Copyright
©The Author(s) 2023.
World J Dermatol. Feb 6, 2023; 11(2): 7-29
Published online Feb 6, 2023. doi: 10.5314/wjd.v11.i2.7
Published online Feb 6, 2023. doi: 10.5314/wjd.v11.i2.7
Table 1 Medical subject heading terms used in each database
| Database | Medical subject heading | Number of studies found |
| PubMed | “hematidrosis”[All Fields] OR (“haematohidrosis”[All Fields] OR “hematohidrosis”[All Fields]) OR (“bloody”[All Fields] AND (“tearings”[All Fields] OR “tears”[MeSH Terms] OR “tears”[All Fields] OR “tearing”[All Fields] OR “lacrimal apparatus diseases”[MeSH Terms] OR (“lacrimal”[All Fields] AND “apparatus”[All Fields] AND “diseases”[All Fields]) OR “lacrimal apparatus diseases”[All Fields] OR “lacerations”[MeSH Terms] OR “lacerations”[All Fields])) OR (“bloody”[All Fields] AND (“sweat”[MeSH Terms] OR “sweat”[All Fields] OR “sweating”[MeSH Terms] OR “sweating”[All Fields] OR “sweats”[All Fields] OR “sweatings”[All Fields])) OR “hemolacria”[All Fields] | 203 |
| Medline | ((hemathidrosis) OR haematohidrosis) OR bloody sweat | 1057 |
| Google Scholar | allintitle: hematidrosis OR haematohidrosis OR bloody sweat | 55 |
| Science Direct | (Hematidrosis) OR (haematohidrosis) OR (bloody sweat) | 200 |
| MedRxiv | (Hematidrosis) OR (haematohidrosis) OR (bloody sweat) | 367 |
| BioRxiv | (Hematidrosis) OR (haematohidrosis) OR (bloody sweat) | 839 |
| SSRN | (Hematidrosis) OR (haematohidrosis) OR (bloody sweat) | 0 |
| Research Square | (Hematidrosis) OR (haematohidrosis) OR (bloody sweat) | 134 |
Table 2 Characteristics of hematidrosis patients
| Ref. | Patient No. | Time from onset to consultation | Triggers of bleeding | Other kinds of bleeding | Comorbidities | Bleeding frequency | Bleeding duration | Other Bleeding characteristics |
| Octavius et al[70], 2021 | #1 | One month | Not mentioned | Not mentioned | Not mentioned | Three times per day | Stopped immediately | Not mentioned |
| #2 | One month | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | |
| Bhattacharya et al[42], 2013 | #1 | One month | Not mentioned | Not mentioned | Not mentioned | > 10 times per day | Not mentioned | Not mentioned |
| Manonukul et al[43], 2008 | #1 | 1.5 yr ago | Not mentioned | Not mentioned | Not mentioned | Recurrent episodes | Not mentioned | Not mentioned |
| Murota et al[45], 2020 | #1 | A few months | Excess pressure exerted while playing on the metal bar | Not mentioned | Not mentioned | Not mentioned | Not mentioned | It did not occur during sleeping |
| Das et al[89], 2020 | #1 | Two weeks | Head trauma | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned |
| #2 | One hour | Anxiety symptoms | Anxiety | |||||
| Matsuoka et al[36], 2020 | #1 | Two years | Not mentioned | Not mentioned | Dissociative disorder and self-harming | Few times per week | Not mentioned | Bloody sweat-like fluid secretion |
| Chabchoub et al[49], 2013 | #1 | 6 mau | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned |
| Shafique et al[38], 2021 | #1 | 3 mo | Not mentioned | Rectal bleed | Significant psychosocial stress due to parental separation | 3-35 times per day | Not mentioned | Occurred during sleep and wakefulness |
| Carvalho et al[35], 2008 | #1 | November 2004 | Physical exertion, increase in room temperature | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Ceased spontaneously |
| Rossio et al[32], 2014 | #1 | Not mentioned | His family was experiencing an extremely stressful time, and his mother had just passed away | Not mentioned | Not mentioned | Not mentioned | 1-2 min | No predetermined time for recurrence |
| Gayal et al[90], 2020 | #1 | Six months | Hearing voices and anxiety | Not mentioned | Schizophrenia | 1-2 or 10-15 times per day | Not mentioned | Depending on the intensity of psychotic symptoms |
| Dragan et al[91], 2017 | #1 | Not mentioned | Not mentioned | Epistaxis, hemoptysis | Tonsillectomy, benign hypertension | Not mentioned | Not mentioned | Not mentioned |
| Alsermani et al[23], 2018 | #1 | Five months | Bullying in schools | Not mentioned | Celiac disease | Twice weekly | 1-2 min | Self-limited, usually in the evening |
| Jayaraman et al[92], 2017 | #1 | Seven days | Scolding from parents due to academic performance | Not mentioned | Mixed anxiety & depressive disorders, nocturnal enuresis | 1-2 a day | 3-5 min | Appears when punished or stressed |
| Jibbawi et al[33], 2021 | #1 | Not mentioned | Emotional stress | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Appears during stress and self-limited |
| Arakkal et al[24], 2016 | #1 | 5 mau | Extreme physical exertion | Not mentioned | Not mentioned | Not mentioned | 2-3 min | Bleeding when waking up, extreme physical activities, self-limited |
| Corrà et al[93], 2020 | #1 | Five years | Stress, anxious situation, exercise | Not mentioned | The peripheral visual deficit, non-hemorrhagic chronic gastritis, severe intestinal subocclusion | Five times daily | Few minutes | Self-limited |
| Mishra[72], 2009 | #1 | Not mentioned | Minor trauma | Hematuria, gastrointestinal bleed, epistaxis | Platelet function (PF3) dysfunction | Not mentioned | Not mentioned | Not mentioned |
| Mutanabbi et al[29], 2021 | #1 | 4 mau | Stress | Hematemesis, hematuria, epistaxis | Not mentioned | 1-2 a week | 3-5 min | Ceased spontaneously, precipitated by upcoming stress & family issues |
| Soliman et al[61], 2019 | #1 | Six months | Not mentioned | Not mentioned | Hypotension, tachycardia, syncope | Not mentioned | 30 seconds | Never at sleep and self-remitting |
| Tshifularo[94], 2013 | #1 | Not mentioned | Severe mental stresses at work, study, and home | Not mentioned | Not mentioned | 2-3 a week every 3-4 mo | 15-20 min | 2-5 ml blood-stained non-clotting discharge |
| #2 | Two years | Severe stress | Four times in 2 years (2009-2010) | Not mentioned | Blood-stained sweaty discharge, not clotting and watery | |||
| #3 | Not mentioned | Stress | Two times in 2 years (2010-2011) | Not mentioned | Painless blood-stained sweat-like discharge | |||
| #4 | Not mentioned | Severe stress at school and home | 1st episode at July 2013 | Not mentioned | Not mentioned | |||
| Meyer et al[95], 2019 | #1 | Two days | Stumbled and fell on an iron toy train (trauma) | Not mentioned | Not mentioned | Almost daily | N/A | Self-limiting, episodic. Bleeding occurred from apparently healthy and undamaged skin; no superficial injuries |
| Techasatian et al[81], 2016 | #1 | April 2014 | Not mentioned | Not mentioned | Not mentioned | > 10 times | 10-30 seconds | The time of the bleeding episode was unpredictable, not related to exertion or triggers |
| Yeşilova et al[96], 2016 | #1 | 2 d | Move from cold to a warm environment, fallen out of bed (trauma) one day before | Not mentioned | Not mentioned | 20 times in 2 d | Not mentioned | Not mentioned |
| Quentric et al[97], 2019 | #1 | Not mentioned | General anxiety related to school | Epistaxis, nipple bleed | Not mentioned | 3-4 times a day | Not mentioned | Spontaneously, mostly at night |
| Mora et al[98], 2013 | #1 | 6 mo | Stress | Not mentioned | Not mentioned | Several times a day | Not mentioned | Spontaneous, self-limited, >30 episodes during hospitalization |
| Praveen et al[99], 2012 | #1 | 3 mo | Stress (She had witnessed her elder sister being kidnapped nine months ago) | Epistaxis | Not mentioned | 2-3 times every week and had two episodes on the same day on four occasions | Not mentioned | Not mentioned |
| Hansson et al[7], 2019 | #1 | Four weeks | Not mentioned | Not mentioned | Not mentioned | 20 episodes in 4 weeks | Not mentioned | Not mentioned |
| Wang et al[44], 2014 | #1 | One month | Not mentioned | Not mentioned | Not mentioned | 2-3 times a day | Not mentioned | The bleed is described as a fresh, small amount of blood |
| Jerajani et al[41], 2009 | #1 | Two months | Continuous mental stress | Not mentioned | Depressive disorder | Not mentioned | Not mentioned | Not mentioned |
| Lipsitt et al[100], 2018 | #1 | 9 mo | Extreme emotional stress, excitement, or physical exertion | Not mentioned | Depression, anxiety, PTSD, non-epileptiform seizure | Seven times a day | Not mentioned | Progressive, episodic |
| Bhagwat et al[101], 2009 | #1 | Two years | Trauma (witnessing a woman beheaded), Feeling anxious | None | Severe depression | 1-2 a day | 15-20 min | Episodic |
| Sue Tin et al[40], 2015 | #1 | Three weeks | No obvious trigger | Not mentioned | Not mentioned | 20 times a day | Not mentioned | Spontaneous, worse during warmer months |
| Pari[102], 2018 | #1 | Five days | Without any provoking factor | Not mentioned | Not mentioned | 2-3 a day | 30 min | Not mentioned |
| Patel et al[79], 2010 | #1 | Sincmaury 2007 | Not mentioned | Not mentioned | Not mentioned | Once-daily | 1 minute | Spontaenous, during school hours 9-11 am |
| Biswas et al[76], 2013 | #1 | Two years | Not mentioned | Not mentioned | An intelligent quotient (IQ) of 60-70 with a loss of insight | 1-2x daily | 10-15 min | Episodic, more frequent when waking up in the morning |
| Jafar et al[69], 2016 | #1 | Two weeks | Not mentioned | Epistaxis | Repeated faint attacks two years ago | Not mentioned | 10-20 min | It was spontaneous, unpredictable, and intermittent, with no specific patterns, and it stopped spontaneously. |
| Wang et al[103], 2010 | #1 | 3 yr | Emotional excitement | Not mentioned | Not mentioned | > 20 times during hospitalization | Not mentioned | It always occurred during the middle of the day, never when sleeping at night |
| Thigarajan[83], 2019 | #1 | Three days | Stress fr’m father's demand on academics | Not mentioned | Primary enuresis, head tonsure, and trivial head trauma in a different location to the bleed | Not mentioned | Few seconds to a few minutes | Self-limited |
| Khalid et al[82], 2013 | #1 | Five years | Emotional stress | None | None | Not mentioned | Not mentioned | Not mentioned |
| Maglie et al[104], 2017 | #1 | Three years | Not mentioned | Not mentioned | Major depressive disorder and panic disorder | Not mentioned | 1-5 min | Could occur in sleep or during physical activity & more intense bleeding occurs during emotional stress |
| Uber et al[71], 2015 | #1 | 6 yr | Not mentioned | Not mentioned | Conversion, dissociative, and generalized anxiety disorder, high peak blood pressure | Not mentioned | Few minutes | Spontaneous, sometimes occur during sleep, coincidental with high blood pressure peak |
| Salas-Alanis et al[37], 2021 | #1 | Not mentioned | Acute emotional distress | Not mentioned | Not mentioned | Numerous | 3-25 min | From 6 years old, all following emotional distress |
| Talwar et al[80], 2021 | #1 | One year | Separation from his aunt | Epistaxis, hematuria, hematochezia | Adjustment disorder | Once per week | A few minutes | It can occur during sleep |
| Chowdhury et al[105], 2019 | #1 | Two years | Migraine | Epistaxis, previous cesarean scar, menorrhagia | Migraine | Not mentioned | Not mentioned | Associated with headache, her son also had hematidrosis |
| Das et al[89], 2016 | #1 | 5 mo | Not mentioned | None | Otitis externa | Not mentioned | Not mentioned | More frequent on 06:00 A.M. |
| Hossain et al[77], 2018 | #1 | One and a half years | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned |
| #2 | Last two months | Not mentioned | Not mentioned | Repeated episodes of stiffening of limbs with associated self-muttering | Not mentioned | Not mentioned | Not mentioned | |
| #3 | Six months | Not mentioned | Not mentioned | Acute anxiety state, repeated episodes of unresponsiveness and conduct disorder | Not mentioned | Not mentioned | Not mentioned | |
| Thao et al[39], 2019 | #1 | One month | Marriage | Not mentioned | Continuous mental stress | Not mentioned | Not mentioned | Not mentioned |
| Récher[31], 2021 | #1 | Not mentioned | COVID-19 containment induced stress | Not mentioned | Not mentioned | Not mentioned | Not mentioned | A vascular pathway remains after 24 hours of bleeding |
| Omar[30], 2018 | #1 | Not mentioned | Stress | Not mentioned | Not mentioned | Occured in bouts | Not mentioned | Not mentioned |
| Tirthani et al[86], 2021 | #1 | Three months | Loss of parents | Not mentioned | Recurrent panic attacks with tachycardia | Not mentioned | 2-3 min | Not mentioned |
| Ricci et al[106], 2018 | #1 | Three months | Major stressful event from an earthquake | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned |
| Bezner et al[25], 2013 | #1 | Two years | Not mentioned | Hematuria | Heavy and irregular menstrual bleed | Up to 20 daily | Not mentioned | The bleeding episodesreportedly decreased during her menstrual period, which typically lasted for approximately ten days |
| Mahamat Abderraman et al[50], 2019 | #1 | Five years ago | Not mentioned | History of hematuria, epistaxis, | Moderate anxiety-depressive disorder, acute urine retention, seizure, genu flexum | Not mentioned | 10 min | Not mentioned |
| Rharrabti et al[51], 2016 | #1 | Not mentioned | Family abuse, parental conflicts | Vulvar bleeding | Conversion disorder. primary enuresis | Not mentioned | Not mentioned | Mostly at day, worsening during parental conflicts |
| Morillo et al[52], 2019 | #1 | Seven months | Not mentioned | Not mentioned | Bronchial asthma, previous history of abortion | Not mentioned | Not mentioned | Not mentioned |
| Kumar et al[78], 2021 | #1 | Not mentioned | Afraid, stress (during exams), anxiety | Not mentioned | High-grade anxiety | Not mentioned | Not mentioned | Spontaneous and recurrent (4-5 times in three days) |
| Camargo et al[53], 2020 | #1 | Four years | Stress and anxiety | Hematuria | Not mentioned | 2-3 times a week | Not mentioned | Sporadic occurrence |
| Shen et al[107], 2015 | #1 | Six months | Not mentioned | Not mentioned | Tonic seizures | 1x every few days | 1-2 min | Spontaneous, transient, self-limited |
| Shahriari et al[108], 2020 | #1 | Six months | Going to the toilet or feeling lonely | Not mentioned | Not mentioned | Every two weeks | Not mentioned | Not mentioned |
| #2 | Not mentioned | Not mentioned | Epistaxis | Not mentioned | Every three weeks | Not mentioned | Not mentioned | |
| #3 | Not mentioned | Fighting with her younger sister without any skin damage | Not mentioned | A history of aggression | Not mentioned | Not mentioned | Not mentioned | |
| Badry et al[27], 2020 | #1 | One month | Stress | Hematemesis | Depression | 3-5 per week | A few minutes | Not mentioned |
| Hoover et al[54], 2019 | #1 | Almost more than seven years | Illness (malaria) or distress | Hematemesis, hematochezia, hematuria | Previous history of treated malaria, human immunodeficiency virus(HIV) and hepatitis B due to blood transfusions | Not mentioned | Not mentioned | Not mentioned |
| #2 | Not mentioned | Irritability and crying | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | |
| Latorre Martinez et al[109], 2012 | #1 | One year | Stress | Not mentioned | Not mentioned | Not mentioned | A few minutes | Not mentioned |
| Kleymenova et al[47], 20201 | #1 | Not mentioned | Weather, stress | Epistaxis | Menstruation problems | Not mentioned | Not mentioned | Not mentioned |
| Rani et al[84], 2018 | #1 | Not mentioned | Autonomic dysfunction | Hematuria | Autonomic dysfunction | Not mentioned | Not mentioned | Not mentioned |
| #2 | Autonomic dysfunction | Not mentioned | Spontaneous skin breaches resembling incision | |||||
| #3 | Emotional & Psychological stressors | Not mentioned | Not mentioned | |||||
| #4 | Emotional & Psychological stressors | Not mentioned | Not mentioned | |||||
| #5 | Emotional & Psychological stressors | Not mentioned | Not mentioned | |||||
| #6 | Emotional & Psychological stressors | Not mentioned | Not mentioned | |||||
| Wang et al[110], 2021 | #1 | One year | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned |
| #2 | Four months | Not mentioned | Hematemesis | Not mentioned | Once every few days to dozens of times a day | Several minutes | Not mentioned | |
| #3 | Five months | Carsickness | Hematuria | Canker sores | Up to 60 times a day | Several minutes | Not mentioned | |
| #4 | Nine months | Anxiety or nervousness, hemolacria induced by intense light | Hematemesis, hematuria | Tonic-clonic seizures | Once every few days to dozens of times a day | Several minutes | Not mentioned | |
| #5 | Two months | Not mentioned | Not mentioned | Not mentioned | Once every few days to dozens of times a day | Several minutes | Not mentioned | |
| #6 | Four years | Military training, minor emotional stress, or even during studying | Not mentioned | Not mentioned | Once every few days to dozens of times a day | Several minutes | Not mentioned | |
| #7 | Six months | Not mentioned | Not mentioned | Not mentioned | Once every few days to dozens of times a day | Several minutes | Not mentioned | |
| Malik et al[34], 2019 | #1 | 6-8 yr | Emotional stress | History of hemolacria | Gestational hypertension (after lost to follow up) | Not mentioned | Not mentioned | Bleeding started 6-8 years ago |
| #2 | Not mentioned | Periods of rage and stress | Epistaxis | Not mentioned | Not mentioned | Not mentioned | Unprovoked, self-limited, and not triggered | |
| Shahgholi[75], 2018 | #1 | Several months | Extreme physical or emotional stress | Hematemesis | Not mentioned | Once or twice a day | 10-15 min | Sometimes occurred spontaneously during sleep, subsided as soon as it is wiped |
| #2 | Not mentioned | Upcoming exam, playing a computer game, watching fiction TV movies or when parents not satisfying his demands | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | |
| #3 | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | 5 min | Spontaneous, unpredictable, and intermittent | |
| Jagannathan et al[111], 2016 | #1 | Not mentioned | Mental stress | Epistaxis | Not mentioned | Not mentioned | Not mentioned | Not mentioned |
| #2 | Not mentioned | |||||||
| #3 | Not mentioned | |||||||
| #4 | Not mentioned | |||||||
| #5 | Not mentioned | |||||||
| #6 | Not mentioned | |||||||
| #7 | Not mentioned | |||||||
| #8 | Hematemesis | |||||||
| Agarwal et al[28], 2017 | #1 | One month | Not mentioned | Not mentioned | Not mentioned | Not mentioned | 10 seconds | Self-limited, during the day |
| Deshpande et al[112], 2014 | #1 | Since February 2013 (around more than one year ago) | Upcoming exams, fight with parents, and parents not satisfying his demands | Hemoptysis, hematuria, epistaxis, hematochezia, hematemesis | Oppositional defiant disorder | Not mentioned | Not mentioned | Not mentioned |
| Zhang et al[16], 2004 | #1 | Four months | Not mentioned | Hematemesis | A previous diagnosis of Henoch-schonlein purpura | Several times a day or once every 3-5 d | Lasts seconds | The bleeding can occur during sleep |
| Kumar et al[78], 2019 | #1 | One year ago | Suspected fear and anxiety of his lecturer | Not mentioned | Not mentioned | Three episodes per day to 20 episodes per month | Not mentioned | Not mentioned |
| #2 | Three months ago | Fearful dreams | Not mentioned | Not mentioned | > 5 episodes per day | Not mentioned | Episodes are not coinciding with dreams but occur after the event at night without any triggering factor in the day times as observed by parents at home and the hospital | |
| Karpukhina et al[48], 2020 | #1 | One month ago | Not mentioned | Epistaxis | High anxiety, neurotic behaviour, and depression | Not mentioned | A few minutes | Not mentioned |
Table 3 Demographics of patients with hematidrosis
| Variables | N (%) |
| Sex (n = 102) | |
| Male | 24 (23.5) |
| Female | 78 (76.5) |
| Age in years (n = 94) (Median - range) | 13 (0.17-72) |
| Prodromes1 | |
| Headache | 18 (26.9) |
| Dizziness | 3 (4.5) |
| Abdominal pain | 11 (16.4) |
| Nausea | 4 (6.0) |
| Vomiting | 4 (6.0) |
| Tingling | 5 (7.5) |
| Photophobia | 2 (3.0) |
| Phonophobia | 2 (3.0) |
| Pain | 3 (4.5) |
| Soreness | 4 (6.0) |
| Asthenia | 3 (4.5) |
| Easily irritable | 2 (3.0) |
| Others | 6 (8.7) |
| Presence of hemolacria | 34 (32.1) |
| Types of journals | |
| Case report | 4 (5.4) |
| Dermatology | 19 (25.7) |
| Otorhinolaryngology | 4 (5.4) |
| General or internal medicine | 17 (23.0) |
| Hematology and oncology | 9 (12.2) |
| Pediatric (including pediatric hematology and oncology) | 15 (20.3) |
| Pharmacy | 1 (1.3) |
| Preprint (Research Square) | 1 (1.3) |
| Psychiatry | 3 (4.1) |
| Reproductive health | 1 (1.3) |
| Healthcare professionals witness the bleeding episodes | |
| Yes | 69 (65.1) |
| No | 25 (23.6) |
| Not explicitly mentioned | 12 (11.3) |
| Family members witness the bleeding episodes | |
| Yes | 50 (47.2) |
| No | 6 (5.6) |
| Not explicitly mentioned | 50 (47.2) |
| Provided bleeding pictures | 85 (80.2) |
| Laboratory tests done | 100 (94.3) |
| Radiologic and/or other tests done | 41 (38.7) |
| Normal results from all the diagnostic tests done | 92 (86.8) |
| Skin biopsies done | 30 (28.3) |
| Normal or non-specific | 19 (63.3) |
| Analyzed the blood from the bleeding site | 71 (67.0) |
| Doctors involved in the case1 | |
| Otolaryngologist | 25 (16.6) |
| Ophthalmologist | 6 (4) |
| Obstetrics and gynaecologist | 3 (2) |
| Psychiatrist | 29 (19.3) |
| Primary care | 4 (2.7) |
| Pediatrics | 31 (20.5) |
| Internal medicine | 19 (12.8) |
| Dermatologist | 25 (16.6) |
| Vascular surgeon | 1 (0.7) |
| Neurologist | 7 (4.8) |
| Tried to exclude other diagnoses | 90 (84.9) |
| Pharmacotherapy2 | |
| Beta-blockers | 65 (43.0) |
| Anxiolytic | 35 (23.2) |
| Antidepressants | 10 (6.6) |
| Atropine patches | 2 (1.3) |
| Drops of adrenaline with gauze | 1 (0.7) |
| Ascorbic acids | 6 (4.0) |
| Antifibrinolytic agents | 2 (1.3) |
| Antihistamine receptor blockers | 6 (4.0) |
| Hemostatics | 2 (1.3) |
| Others | 22 (14.6) |
| Psychosocial therapy2 | |
| Psychotherapy | 15 (37.5) |
| Behavioural therapy | 6 (15) |
| Relaxation technique | 6 (15) |
| Counseling | 13 (32.5) |
| Outcome (n = 90) | |
| Complete resolution | 37 (41.1) |
| Time taken for complete resolution in days (median) (n = 26) | 60 (2-730) |
| Improvement of symptoms | 37 (41.1) |
| Time taken for improvement of symptoms in days (median) (n = 19) | 28 (10-720) |
| Relapse | 8 (8.9) |
| Time taken for relapse in days (mean) (n = 6) | 60 (53.4) |
| Spontaneous resolution | 4 (4.4) |
| The patient is still under follow up | 1 (1.1) |
| Loss to follow up | 3 (3.3) |
| Possibilities of hematidrosis | |
| Highly likely | 21 (19.8) |
| Likely | 58 (54.7) |
| Unlikely | 27 (25.5) |
Table 4 Differential diagnosis of hematidrosis
| Hematologic disorders (Bezner et al[25], 2013; Peretz et al[68], 2016) |
| Acquired disorder of hemostatic mechanism |
| A hereditary disorder of hemostatic mechanism |
| Infection (Jirka, 1968; Peretz et al[68], 2016) |
| Chromobacterium prodigiosum |
| Micrococcus castellani |
| Disorders of vascular integrity (Bezner et al[25], 2013; Peretz et al[68], 2016) |
| Vasculitis |
| Amyloidosis |
| Connective tissue disorders |
| Gynecologic disorders (Bezner et al[25], 2013) |
| Ectopic endometriosis |
| Pathologic processes causing an acute increase in intracranial pressure |
| Cerebral venous thrombosis |
| Subarachnoid hemorrhage |
| Valsalva maneuver |
| Drugs (Girolami et al[74], 2014; Peretz et al[68], 2016) |
| Antiplatelets such as non-steroidal anti-inflammatory drugs |
| Anticoagulants |
| Glucocorticoids |
| Antidepressants (e.g. selective serotonin reuptake inhibitors) |
| Antiepiletics (e.g. topiramate) |
| Antibiotics |
| Chemotherapeutic agents |
| Intoxication with lysergic acid diethylamide (LSD) |
| Herbal supplement (e.g. Gingko Biloba) |
| Trauma (Meyer et al[95], 2019; Peretz et al[68], 2016; Rani et al[84], 2018; Yeşilova et al[96], 2017; Zhang et al[16], 2004) |
| Sleep disorders (parasomnia) (Peretz et al[68], 2016) |
| Psychiatric disorders (Bezner et al[25], 2013; Karpukhina et al[48], 2020; Peretz et al[68], 2016) |
| Factitious disorder/factitious disorder by proxy |
| Psychogenic purpura |
| "Artistic bleeding" |
| Religious stigmata or culture-bound phenomenon (Bezner et al[25], 2013; Girolami et al[74], 2014) |
| Sweat gland disorders (e.g. chromhidrosis) (Jerajani et al[41], 2009) |
- Citation: Octavius GS, Meliani F, Heriyanto RS, Yanto TA. Systematic review of hematidrosis: Time for clinicians to recognize this entity. World J Dermatol 2023; 11(2): 7-29
- URL: https://www.wjgnet.com/2218-6190/full/v11/i2/7.htm
- DOI: https://dx.doi.org/10.5314/wjd.v11.i2.7