What Causes It? | MS Meds and Bruising | Risk Factors | Prevention | Support

Some people with multiple sclerosis (MS) find that they bruise easily or develop bruises seemingly out of the blue. “Does anyone else bruise easily?” asked one member of MyMSTeam. “I don’t know if it has anything to do with having MS, but I have noticed I barely hit something, and I bruise like someone has been beating me.” Another member wrote, “I look like a bruised banana. It’s embarrassing.”

There are several possible causes of bruising that can be related to MS, including side effects of medications and injuries as a result of bumps or falls. Here is what you need to know about bruising and how to help prevent it. As with any symptom of MS, talk to a health care professional if you are concerned about excessive or easy bruising.

What Causes Bruising in MS?

MS itself is not believed to cause easy or excessive bruising. However, the symptoms of multiple sclerosis, as well as some treatments for MS, can cause a person to develop bruises more frequently than usual.

Minor Injuries, Bumps, and Falls

People with MS may be more prone to everyday injuries than those without the condition, causing them to develop frequent bruises.

In MS, immune system attacks damage the myelin sheath that acts as a protective coating around nerve cells in the central nervous system, which includes the brain and spinal cord. This damage, known as demyelination, causes lesions. Depending on where it occurs, demyelination can affect your motor functions, including balance, movement, and coordination.

Demyelination in parts of the brain responsible for coordination can cause a person to lose their balance, feel clumsy, or lose their footing while walking. Demyelination due to multiple sclerosis can cause problems with depth perception and unusual sensations.

These sensations might include:

• Dizziness
• Vertigo
• Muscle weakness
• Numbness
• Tremors (shaking)

Many people with MS experience spasticity, which causes muscle stiffness, muscle tightness, or involuntary spasms. Foot drop, or being unable to lift the front part of your foot to the proper angle when walking, is another common symptom of MS that impacts walking.

All of these symptoms may make a person with MS more prone to falling or injuring themselves, which can lead to bruises.

MS Medications and Bruising

Bruises often occur when capillaries (small blood vessels near the skin’s surface) break as a result of injury. Blood leaks out of vessels and breaks down, resulting in the familiar marks. In light-skinned people, the initial black-and-blue coloration fades to a greenish, yellowish mark before it disappears altogether. In dark-skinned people, bruises appear most visibly in the earliest stages, and, due to melanin, can look red, brown, or black.

Many disease-modifying therapies (DMTs) used to treat relapsing MS are injected, either under the skin (subcutaneous injection) or into a vein (intravenous or IV injection). If your DMT is injected, you may notice bruising at the injection site.

In rare cases, one DMT in particular can cause bleeding and bruising that may be signs of a serious complication. If you take alemtuzumab (Lemtrada), contact your health care provider immediately if you experience any of these symptoms:

• Easy bruising
• Unusual or prolonged nosebleeds
• Excessive or unusual gum bleeding
• Cuts that won’t stop bleeding
• Blood-producing coughs
• Heavier-than-normal menstrual flow
• Petechiae (tiny red, pink, or purple spots on the skin)

Where Did That Bruise Come From?

The condition MS can cause cognitive symptoms, including short-term memory issues. If you find yourself not noticing or remembering where some of your bruises came from, you may have forgotten a bump or fall. You also may not remember small injuries due to numbness, high pain tolerance, or just growing so used to these minor bumps that you don’t notice them.

Other Risk Factors for Easy Bruising

Females and older adults tend to bruise more easily than other people. Apart from MS, there are other conditions and risk factors that can cause you to bruise easily. That includes taking medications and supplements such as:

• Corticosteroids (steroids)
• Anticoagulants (blood thinners)
• Aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs)
• Ginkgo (a plant used in some supplements)

Some health conditions can also raise your risk for bruising. These can include:

• Liver disease
• Family history of easy bruising or bleeding
• Bleeding disorders (such as hemophilia or Von Willebrand disease)
• Cancer (such as leukemia)
• Deficiency in vitamin C or vitamin K

Seek medical advice if you are concerned about any of these risk factors for bruising.

Preventing Bruises With MS

If you experience frequent bruises while living with MS, there are steps you can take to reduce or prevent bruising.

Help With Medications

If you have trouble sticking to an injected medication due to injection-site bruising or other injection-related concerns, talk to your doctor. They may have tips for how to avoid bruising or rotate injection sites to make things easier.

If that doesn’t help, ask your doctor about whether switching to an oral (taken by mouth) DMT might be safe and effective for treating your MS. There are several oral treatment options now available.

Tailor Your Environment to Your Needs

Making important areas and items more easily accessible can reduce the risk of falls or injuries, reducing the chances of developing bruises. Arrange your home in a way that is as easy for you to navigate as possible, particularly in high-risk areas such as stairs or bathrooms. Make sure lighting is good so all areas are easy to see, especially at night.

Use Assistive Devices

Assistive devices, like canes and walking sticks, can provide much-needed support on days when your balance or depth perception are particularly altered.

Ask for Help When Needed

Rather than putting yourself into a situation that could be risky for falls or injuries, ask for help. Stairs, high shelves, and slippery floors can present dangers or increase the chance of injury and bruising. You may prefer to be independent, but seeking help at the right times can prevent pain and bruising.

Find Your Team

On MyMSTeam, the social support network for people with MS and their loved ones, more than 183,000 connect from all over the world. Here, you can ask questions, offer support and advice, and meet others who understand life with multiple sclerosis.

Do you bruise easily with MS? Have you found ways to prevent or avoid bruises? Share your story or tips in the comments below or by posting on MyMSTeam.