From the Research
Hematohydrosis, also known as hematidrosis or blood sweating, is a rare medical condition where a person sweats blood, and the most effective treatment involves addressing the underlying cause, often extreme stress or anxiety, with beta-blockers like propranolol being a viable option, as demonstrated in a case series where patients were treated with propranolol, resulting in a marked diminish in the frequency and severity of their episodes 1.
Pathophysiology and Clinical Presentation
Hematohidrosis is characterized by the oozing or secretion of blood through intact skin and mucosa, particularly through eccrine glands, with the fluid having a bloody tinge or being frank blood, and patients generally presenting in a good state of health, as reported in a case report and review of the pathophysiology and therapeutics of adult hematohidrosis 2. The condition is often precipitated by stressful situations, and the exact mechanism involves activation of the sympathetic nervous system during extreme stress, leading to the constriction and subsequent dilation of blood vessels around sweat glands.
Treatment Options
Treatment typically involves addressing the underlying cause, which is often extreme stress or anxiety, and may include:
- Beta-blockers like propranolol (10-40mg daily) to reduce the physical manifestations of anxiety, as demonstrated in a case series where patients were treated with propranolol, resulting in a marked diminish in the frequency and severity of their episodes 1
- Anxiolytics such as diazepam (2-10mg as needed) for acute episodes
- Antidepressants like sertraline (50-200mg daily) or fluoxetine (20-80mg daily) to manage chronic anxiety
- Topical treatments with vitamin C, hemostatic agents, or atropine to reduce bleeding
- Psychological interventions, including cognitive behavioral therapy, as essential components of treatment
- Oral oxybutynin, as reported in a case of hematohidrosis of the mid-face and hands in a 13-year-old girl who was treated successfully with oral oxybutynin 3
Importance of Medical Attention
The condition is self-limiting in most cases, but medical attention should be sought immediately when it occurs to rule out other bleeding disorders or medical conditions, as reported in a case report and review of the pathophysiology and therapeutics of adult hematohidrosis 2. A thorough investigation, including bleeding time, clotting time, and prothrombin time, should be conducted to confirm the diagnosis and rule out other underlying conditions, as demonstrated in a case of hematohidrosis where the patient was diagnosed clinically by exclusion and confirmed by benzidine test, biochemical and microscopic examination of fluid 4.