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?” one MyPsoriasisTeam member asked.

If you experience bruising with psoriasis, you’re not alone. Here, we discuss what causes bruises, whether they’re connected to psoriasis, and when to seek medical advice. If you have questions about psoriasis and bruising, schedule an appointment with your healthcare 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 blood cells repair the broken blood vessel, your body reabsorbs the blood. During this process, the bruise often turns a shade of blue and then greenish-yellow until it heals completely.

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

Bruising and Psoriasis

Bruising isn’t a typical psoriasis symptom. However, some people living with this common skin condition find that they bruise easily.

What Members Are Saying About Bruising

“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.”

“I get blood spots under the skin where my skin flares. I think the bruising may be a mixture of that and maybe some microtrauma, like bumping against things but not hard enough to hurt.”

If you bruise easily, talk with your healthcare provider. This symptom could be a sign of an underlying medical issue — or it may be nothing to worry about. It might also be a side effect of your psoriasis treatment.

Side Effects of Psoriasis Treatments

Bruising may be a side effect of some psoriasis treatments, including the following medications.

Corticosteroids

Corticosteroids are a common and effective treatment for psoriasis. They work by calming or reducing immune system activity. According to the National Psoriasis Foundation, easy bruising is a potential side effect of this type of treatment.

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

Acitretin

Acitretin is another psoriasis treatment that may cause bruising. A vitamin A product, this oral retinoid is mainly used for pustular psoriasis. It’s not usually the first treatment doctors choose for plaque psoriasis today. When combined with phototherapy (an ultraviolet light treatment), acitretin can also treat plaque psoriasis. Other side effects of acitretin include joint pain and headaches.

Methotrexate

Seek immediate medical care if you notice easy bruising while taking methotrexate. Bruising isn’t a common side effect of this disease-modifying antirheumatic drug (DMARD). It sometimes means that the drug is affecting the bone marrow, which makes blood cells. This can happen even at normal doses and is a serious side effect. With some other psoriasis treatments, bruising may occur and is often less serious.

Biologics

You may notice bruising at an injection site if you inject biologics at home. “I seem to be bruising on a biologic,” one member said.

Ask your healthcare provider how to minimize this side effect. Your doctor may suggest 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 raise your risk of bruising include certain laser treatments and frequent use of over-the-counter pain relievers like ibuprofen.

If you notice increased bruising, don’t stop taking your medication. Talk to your healthcare 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 can occur with some autoimmune diseases, such as rheumatoid arthritis. Most often, though, it’s linked to low platelet counts. Psoriasis has been linked to increased platelet activity and sometimes higher platelet counts, but platelet levels can vary. A blood test can help your doctor check whether platelet changes may be contributing to easy bruising.

Skin injuries like cuts, sunburns, bugbites, and bruises can lead to a psoriasis flare. Can a psoriasis flare also cause skin injuries? It’s possible. If your skin itches, rubbing or scratching it may damage the blood vessels below and lead to a bruise. If this happens often, talk to your doctor about how you can prevent and control itching.

Is This a Bruise?

It can be hard to tell the difference between a bruise and skin symptoms of psoriasis. This may be especially difficult with a new bruise or a recent psoriasis diagnosis. Here are a few tips:

Bruises	Psoriasis
Bruises tend to be black, red, purple, or blue and change colors as they heal.	Psoriasis plaques vary by skin tone. They may look pink or red on light skin and purple or gray on darker skin.
Bruises can be tender or painful, but they usually don’t 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. Yours may heal faster or slower, depending on the type of bruise and its cause.

Consult a healthcare professional if you have:

• Signs of infection, like streaks or pus
• Painful swelling in the bruised area
• A bruise that keeps coming back in one location
• Frequent large bruises
• A lump under the bruise
• Bruises that seem to occur for no reason
• A history of bruising or bleeding
• Family members who bruise easily

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

Join the Conversation

On MyPsoriasisTeam, people share their experiences with psoriasis, get advice, and find support from others who understand.

Do you experience bruising with psoriasis? How do you manage it? Let others know in the comments below.