Senile purpura on the hands and arms is a common problem seen in elderly patients. Loss of subcutaneous tissue from aging and decreased dermal thickness from photoaging is the obvious causes. A number of products have been introduced to improve the appearance of hand bruises, but none can prevent the problem. The best way to prevent the bruising is to minimize trauma. I advise my senior patients to purchase a thick terry cloth knee hi men’s sport sock and cut the toe open. I then ask them to slide the tube over their forearms and back of the hands and then put on a long sleeve shirt and button at the wrists. This provides inexpensive washable extra padding that is anchored in place by the long sleeves.
Many of the creams for bruising are moisturizers that contain substances such as papain or bromelain, which are plant derived enzymes that are thought to break down the red blood components that create the bruised appearance. It is hard to know if these products work, since a bruise will resolve on its own in time. The biggest problem with bruising is the left behind hemosiderin mixed with some melanin that leads to brown skin staining. I am not aware of any good treatment for the residual pigmentation. Thus, I think the best solution is prevention.
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