Courtesy of Godoy Medical Forensics
PHYSICAL SIGNS OF ABUSE
When searching “physical signs of abuse,” many journals and websites list the following physical characteristics:
- Restraint or grip markings
- Black eyes
- Unusual pattern of injury
- Repeated trips to the Emergency Department
….with “bruises” often listed first since most are caused by physical injury. However, there are underlying conditions that can make bruising more common.
CAUSES OF EASY BRUISING
Easy bruising can be defined as bruising without a history of trauma or bruising out of proportion to mild trauma. Possible causes of easy bruising can be related to:
- Medications – several medications are associated with an increased risk of bruising such as blood thinners, nonsteroidal anti-inflammatory drugs (NSAIDS), some antidepressants and certain antibiotics
- Nutrition – Bruising can result from a number of underlying nutritional problems, including deficiencies in dietary protein, vitamin C and vitamin K.
- Bleeding disorders – disorders associated with clot formation may demonstrate immediate bleeding.
- Senile Purpura – With age and photodamage, the innermost layer of the skin becomes thin and increases the fragility of blood vessels. Therefore, even with negligible or minor trauma, the superficial blood vessels tear causing bruising.
MORE ABOUT SENILE PURPURA
Senile: characteristic of or caused by old age.
Purpura: purple-colored spots on the skin caused by the bursting of small blood vessels.
Senile purpura typically affects the elderly, as their skin tissues atrophy (waste away) and blood vessels become more fragile due to chronic sun exposure, aging and medications. Over 10% of those aged over 50 years old will be affected by senile purpura. Senile purpura is characterized by persistent non-palpable dark purple bruises, which fade to brown over a span of a few weeks. The brown discoloration may clear over weeks to months or may be permanent. These lesions are most commonly found on the surface of the forearms and hands. New lesions appear without recognized trauma.
WHAT DOES THIS HAVE TO DO WITH CRIMINAL CASES?
Noticeable bruises on a child, friend or loved one are concerning and seem to contribute to suspicions of child abuse or interpersonal violence. However, it is important for a medical expert to review records to determine if there is an underlying medical condition that may also be the cause of easy bruising with no intentional physical abuse or trauma.
Kraut, E. (2019, February 8). Easy Bruising. Retrieved from Up To Date: https://stanford.io/2X5GB2f.
Kuter, D. (2019, January). Merck Manual Professional Version. Retrieved from Senile Purpura: https://mrkmnls.co/2X4BTSb.