how not to f*ck up your face

Why Do I Get Purple Blotches on My Skin Out of Nowhere?

Photo-Illustration: by The Cut; Photo: Getty Images

This column first ran in Valerie Monroe’s newsletter, How Not to F*ck Up Your Face, which you can subscribe to on Substack.

A question about an aptly (and unsavorily) named condition.

Q: The purple bruising looks as bad as it sounds — senile purpura. I’m a 60-year-old, board-certified dermatology nurse, and I still have few answers about how to fix this unattractive problem. I concocted a special mixture that has helped a little: I combine a half-jar of CeraVe cream, 20–25 grams of 0.1-percent tretinoin cream, and about a tablespoon of arnica oil and apply it once or twice per day. When I use it, the bruising isn’t quite as bad and maybe heals a bit quicker. But I hear that intense pulsed light treatments are showing promise. What do your experts know? 

A: I prefer the alternative name for this condition: solar purpura, which sounds more like violet light emitted from a tropical sunset. But both describe the purple blotches that can appear on severely photodamaged skin on the arms and legs, says HNTFUYF DermDiva Heidi Waldorf. I’ll bet you know that senile means old and solar means sun, but did you know that purpura means the condition of purpleness or, for our purposes, bruise?

Because the condition is caused by chronic sun exposure, the incidence of SP increases with age, says Waldorf, and approximately 12 percent of people 50 or older have it — and 30 percent of people 75 or older. (In my family, 100 percent of people 85 or older have had it.) The cause? Obviously, bumping into things. And, adds a more serious Waldorf, severely damaged dermal structure.

Because the connective tissue (collagen and elastin) can’t support the microvasculature (blood vessels), even minor injury causes blood to leak from the vessels. This leads to bruising, a.k.a. those purple blotches. There’s more: As the skin becomes thin and fragile with advanced age, SP is often associated with tears, as the epidermis shears off, then heals with scarring. Welcome aboard the train to Scary Town. Tickets, please!

Treatment options for early signs of SP include all of the things generally recommended for aging and photoaging to improve the epidermis and dermis — such as sun protection, moisturizers, retinoids, and alpha-hydroxy acids, advises Waldorf. Once the skin becomes fragile, it’s important to maintain the skin barrier with gentle cleansing, moisturizers, alpha-hydroxy-acid lotions (which help reduce atrophy), and, if necessary, wound care. Bruises can be treated with topical arnica in products like Alastin INhance. (Waldorf doesn’t recommend oral arnica, because its safety and efficacy is unknown for long-term use.) And to answer your question about intense pulsed light therapy, Waldorf says that although doctors use vascular lasers and pulsed light to speed clearance of bruises, it’s not realistic for recurrent bruising like SP.

In spite of the evidence of my sun-loving, banged-up relatives, the kind of bruising seen with SP isn’t a fact of life for everyone, says Waldorf. The healthier your skin is as you age, with minimal photodamage and a healthy skin barrier, the less likely you’ll be to bruise. A few other considerations that might influence bruising: As we age, we’re more likely to take anticoagulant medications (blood thinners) and supplements like vitamin E and fish oils and omegas (which have anticoagulant effects). And thin-skinning medications like chronic steroids increase bruising at any age.

As for your topical mix, dear enterprising reader, Waldorf says it’s very reasonable. But you might get more effectiveness by rubbing in just a pea-size amount of prescription tretinoin on each forearm and hand nightly. (If 0.1 percent is too irritating, try 0.025 or 0.05 percent.) Alternatively, you could try an over-the-counter retinol or, because it’s easily available and cost-effective, invest in a large bottle of 10–15 percent alpha-hydroxy-acid cream or lotion like AmLactin, Lac-Hydrin, or Neostrata. Using a moisturizer daily — whether CeraVe, Lipikar, or one with a retinol or AHA — is important to maintain the stratum corneum (the dead outer layer of the epidermis), which provides an intact skin barrier, says Waldorf. And don’t forget sunscreen. Always sunscreen.

One last point: Any new episodes of unexplained bruising should be evaluated by your doctor. And watch where you’re going!

Valerie Monroe was beauty director at O, The Oprah Magazine, where she wrote the monthly “Ask Val” column for nearly 16 years. Now, she writes the weekly newsletter How Not to F*ck Up Your Face. Her goal continues to be to shift our thinking in the beauty arena from self-criticism to self-compassion and to learn how to be loving witnesses to ourselves and one another as we age.

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Why Do I Get Purple Blotches on My Skin Out of Nowhere?