Hematidrosis: blood sweat

Abstract

A n 18-year-old woman presented with a 6-month mucocutaneous bleeding from the nose, lacrimal ducts, forehead, hands, nails, and navel. Initially bleeding episodes were infrequent, but increased to several times a day by the time of evaluation. Episodes were spontaneous, self-limited, and immediately preceded by intense headache and abdominal pain. Usually high stress was also present. There was no history of previous illnesses. Physical examination showed no signs of self-inflicted lesions. All laboratory, image, and coagulation tests, including platelet aggregation, were normal. More than 30 bleeding episodes were witnessed during hospitalization and samples of the fluid contained all normal blood cells. A skin biopsy, taken immediately after bleeding, was normal. Treatment with ␤-blockers was effective. Twenty months after diagnosis the patient has only rare bleeding episodes. Hematidrosis is a rare phenomenon characterized by blood oozing from skin and mucosa. Although the pathologic mechanism remains unclear, it has been proposed that dermal defects may lead to blood-filled spaces that would exude into follicular canals or directly to the skin surface. The response to propranolol and association of stress with the bleeding episodes suggests the involvement of sympathetic nervous system activation in hematidrosis.For additional images, visit the ASH IMAGE BANK, a reference and teaching tool that is continually updated with new atlas and case study images. For more information visit

Bleeding from the eyes and through intact skin: Physiologic, structural, spiritual, or faked?

“…The bloody sweat excretion can occur in situations of stress or exertion, and can be visualized on physical examination as emanating from the hair follicles [2]. A recent report by Wang et al found only minor extravasation of red blood cells and loosening of the connective tissue on histopathology in a 13-year-old female with hematidrosis [3], and a recent case in an 18-year-old female demonstrated no anatomic anomalies [4]. In these exceedingly rare cases, the laboratory findings are reported as normal and the physical examination may reveal no obvious abnormalities in the absence of discrete bleeding events.…”

“…The most compelling factor making the diagnosis of hematidrosis less likely in Twinkle is that the initiation of the bleeding episodes was never observed by anyone other than, on several occasions, the patient's mother. Typically, in other reports of this exceptionally rare and poorly defined condition, [3,4] health care providers have directly observed the bleeding whereas in Twinkle's case, the blood was only observed in a drying form following an episode.…”

“…Other components of her treatment plan included initiation of iron supplements, strong encouragement to return to school and normal play activities, and psychological intervention to address underlying psychopathology [21]. Additionally, a trial of propranolol could have been initiated, as this was shown to be beneficial in case reports of hematidrosis [3,4].…”

Hematidrosis: a report with histological and biochemical documents

“…Hematidrosis is an extremely rare condition. The manifestations of this phenomenon consist of bloody sweat from non‐trauma of the skin and sometimes present with tear blood or bloody otorrhea . The patient has to be ruled out from other bleeding tendency conditions, which can cause spontaneous bleeding episodes.…”

Hematidrosis on the forehead following trauma: a case report

“…Hematidrosis, also known as hematohydrosis and hemidrosis, is an episodic, rare skin disease in which blood oozes from the sweat glands . Although its etiopathogenesis is not fully known, it is thought to occur in times of emotional or physical stress . We present an 11‐year‐old patient diagnosed with hematidrosis on the right side of the forehead following trauma, who responded to local adrenaline treatment.…”