Efficacy of beta-blockers in the treatment of hematidrosis: A systematic review

Abstract

BACKGROUND

Hematidrosis is an extremely rare and enigmatic condition characterized by spontaneous bleeding through intact skin or mucosa, typically occurring in response to severe emotional stress. Although its exact pathophysiology remains unclear, the condition is thought to involve sympathetic nervous system overactivation and capillary fragility, leading to blood extravasation via sweat glands or hair follicles.

AIM

To evaluate the efficacy and safety of beta-blockers, particularly propranolol, in the management of hematidrosis.

METHODS

A systematic literature search was conducted in January 2024 across six major databases to identify studies published between 2014 and 2024 that reported the use of beta-blockers in patients with hematidrosis. Eligible studies included clinical case reports or case series that described beta-blocker treatment outcomes. Data were synthesized narratively in accordance with the PRISMA 2020 guidelines.

RESULTS

Twenty studies met the inclusion criteria. Among them, propranolol was the most frequently prescribed beta-blocker and was associated with symptomatic improvement in over 75% of cases. Some studies also reported enhanced outcomes when beta-blockers were used in conjunction with psychotherapy. Reported adverse effects were minimal, and treatment was generally well-tolerated. However, the available evidence remains limited to low-level observational data, mostly case reports and small case series.

CONCLUSION

Beta-blockers, especially propranolol, appear to be an effective and well-tolerated treatment option for hematidrosis, particularly in stress-induced presentations. Despite promising findings, the evidence base is constrained by the lack of high-quality studies. Future research should focus on prospective, controlled trials to establish standardized diagnostic and treatment protocols for this rare condition.

Keywords: Hematidrosis; Beta-blockers; Propranolol; Adrenergic inhibition; Psychogenic bleeding; Stress-related disorders; Sympathetic overactivation

Core Tip: Hematidrosis is an extremely rare condition characterized by spontaneous bleeding through intact skin, often triggered by emotional stress. This systematic review evaluates the efficacy and safety of beta-blockers, particularly propranolol, in managing hematidrosis. The findings indicate that propranolol can significantly reduce symptom frequency and severity, especially when combined with psychotherapy. By focusing solely on clinical studies involving beta-blocker use, this review bridges a critical gap in the literature and highlights the need for standardized treatment protocols and controlled clinical trials. The results support a multidisciplinary approach targeting both physiological and psychological triggers.