations, can help avoid injuries. This is particularly important for children and older people.
• Try natural oils. St John’s wort, rosemary or lavender oil may help with small bruises. They stimulate circulation and support healing. Put a few drops on the affected area and massage gently — ideal from the second day onwards.
• If hematomas occur for no apparent reason or very frequently, seek medical advice. A vascular weakness, a clotting disorder or a side effect of medication may be behind it. Better to see a doctor one time too many than not enough.

Bruises are usually harmless, but they provide valuable clues about how our body reacts to external forces. With proper care — from immediate cooling to circulation-promoting home remedies — the healing process can be significantly accelerated. However, anyone who gets hematomas frequently should remain vigilant, because sometimes there is more behind them than just a small bump.