Background

Bruises are typically caused by trauma, often by absorption of direct mechanical energy (a physical blow) by penetration of the skin and subdermal tissues by random sharp objects or controlled objects such as needles and scalpels (e.g. injections, dermal infusions or surgery). In each case a typical pattern of events occurs with, on a macroscale, disruption to local capillaries and venules and, on a microscale, damage to cells and extracellular matrix materials. The disruption of the capillaries and venules will result in red blood cells haemorrhaging, the cells being released into the interstitial space. The latter combined with local nerve responses and release locally of molecules such as histamine will cause local vasodilation resulting visually in initial skin reddening and then as red cells and their haemoglobin breakdown products build up more dramatic changes to skin colour. Over time, once haemostasis has been restored, initially through the fundamental clotting mechanisms triggered through the extrinsic and intrinsic pathways, the haemorrhaged red cells will be broken down and the haemoglobin released will be converted to bilirubin and biliverdin, both colourful molecules adding tinges of yellow and purple to the visual appearance of the skin (the classic "bruise" presentation). In the final phases the inflammatory response will attract a range of phagocytic cells and fibroblasts which will eventually clear the debris and lay down a new extra cellular matrix for subdermal tissue reconstruction. It is also relevant to note that age related changes may produce a bruise like effect known as senile purpura that maybe controlled by some of the same physiological drivers seen in trauma induced bruising. In addition to the above elements bruise formation maybe associated with some pain and discomfort not only at the time of the immediate trauma but also once bruise formation has been initiated and progresses.

Attempts to treat or cosmetically mask bruising have resulted in a range of skin potions targeted at various single or multiple elements of the physiological drivers involved. The novelty of this invention is that it seeks to combine a range of natural and synthetic compounds so that they work synergistically to direct the physiology and the outcome of bruising, ameliorating the biological impact and improving the skin appearance and in some manifestations of the invention also reducing any pain. The timing and composition of the treatment application may vary according to whether the bruise has been initiated, if it is developing or whether haemostasis has been achieved.

References:-

David Funt ;Plastic Surgical Nursing January/March 2015;Volume 35;lssue l;pp: 13-32 ;Dermal Fillers in Aesthetics: An Overview of Adverse Events and Treatment Approaches

July 2011 VOLUME 10 <· ISSUE 7 Copyright © 2011 Journal of Drugs in Dermatology

Berlin MD, Eisenberg,; Drugs Dermatol.2011;10(7):718-722.A Randomized, Placebo-Controlled, Double-Blind Study to Evaluate the Efficacy of a Citrus Bioflavanoid Blend in the Treatment of Senile Purpura

Fortschr Med. 1977 Jun 16;95(23):1557-60;Controlled study on the efficacy of external treatment in surface-near thrombophlebitisl.Schedel F, Hennemann B, Reindl P.

Am J Health System Pharm Vol 64 Dec 1 2007 Cohen J;The Role of Topical Vitamin K Oxide Gel in the Resolution of Post procedural Purpura; J Drug Derm; 2009; 8: 1020-1025

US Patent 2013210777(al) 2011-02-17 Amelioration of the appearance of bruises

US Patent 2011144215(A1) 2006-05-26 Bruise amelioration composition and method of use

Eccles R. Menthol and related cooling compounds J. Pharm. Pharmacol. 199446:618-630

The Invention

Understanding the mechanism of bruise development identifies possibilities for bruise amelioration and cosmetic improvement. The composition of the treatment cream applied will depend upon the status of the skin, namely immediately prior to trauma, with the bruise not yet initiated, bruise pathway initiated by trauma/insult/other, internal haemostasis achieved and bruise repair pathway progressing. In this invention a choice of bruise amelioration treatment is proposed and the treatment chosen may depend upon the state of bruise progression. If the bruise has reached equilibrium and is under repair then the optimum treatment is to displace the interstitial fluid, the blood and detritus which involves application of a skin cream the main components of which are glycerol and water, which pass through specific channels in the skin cellsfaquaporin channels) into the interstitial space and will tend to displace any blood contaminated interstitial fluid driving it to be taken up by the lymphatics and venules. The other key components of the cream are skin opacifiers designed to soften the skin and cause it to become more visually opaque so the external visible signs of bruising are reduced. Finally a silicone film former is added which when applied to the skin controls the microenvironment of the skin by reducing the skin permeability further hydrating and opacifying the skin cells as well as helping the displacement of any sub dermal fluid .

In a further development of the treatment, and for use immediately prior to or immediately post trauma, a skin cream is applied that contains a series of agents each simultaneously targeting a driver of the bruise formation and or of the elements that cause the typical appearance of the bruise site. Initially the first aim is to stop any haemorrhage and leaking of red blood cells by activation of the usual clotting mechanisms. This may be combined with an astringent and an anti-inflammatory to damp down drivers of swelling and redness along with a clot buster to inhibit clot formation or break down formed clots.

In addition to these elements if there is pain associated with the bruise this may be alleviated by the addition of menthol to the cream in a concentration of 1-2%. Menthol gives both a sensation of cooling as well as having a local anaesthetic effect. Both effects are probably driven by the effect of menthol on the movement of calcium ions influencing the thermos receptors and the nociceptors.

Combining all these components that influence different aspects of bruise development and any pain or consequent cosmetic effects can have benefits. These components potentially working synergistically with the other main components of the cream the glycerol, water and silicone film former to ameliorate the impact of trauma on initial bruise formation and spread as well as ameliorating the short and long term impact of bruise components on cosmetic appearance and pain. A typical manifestation of the creams is given in the examples below:- Example 1

Bruise MD

Amelioration Formulation Wt/Wt

%

Glycerol 52.1

Almond Oil 10

Grapeseed Oil 10

DC 593 10

Aqua 14.4

Ultrez 10 1.5

Lavender 0.3

Phenoxyethanol 1

Example 2

Bruise MD

Amelioration Formulation

+ treatment

Wt/Wt

%

Glycerol 49

Almond Oil 8

Grapeseed Oil 8

Shea butter 2

Tocopherol Vit E 2

etinyl Palmitate Vit A 2

Vitamin K 0.1

Witch Hazel 2

NAB Arnica 1

DC 593 8

Aqua 14.4

Ultrez 10 1.5

Lavender 0.3

Phenoxyethanol 1

Triethanolamine 0.7 Example 3

Bruise MD

Amelioration formulation + treatment and pain relief

%

Glycerol 58.5

Almond Oil 10

DC 593 10

Aqua 16

Ultrez 10 1.5

Phenoxyethanol 1

Triethanolamine 1

menthol 2

Total 100