Easy bruising is often attributed to anemia, but you may find you have fabulous iron numbers and still bruise like a darn peach. So what gives? And should you be concerned? Here’s why some people bruise more easily than others and when it warrants a visit to the doctor.

First things first: What exactly is bruising?

You probably have some idea about what bruises are, but you might not know exactly what’s going on beneath the surface when they crop up. “Bruising is skin discoloration resulting from pooled blood as capillaries [tiny blood vessels] leak underneath the skin,” explains general practitioner Dr. Liana Casusi, M.D., a consultant for Oh So Spotless. “An injury to the area can cause the bursting of these fragile vessels, allowing blood to leak out and collect under the skin, showing up as a bruise.” Initially bruises look purplish-blue (or “black and blue”), but they change to yellow as our body reabsorbs the blood.

Of course, the severity of an injury influences the appearance of the bruise; they can range from light blemishes to big and bold mixtures of colors, according to board-certified dermatologist Dr. Todd Minars, M.D., of Minars Dermatology in Hollywood, FL. “Likewise, some bruises are sore to the touch (or painful, if severe enough) and others are all but forgotten aside from their visual evidence.” 

Why do some people bruise more easily than others?

Ever wonder why some people turn black and blue from the slightest of pokes? Here are six possible reasons why they’re more sensitive than others.

1. Clotting Issues

Two primary causes typically explain easy bruising. “The first is that someone’s normal clotting mechanism has been affected, which is to say they are no longer able to clot minor contusions as they used to or as one normally could expect,” says Minars. This is often caused by the frequent use of blood thinners, such as aspirin, antiplatelet medications, and anticoagulants, notes Casusi. NSAIDs (think ibuprofen), steroids, and even certain natural supplements—particularly garlic, ginseng, ginkgo, and vitamin E—can also contribute, adds Danielle Baruch, M.D. a board-certified dermatologist at Mercy Medical Center in Baltimore.

2. Fragile Capillaries

The second general cause? Some individuals have normal clotting function but capillaries that are more fragile, says Minars. “Capillary fragility offers no serious complications to the patient, but can indicate a more serious problem elsewhere, such as a vitamin deficiency or dermatological disorder.”

3. Serious Health Conditions

In rare (and serious) cases, bruising easily can reflect low platelet counts, abnormal platelet functioning, or deficiencies in proteins that assist with blood clotting, according to Casusi. “Aside from easy bruising, these diseases can actually lead to uncontrollable internal or external bleeding, which may be fatal if not detected early,” she explains.

Luckily, there are telltale signs that your bruises reflect these serious issues. “Typically, these bruises appear at sites that are not much exposed to trauma, such as the trunk, face, or back,” says Casusi. “If you develop bruises around these areas for no apparent reason, have family members who also suffer from easy bruising, bleed excessively from minor cuts, or notice a sudden onset of easy bruising after starting a medication, then see a doctor,” says Casusi. Laboratory tests can be conducted to figure out what’s causing your condition.

4. Aging

“With age, all of us lose some of the collagen and fat that supports our skin and blood vessels,” explains Baruch. This decline in cushion results in bruises developing after even minor bumps and injuries, especially in locations like forearms and legs, since our skin gets thinner as we age.

5. Sun Damage

Since the ultraviolet rays from the sun accelerate the decline of collagen in the skin, people with lots of sun damage may notice they bruise more than others. “Years of sun exposure, particularly on high-frequency sun-exposed areas like our arms, legs, and chest, weaken the collagen, which is essentially the supporting tissue in the skin which supports the capillaries,” says Minars.

This kind of bruising is aptly named ‘solar purpura’ and it is very common. “You will see it in older people as constant bruises on their arms,” she says. “Their clotting is normal, but the capillaries just burst easily. They complain that the slightest bumps cause bruising, or they don’t even know what caused the bruise.”

6. Low Vitamin C Levels

Vitamin C deficiency may also be a reason you bruise easily. As with sun exposure, the reason for such bruising with this condition relates to collagen: “This vitamin is essential for the formation of collagen,” explains Casusi. Without ample amounts of it, your collagen production (and resilience against bruising) takes a hit.

Try: The Vitamin Shoppe brand Vitamin C

When To See A Doctor

In general, one or two unexpected bruises are probably of no concern. “However, if you’re noticing more than that without obvious reasons for the bruises, it deserves at least an exploratory visit to your primary care doctor or dermatologist,” says Minars. “They’ll likely perform a normal check-up and run panels or bloodwork to gain more insight if they have concerns.”  

Developing bruises in locations like your face or abdomen is another reason to get checked out, according to Baruch. 

“Other concerning features that warrant medical attention would be bruises that do not go away on their own over the course of a week or two, bruises that are excessively painful, or bruises that suddenly pop up in combination with other symptoms that are new to you,” she adds. “Developing excessive bleeding after medical procedures or dental work may be due to blood clotting disease and should also prompt a visit to your physician.”

The bottom line: Though easy bruising is often benign, it never hurts to check in with your primary care physician or dermatologist to confirm what could be behind the unsightly spots.