by Wesley W. Wilson, MD
NOTE: If you have any questions for “Ask the Doctor,” please send them to the Voice editorial office. The only questions Dr. Wilson will be able to answer are the ones used in this column.
Wesley W. Wilson, MD, has retired as an Internal Medicine practitioner at the Western Montana Clinic in Missoula, Montana. Dr. Wilson was diagnosed with type 1 diabetes in 1956, during his second year of medical school. He remains interested and involved in diabetes education for patients and professionals.
Q: My mother is an elderly woman who has had type 2 diabetes for decades. Recently she sustained an oddly severe and persistent bruise on her arm from a child’s thrown football. Is this from diabetes? Does long-term diabetes affect the healing of the skin?
A: Diabetes can certainly slow healing of the skin, especially when there is impaired nerve or blood vessel function. We all know we must be careful to avoid breaks in the skin of our feet. A wound on the foot can lead to severe infection and potentially serious problems.
It would be a mistake to assume the severe bruise your mother has is due to diabetes. Increasing age is associated with increased blood vessel fragility. You may have heard the term “senile ecchymosis” which refers to the fact that older persons often show spontaneous bruises or areas of bleeding under the skin. Another factor might be due to the fact that many persons with diabetes now take aspirin in an effort to reduce the likelihood of heart attack or stroke. The American Diabetes Association recommends all persons with diabetes take aspirin unless there is a contraindication. Aspirin has a strong anti-clotting effect and can increase bruising and bleeding.
Perhaps she is taking some other medications which might affect blood clotting? You should ask her pharmacist if any of her medications have anti-clotting effects. There are other diseases that increase risk of subcutaneous bleeding—such as liver disease. Certainly if the bruise is severe enough to cause concern, it would be wise to have it evaluated by her health care provider.