Hematomas are common after an injury and usually resolve on their own. While they can cause discomfort, including itching, this sensation is a normal part of the body’s healing process.
Understanding Hematomas
A hematoma forms when blood leaks from a damaged blood vessel and pools in surrounding tissues. This collection can occur anywhere, from small, superficial spots to larger, deeper accumulations. Unlike a bruise, which is a discoloration from smaller capillary leakage, a hematoma involves bleeding from larger vessels, forming a more significant collection that can sometimes be a palpable lump. The pooled blood causes a characteristic dark red, purple, or black appearance, changing color as the body reabsorbs it.
Reasons for Itching
The itching associated with a healing hematoma stems from several physiological processes. As the body breaks down and reabsorbs the pooled blood, byproducts like bilirubin are released, which can trigger itching. The immune system also releases inflammatory mediators, such as histamine, in response to the injury, which can cause the surrounding skin to itch.
The healing process involves increased blood flow and white blood cell activity to clear debris and repair tissues. This heightened cellular activity and nerve stimulation can contribute to itching and tingling. The skin overlying the hematoma may also stretch or become dry as swelling subsides and the area heals, which can independently cause itching. Larger hematomas may itch more due to a greater inflammatory response and tissue changes.
Relieving Discomfort
Managing the itching and discomfort of a hematoma involves several gentle approaches. Applying a cold compress to the affected area for 15-20 minutes at a time, several times a day, can help reduce swelling and provide temporary itch relief. Wrap ice packs in a thin towel to prevent direct skin contact. Elevating the injured area above the heart can also help minimize swelling by promoting fluid drainage.
Keeping the skin moisturized is beneficial, as dry skin can exacerbate itching. Loose clothing over the area can prevent irritation and allow air circulation. While scratching should be avoided to prevent further skin damage or infection, over-the-counter antihistamines or topical anti-itch creams may help alleviate the sensation. For pain relief, acetaminophen is recommended, while nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen should be avoided as they can increase bleeding risk.
When to Consult a Doctor
While most hematomas resolve without complications, certain signs indicate a need for medical evaluation. Seek immediate medical attention if the hematoma is accompanied by severe or increasing pain not relieved by over-the-counter medication, or if it rapidly increases in size or swelling.
Consult a doctor if you notice:
- Signs of infection, such as increased warmth, redness, pus draining, or a fever.
- Significant restriction of limb or joint movement.
- Neurological symptoms like confusion, severe headache, vision changes, or weakness (especially after a head injury).
- You are taking blood thinners or have a bleeding disorder, and a hematoma develops.