You may be familiar with psoriasis plaques that itch, burn, or sting. You may be used to the lesions that can accompany flare-ups. You may even be on the lookout for joint pain, which can be an early symptom of psoriatic arthritis (PsA). But bruises? No one warned you about those.

“Do you have bruises on your skin as part of your psoriasis?” asked one MyPsoriasisTeam member. “Does anyone else get unexplained bruises that show up out of nowhere?” asked another.

If you experience bruising with psoriasis, you are not alone. In this article, we look at what causes bruises, whether they are connected to psoriasis, and when to seek medical advice. If you have questions about bruises and psoriasis, schedule an appointment with your health care provider or a dermatologist.

What Are Bruises?

Bruises develop when blood vessels beneath the skin break, creating an opening for blood to leak out and pool in the soft tissue under the skin. The black, red, purple, or blue discoloration generally seen at the start of a bruise is the trapped blood. As your blood cells repair the broken blood vessel, your body reabsorbs the blood. During this process, the bruise color often changes to a shade of blue and then greenish-yellow until it heals completely.

Physical causes of bruises include:

• Falling
• Bumping into or against a hard surface
• Being hit or punched
• Playing contact sports
• Having a car or motorcycle accident

Medical causes of bruises include:

• Having a vitamin C or vitamin K deficiency
• Having a bleeding disorder, like hemophilia
• Taking blood thinners
• Having cancer or liver disease
• Taking nonsteroidal anti-inflammatory drugs (NSAIDs)
• Taking certain dietary supplements, like ginkgo biloba, which can thin the blood

Thin skin can also increase the likelihood of bruising. Our skin naturally thins as we age, making some people more prone to bruising. Corticosteroids can also thin the skin.

Bruising and Psoriasis

Although bruising is not a typical skin symptom of psoriasis, some people living with this common skin condition find that they bruise easily. These are some experiences MyPsoriasisTeam members shared in their own words:

• “I get bruises all over my arms and legs — big, bright bruises. I even had one on my arm that stuck around for several weeks.”
• “I always have bruises showing up when there’s no way I could have bumped that spot.”
• “I recently started getting weird bruises and am having a psoriasis flare right now.”
• “My skin is very thin. I have to be careful not to bump into things, as it creates blood bruises.”
• “I get blood spots under the skin where my skin flares. I think the bruising may be a mixture of that and maybe some micro-trauma, like bumping against things but not hard enough to hurt.”

If you bruise easily, talk to your health care provider. It could be a sign of an underlying medical issue or nothing to worry about at all. It might also be a side effect of your psoriasis treatment.

Side Effects of Psoriasis Treatments

Bruises may be a side effect of some psoriasis treatments. For example, the following medications may cause bruising:

• Corticosteroids
• Acitretin
• Methotrexate (although not common)
• Biologics

Corticosteroids

Corticosteroids are a common and effective treatment for psoriasis. They work by suppressing the immune system (reducing its activity). The purpose of suppressing the immune system is to control overactive immune responses, but it also may make the body more susceptible to infections. According to the National Psoriasis Foundation, easy bruising is a potential side effect of this type of treatment.

If your dermatologist recommends a topical steroid cream or ointment, tell them about any physical changes you notice after using it, including increased bruising. In addition to thinning the skin, corticosteroids like prednisone can also reduce your blood’s ability to clot, which may lead to bruising.

Acitretin

Acitretin (Soriatane) is another psoriasis treatment that can cause bruising. This oral retinoid is a vitamin A product and a first-line treatment for pustular psoriasis and other severe types of psoriasis. When combined with phototherapy (an ultraviolet light treatment), acitretin can also effectively treat plaque psoriasis. In addition to bruising, other side effects of retinoids include joint pain, fatigue, headaches, and depression.

Methotrexate

Seek immediate medical care if you notice easy bruising while taking methotrexate. This is not a common side effect of this disease-modifying antirheumatic drug (DMARD) and could be a sign of an overdose, which can be fatal. With other psoriasis treatments, bruising is more common and usually not a cause for concern.

Biologics

Biologics are medications that come from living organisms, such as bacteria, yeast, or animal cells, that are used to treat various medical conditions.

Biologics can also cause bruising on some parts of the body, but perhaps for a different reason. You may notice bruising at the injection site if you inject biologics at home. To minimize this side effect, ask your health care provider about the benefits of injecting the medication slowly, rotating the injection site, and using ice to numb the area before and after the injection. You can also ask your care team to watch you do a few injections. They may have tips for reducing bruising and other side effects.

Other psoriasis therapies that may increase your risk of bruising include certain laser treatments and frequent use of over-the-counter pain relievers like ibuprofen (Advil) and naproxen (Aleve).

Some MyPsoriasisTeam members have noticed a link between psoriasis treatments and bruises. “Is bruising easily a side effect of Enbrel?” asked one member. “I seem to be bruising on Humira,” shared another.

A MyPsoriasisTeam member living with PsA has a different perspective. “My doctor suggested it was a side effect of a medication, but I’ve had bruises since before starting medication for PsA,” they said.

If you notice increased bruising, don’t stop taking your medication. Talk to your health care provider first. They may be able to adjust your dosage, suggest a new therapy, or make other changes to improve your quality of life.

Other Reasons for Bruising With Psoriasis

Bruising is common with some autoimmune diseases, like rheumatoid arthritis, but is often associated with low platelet counts or some of the same medications used to treat psoriasis. With psoriasis, you are more likely to have high platelet counts, but if you have other autoimmune diseases, they may be affecting your platelet levels. Your doctor can perform a simple blood test to check your platelet levels.

Skin injuries like cuts, sunburns, bug bites, and bruises can lead to a psoriasis flare, but can a psoriasis flare also cause skin injuries? Potentially. If your skin itches, you might rub or scratch it in a way that damages the blood vessels below and leads to a bruise. If this happens frequently, talk to your health care provider about options for preventing and controlling itching.

Is This a Bruise?

It can be hard to tell the difference between a bruise and skin symptoms of psoriasis, especially if the bruises are new or if your psoriasis diagnosis is recent. Here are a few tips:

• Bruises are generally black, red, purple, or blue, and they change colors as they heal.

• Psoriasis plaques vary by skin tone and may look pink or red on lighter skin and purple and gray on darker skin.

• Bruises can be tender or painful but do not usually itch.
• Psoriasis plaques often itch or burn but can also cause soreness.
• Bruises may be accompanied by swelling or a raised bump.

• Psoriasis plaques can be raised and are often dry, cracked, and scaly. They may also bleed.

Ask your dermatologist or rheumatologist to take a look if you have questions about skin changes or discoloration.

When To Seek Medical Advice

Most bruises will heal and fade on their own within two weeks. Your bruise may heal faster or slower depending on what type of bruise you have and what caused it.

Consult a health care professional if you:

• Notice signs of infection, like streaks of redness, pus, or fever
• Experience painful swelling in the bruised area
• Notice a bruise that keeps coming back in one location
• Frequently have large bruises
• Notice a lump under the bruise
• Have bruises that seem to occur for no reason
• Have a history of bruising or bleeding
• Have family members who bruise easily

Your health care provider is there to support you throughout your medical journey. If you experience any new or worsening side effects or symptoms related to bruises or psoriasis, do not hesitate to seek their medical advice. Promptly sharing any changes or concerns can ensure that you receive timely and appropriate care.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis and their loved ones. On MyPsoriasisTeam, more than 117,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis and psoriatic arthritis.

Do you experience bruising with psoriasis? How do you manage it? Share your experience in the comments below, or start a conversation by posting on your Activities page.