Bruising of the hands and arms – a condition known as actinic purpura or Bateman purpura – affects mainly older and light-skinned individuals who bruise easily. In individuals with this condition, even minor trauma to the skin can result in flat, reddened blotches that turn purple and darken. Typically, these bruises cover the back of the hands and arms. In some cases, the face and neck may be affected. The skin also appears sun-damaged, thin and wrinkled.

The condition occurs due to a lifelong accumulation of sun damage that has weakened the blood vessels. It most often appears in elderly individuals. Once a bruise appears, it typically takes a few weeks for it to fade and disappear.

The bruising itself usually cannot be treated. However, patients can take steps both to minimize further sun damage, and to prevent the appearance of new bruises. Makeup is also available to help cosmetically cover up the bruises.

Bruising of the hands and arms may result from a condition called actinic purpura or Bateman purpura. It involves flat, purple blotches (macules) 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 (reddish to purple to greenish to brown). 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 should consult a physician if they experience any of the following:

• Bruising that occurs suddenly without a previous history of bruising, especially soon after beginning a new medication
  
  
• Frequent bruising accompanied by abnormal bleeding elsewhere, such as from the nose, gums or urinary or intestinal tracts
  
  
• Unusually large or painful bruises, especially if they appear to develop for no reason

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. Several blood tests may be performed including:
  
  
• • Coagulation studies. Tests that determine how well a patient’s blood clots.
    
    
  • Complete blood count. A series of tests to look for abnormalities in the blood that may indicate the presence of disease.
    
    
  • Platelet count. Measures the number of platelets in blood. Platelets are necessary for normal blood clotting.
    
    
• Liver function tests. A series of tests that determine how effectively a patient’s liver functions.
  
  
• Stool guaiac test. Checks for the presence of hidden (occult) blood in the stool.
  
  
• Urine tests. A series of chemical and microscopic tests to look for abnormalities in the urine that may indicate the presence of disease.

Patients who experience bruising of the hands and arms due to actinic purpura are likely to continue to have them throughout their lifetime.

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 (dermis). 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 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 fish oil, ginkgo, ginger and garlic, also may have a blood-thinning effect that leads to increased bruising.

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. It can be found in cosmetic departments and is excellent at covering bruises.

Avoiding prolonged exposure to the sun, particularly during peak hours of the day (between 10 a.m. and 4 p.m.), 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 to 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.

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. Long-sleeved shirts and pants may also provide extra protection from the sun.

People who bruise easily can also reduce their risk of minor bumps and injuries by reducing household clutter. Wearing long-sleeved shirts and pants also offers some protection against the shear forces and light trauma that provoke bruising.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to bruising hands and arms:

1. What may be causing my bruising?
   
   
2. What tests will you use to determine the cause of my bruising?
   
   
3. Is my bruising a cause for concern?
   
   
4. Under what circumstances should I consult a physician for a bruise?
   
   
5. How long will my bruises last?
   
   
6. What are my treatment options?
   
   
7. How can I reduce swelling at the site of a bruise?
   
   
8. How can I prevent these bruises from occurring?