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Therapeutics in Dermatology
A reference textbook in dermatology

Painful bruising (syndrome)

10 April 2012, by CONSOLI S.G.

The skin is a special organ in terms of one’s relational life: visible, it may be touched and is easily accessible. It is particularly associated with one’s emotional, socio-affective and psychological life. The skin may thus be a means of expression of both commonplace emotional difficulties like blushing in public for example, and rare and serious psychological troubles such as self-mutilation.

Painful bruising syndrome is characterised by the spontaneous appearance, most often in women and primarily on the arms and legs, of painful ecchymoses which are heralded by skin reactions such as pruritus, or a burning or tingling sensation, followed by inflammatory erythema and oedema, and sometimes accompanied by various somatic disorders. Intradermal tests to the patient’s own erythrocytes do not always yield positive results.

Several etiological theories have been put forward, but no cause is found repeatedly. Somatic hypotheses incriminate the sensitisation to the stroma of the patients’ own erythrocytes or the dysfunction of neuromediators within the neuro-immuno-cutaneous network.

Psychological hypotheses consider that a brutal psycho-affective event may trigger the condition in patients suffering from depression.

It is easy to understand why under these conditions a great number of different treatments have been used, giving rise to only temporary and non-reproducible improvements in cases where improvements were observed.

Treatment should therefore include the following:

– Symptomatic treatment of the ecchymoses (warm baths, re-education, use of a splint).
– Treatment of a potential somatic cause. Of all the available treatments, those giving rise to the fewest side effects should be privileged over the others (e.g. antihistamines or beta blockers).
– Treatment of the associated psychological suffering by combining administration of antidepressants (if the patient is depressed) with supportive or relaxation psychotherapy, and meetings with social workers.

Painful bruising syndrome is therefore a complex dermatological disorder involving both somatic and psychological factors.

Physicians should gain the patients’ trust and be very attentive to the patients’ somatic and psychological complaints prior to undertaking the required somatic investigations (that must not be multiplied unnecessarily) and the various, progressive treatment steps. In fact, the best treatment results are obtained with the implementation of a double treatment strategy, i.e. one that is both somatic and psychological.

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