University Journal of Surgery and Surgical Specialities

ISSN 2455-2860 2019, Vol. 5(3)

HEMATIDROSIS MADHAN KUMAR K Department of CHILD HEALTH, MADRAS MEDICAL COLLEGE AND GOVERNMENT GENERAL HOSPITAL

Abstract : Hematidrosis is an extremely rare clinical entity she had more than 5-6 instances of spontaneous intermittent characterized by recurrent episodes of skin bleeding mixed bleeding per day that was visualised by almost all of our ward with sweat1.we report a case of Hematidrosis in a 11 year old doctors and nurses. Her medical records were non contributory girl who presented with spontaneous bleed from forehead not with no known underlying disease. Her development was normal associated with trauma bleeding was visualized during with normal tanners staging and according to the mother ,the girl hospital stay and examination of secreation confirmed it to be had an episode of vaginal bleed for one day 3 months back and blood with cellular elements. This girl was successfully treated she had not attained menarche yet.. Her complete blood count, with propranolol . blood chemistry, platelet aggregation, bleeding time, coagulation Keyword :Hematidrosis, propranolol, hemato screening all within normal limits3. Microscopic examination of folliculohidrosis ,skin bleed ,hematohidrosis. blood exudates from face revealed the same components of peripheral blood including red blood cells, leukocyte sand platelets mixe d with epithelial cells. Benzidine test was done on the collected blood secreation which turned to blue in colour further confirming the presence of heme. The girl was started on propranolol 10 mg twice a day and the frequency of episodes gradually got reduced. DISCUSSION Hematidrosis is an extremely rare and enigmatic disorder which may sometimes lead to stigmatization of the patients because of Child with Hematidrosis religious belief. It is a condition in which capillary blood vessels INTRODUCTION that feed the sweat glands rupture causing them to exude blood. Hematidrosis is a extremely rare and enigmatic disorder The term hemato folliculohidrosis has been proposed because it characterized by recurrent episodes of self limited bleeding appears along with sweat like fluid and blood exudes via the from skin1. In this situation , the authenticity of most cases follicular canals. Underlying pathogenesis is that, under exteme remain question because of self inflicted trauma and psychological stress the sympathetic system gets chromhidrosis ( excretion of sweat containing colored activated ,resulting in hemorrhage of vessels (capillaries) pigments ) which should be excluded.. Acute fear and supplying the sweat gland causing entry of blood through sweat extreme level of stress were found to be the most common ducts finally resulting in bloody sweat4 Diagnosis is made by inciting causes, but it may also appear intermittently without documenting recurrent bleeding that is witnessed by medical obvious precipitating factors3. We report a case of personnel and by identifying peripheral blood exudate from intact Hematidrosis diagnosed and treated successfully. skin in order to rule out bleeding from self injury and CASE REPORT chromhidrosis. Other differential diagnosis should be considered A 11 year old girl came to the hospital with complaints of from chromhidrosis to a variety of hemorrhagic disorder. recurrent episodes of spontaneous bleeding from forehead Laboratory investigation of hemostatic functions is helpful to and Buccal mucosa for past 1 month, 2-3 episodes per day. detect hemorrhagic disorder. In medical literature there are only The bleeding was spontaneous from forehead lasted for three papers describing histopathological analysis in patients seconds to minutes. The consistency of bleeding was little with Hematidrosis. thinner than blood and stopped as soon as the site was mopped leaving behind no oozing site. During hospitalization

An Initiative of The Tamil Nadu Dr. M.G.R. Medical University University Journal of Surgery and Surgical Specialities

To date, no particular treatment has been identified for this disorder. Administration of vitamin c and General hemostatic drugs has not prove to be efficacious. Manonukal et al administered lorazepam , an anxiolytic to a patient to reduce her anxiety state and got an unexpected result2. However our patient was not responsive to anxiolytic diazepam. In most patients reported recurrent bleeding episodes were a consequence of intense emotional excitement of severe fear. Therefore we speculated that sympathetic nerve activation might play a role in these episodes and prescribed our patient propranolol which regulates sympathetic nerve function. Hematidrosis is a rare and mystical disorder very little known about its etiology, histopathology or its mechanism. Although the bleeding phenomenon is frightening it seems not affect the general state of health. Our results suggest sympathetic nerve activation might be involved in bleeding episodes. Beta adreno receptor antagonist could be used as effective treatment but therapy should be tailored for individual patients. REFERENCE: 1.Holoubek JE, Holoubek AB. Blood, sweat and fear. A classification of hematidrosis. J Med 1996;27:115-33. 2.Manonukul J, Wisuthsarewong W, Chantorn R, Vongirad A, Omeapinyan P. Hematidrosis: A pathologic process or stigmata. A case report with comprehensive histopathologic and immunoperoxidase studies. Am J Dermatopathol 2008;30:135-9. 3.Zhaoyue W, Ziqiang Yu ,Jian S ,Lijuan C ,Xiaojuan Z, Xia B ,et al . A case of hematidrosis successfully treated with propranolal .Am J Clin Dermatol.2010;11:440-3 4.Jerajani HR, Jaju B, Phiske MM, Lade N. Hematohidrosis - A rare clinical phenomenon. Indian J Dermatol 2009;54:290-2. 5.Zhang FK, Zheng YL, Liu JH, Chen HS, Liu SH, Xu MQ, et al. Clinical and laboratory study of a case of hematidrosis. Zhonghua Xue Ye Xue Za Zhi 2004;25:147-50.

An Initiative of The Tamil Nadu Dr. M.G.R. Medical University University Journal of Surgery and Surgical Specialities