Why am I getting purple spots on my skin out of nowhere?
Photo Illustration: by The Cut; Photo: Getty Images
This column first appeared in Valerie Monroe’s newsletter. How not to mess up your facewhich you can subscribe to on Substack.
A question about a disease with an apt (and unsavory) name.
Q: The purple bruise looks as bad as it sounds – senile purpura. I’m a 60 year old Registered Dermatology Nurse and I still have few answers on how to fix this ugly problem. I created a special blend that helped a little: I combine half a jar of CeraVe cream, 20-25 grams of 0.1% tretinoin cream, and about a tablespoon of arnica oil and apply it once or twice a day. When I use it, the bruising isn’t quite as bad and may heal a little faster. But I’ve heard that intense pulsed light treatments show promise. What do your experts know?
A: I prefer the alternative name for this condition: solar Purpura, which sounds more like the violet light of a tropical sunset. But both describe the purple spots that can appear on severely photodamaged skin on the arms and legs, says HNTFUYF DermDiva Heidi Waldorf. I bet you know that senile means old and solar means sun, but did you know that? purpura Does this mean the state of purple coloring or, for our purposes, a bruise?
Because the condition is caused by chronic sun exposure, the incidence of SP increases with age, Waldorf says, and about 12 percent of people age 50 and older have it — and 30 percent of people age 75 and older. (In my family, 100 percent of people had AB 85 years the disease.) The cause? Obviously bumping into things. And, adds a more serious Waldorf, badly damaged skin texture.
Because the connective tissue (collagen and elastin) cannot support the microvessels (blood vessels), even a minor injury will result in blood leaking from the vessels. This leads to bruising, called purple spots. There’s more: Because skin becomes thin and brittle with age, SP is often associated with tears as the epidermis shears off and 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 commonly recommended for aging and photoaging to improve the epidermis and dermis — like sunscreen, moisturizers, retinoids, and alpha-hydroxy acids, Waldorf advises. Once skin becomes fragile, it is important to maintain the skin barrier with gentle cleansing, moisturizing creams, alpha hydroxy acid lotions (which help reduce atrophy), and wound care when necessary. Bruises can be treated with topical arnica in products like Alastin INhance. (Waldorf doesn’t recommend oral arnica because its safety and effectiveness with long-term use is unknown.) And to answer your question about intense pulsed light therapy, Waldorf says that while doctors use vascular lasers and pulsed light to speed bruise healing, it is it is not realistic with recurring bruises like SP.
Despite evidence from my sun-loving, broken-down relatives, the kind of bruising seen on SP isn’t a fact for everyone, Waldorf says. The healthier your skin is with age, with minimal photodamage and a healthy skin barrier, the less likely you are to bruise. Some other considerations that might affect bruising: As we age, we are more likely to take anticoagulant medications (blood thinners) and supplements such as vitamin E and fish oils and omega fatty acids (which have anticoagulant effects). And thin-skinned drugs like chronic steroids increase bruising at any age.
As for your thematic mix, dear enterprising reader, Waldorf says it is very reasonable. However, you may find greater effectiveness if you only apply a pea-sized amount of prescription tretinoin to each forearm and hand each night. (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 readily available and inexpensive, invest in a large bottle of 10-15 percent alpha . Hydroxy acid cream or lotion amlactin, Lac hydrinor Neostrata. Use a moisturizer daily – whether Cerave, Lipicaror one with a retinol or AHA — is important for maintaining the stratum corneum (the dead outer layer of the epidermis), which keeps the skin barrier intact, says Waldorf. And don’t forget sun protection. 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 column Ask Val for almost 16 years. Now she writes the weekly newsletter How not to mess up your face. Her goal remains to shift our thinking from self-criticism to self-compassion in the beauty arena and to learn how we can be loving witnesses to ourselves and to each other as we age.