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Aug 2012

Recurrent Bleeding in an 18-Year-Old Girl

Author Affiliations

Author Affiliations: Department of Dermatology, Hospital General Universitario de Alicante, Alicante, Spain.

Arch Dermatol. 2012;148(8):960-961. doi:10.1001/archdermatol.2012.1007

Hematidrosis is an extremely rare and enigmatic disorder characterized by recurrent episodes of self-limited skin bleeding that can affect almost any part of the body. Although the condition is not life-threatening, affected individuals can be stigmatized owing to religious beliefs.

An 18-year-old white woman presented with a year-long history of recurrent episodes of spontaneous bleeding lasting for a few minutes. Bleeding episodes occurred from previously healthy skin of her forehead, ears, eyelids, abdomen, and interdigital folds of both hands (Figure 1) and were related to emotional and physical stress and occasionally preceded by headache and abdominal pain. After these episodes, physical examination revealed absence of skin disruption or signs of self-inflicted lesions, even with dermoscopic examination (Figure 2). A fresh smear of the hematic exudate taken from her abdomen showed all blood elements in diluted form. The findings of a complete hematologic study were normal, and there was no evidence of internal bleeding or psychiatric abnormality. A biopsy specimen was taken immediately after interdigital fold bleeding and showed normal skin without any relevant histopathologic changes. Diagnosis of hematidrosis was made, and treatment with propranolol, 30 mg/d, was started. Frequency of the episodes decreased after starting treatment with propranolol.

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