Hematidrosis – Pathophysiology, Complications, and Treatment.

Description

Hematidrosis or hematohidrosis is extremely rare. Only a handful of cases have ever reported. The condition causes a person to sweat blood, often on the face or forehead, without being cut or injured. Symptoms appear as blood droplets on the skin, bloody sweat or sweat with blood in it.

One theory behind hematidrosis is that it’s linked to the body’s “fight or flight” response. The thought is that during high stress, capillaries can rupture causing blood to seep into the sweat glands and then out onto the skin. In other cases, hematidrosis may be a symptom of a medical condition like high blood pressure. If stress is a potential trigger, addressing life situations will be important. For an ongoing hematidrosis problem, blood pressure medications, antidepressants, anti-anxiety medications, or meds that help control bleeding might be considered. Anxiety caused by seeing blood on the skin and related social stigma will likely also need to be addressed to help a hematidrosis sufferer.

Pathophysiology

The pathology behind this disorder was explained by Zugibe as follows: the rich capillary plexus around the sweat glands is intensely susceptible to stress, and this results in vasoconstriction. As a consequence the blood inside is trapped and the capillaries dilate until they rupture. This blood enters the sweat gland lumen and is eventually excreted as blood-stained sweat on the skin surface. Thus the appearance of blood in the sweat is the result of severe anxiety causing sympathetic overactivation to an extreme degree.

Another hypothesis put forward by Manonukul and others is that individuals who experience hematidrosis have stromal defects in the dermis which cause weakening of the skin support. The presence of lacunae predisposes to their communication with the dermal capillaries and leads to the formation of blood-filled spaces which dilate with the inflow or blood during times of stress. The blood drains from the sinuses into the canals leading into the sweat glands or straight on to the surface of the skin, which leads to bloody sweat.

The latter is dependent on the achievement of adequate pressure within these sinuses. Following the subsidence of the stimulus, the sinuses collapse leaving no trace. However, skin biopsies taken immediately after the occurrence of hematidrosis have sometimes shown signs of such traces. These are not blood vessels, as confirmed by immunoperoxidase studies. Other studies have failed to show such features.

Another study using biopsies in patients with hematidrosis showed obstructed capillaries with bleeding into the surrounding skin, but no evidence of anatomical abnormality. This led to the suggestion of an underlying vasculitis.

Causes and risk factors

Bleeding occurs when tiny blood vessels rupture. Some blood vessels, including those near the sweat glands and in mucous membranes, are closer to the skin’s surface. This makes them more likely to rupture. It also explains why hematidrosis is more common near the nose, forehead, and other parts of the body located near sweat glands or mucous membranes.

Physical and psychological stresses are suspected of causing the condition. This theory might explain why reports on religious figures often highlight stories of bloody sweat. In biblical mythology, for example, Jesus purportedly sweats blood while praying in anticipation of his crucifixion and death. This apparently miraculous occurrence could be little more than intense stress causing blood vessels to rupture.

Although stress likely plays a role, it cannot fully explain this phenomenon. Rates of stress, anxiety disorders, and other mental health conditions have increased in recent years, yet hematidrosis has not. This suggests that other abnormalities may play a role.

People with a history of hematidrosis may have defects in the dermis, the layer of skin beneath the outer layer. This hypothetical skin defect could provide space for blood to accumulate, making it possible to sweat blood.

However, not all cases of bloody sweat are attributable to physical or emotional stress. A 2013 case study details the story of a 12-year-old girl with hematidrosis. The girl had no bleeding disorders, no apparent other medical conditions, and no history of psychological problems or stress. Each bleeding episode lasted 10-15 minutes and did not appear to upset the girl.

Doctors treated her with atropine, a drug that blocks certain functions of the involuntary nervous system. Over time, her symptoms decreased, and she received no other treatment. The underlying cause of her symptoms remains a mystery.

It is common for doctors to find no underlying cause for hematidrosis. Some other studies have found that nervous system issues may play a role in hematidrosis

Symptoms of Hematidrosis

• People who have hematidrosis may sweat blood from their skin. It usually happens on or around the face, but the skin might be lining the inside of your body, too, like in your nose, mouth, or stomach. The skin around the bloody area may swell temporarily.

• Crying tears of blood is related. It’s called hemolacria. Bleeding from the ears is called blood otorrhea.

• Hematidrosis can look like blood, bloody sweat, or sweat with droplets of blood in it. Sweating a different color — like yellow, blue, green, or black — is a different condition called chromhidrosis.
• The bleeding usually stops on its own, and it’s not serious, although it can make you dehydrated. And, of course, it can be disturbing.

Complications of Hematidrosis

• Hematidrosis rarely causes serious side effects, though some people experience dehydration and anxiety. Doctors may give additional medication to treat these symptoms.
• Psychological counseling can also help if a person with hermatidrosis has depression and anxiety.

Diagnosis

The doctor will ask you about the bleeding, including how long it lasts and when and how often it happens. They’ll talk to you about your health in general, your medical problems, and the health history of close family members. They’ll also want to know what’s going on in your life.

To try to figure out what led to the hematidrosis, they may do blood and imaging tests to look for clues and rule out other problems. You’ll probably get tests to check how well your liver and kidneys are working. You may have tests like a CT scan or ultrasound, depending on where the bleeding is.

Doctors who specialize in blood, skin, or other areas might get involved, too. They normally perform a wide variety of tests, including:

• Blood tests to see if platelet and red and white blood cell counts are normal
• Biopsies of the affected area to test for abnormal cells
• Testing for various infections
• Psychological testing
• Neurological testing, including brain scans

Treatment for Hematidrosis

If the doctor finds or suspects that something is setting the hematidrosis off, they’ll try to treat that underlying issue to prevent it from happening again. You may get:

• Beta-blockers or vitamin C to lower your blood pressure
• Antidepressants, anti-anxiety medication, or therapy to curb episodes related to high emotional stress
• Drugs to help your blood clot or stop bleeding