Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Dermatol. Feb 6, 2023; 11(2): 7-29
Published online Feb 6, 2023. doi: 10.5314/wjd.v11.i2.7
Systematic review of hematidrosis: Time for clinicians to recognize this entity
Gilbert Sterling Octavius, Fellisa Meliani, Rivaldo Steven Heriyanto, Theo Audi Yanto
Gilbert Sterling Octavius, Fellisa Meliani, Rivaldo Steven Heriyanto, Theo Audi Yanto, Department of Medicine, Universitas Pelita Harapan, Tangerang 15811, Indonesia
Author contributions: Octavius GS and Yanto TA did the conception of this research; Data collections and selections are done by Octavius GS, Heriyanto RS, and Meliani F; Octavius GS, Heriyanto RS, and Meliani F drafted the article while Yanto TA did critical revision of the article; Final approval of the version to be published was granted by all authors.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Gilbert Sterling Octavius, MD, MM, Doctor, Researcher, Department of Medicine, Universitas Pelita Harapan, MH Thamrin Boulevard 1100, Klp. Dua, Kec. Klp. Dua, Kota Tangerang, Banten, Tangerang 15811, Indonesia.
Received: August 22, 2022
Peer-review started: August 22, 2022
First decision: September 27, 2022
Revised: October 12, 2022
Accepted: November 29, 2022
Article in press: November 29, 2022
Published online: February 6, 2023

Hematidrosis is a sporadic disease, to a point where its existence is still denied up to date. It is also linked to stigmata, psychological roots, and religious beliefs, whih has strengthened clinicians' disbelief in hematidrosis.


To conduct a thorough review to classify the likelihood of hematidrosis cases.


We searched PubMed, Science Direct, Medline, and Google Scholar, as well as four different preprint databases, including Medrxiv, Research Square, SSRN, and Biorxiv. We included studies from 1996 onwards, with no limitation on language. Hematidrosis was classified as "unlikely", "likely", and "highly likely".


There are 74 articles with 106 hematidrosis cases. India (n = 40) and China (n = 11) report the most cases. Patients are mostly female (76.5%) with a median age of 13 years. The head region is the most common bleeding site (n = 168/254). Headaches (26.9%) and abdominal pain (16.4%) are the most common prodromes. Beta-blockers (43%) and anxiolytic (23.2%) are the most commonly prescribed pharmacotherapy. Psychotherapy (37.5%) and counseling (32.5%) are the most utilized non-pharmacotherapy measures. Only 41.1% and 19.8% of all cases reach complete resolution and are highly likely to be hematidrosis, respectively.


Although hematidrosis is rare and the pathophysiology is still largely unknown, that does not mean hematidrosis does not exist. It is important to note that the most frequent trigger factors are either anxiety, fear, or excessive stress. Clinicians need to exclude other diagnoses and search for stressors to alleviate the bleeding.

Keywords: Hematidrosis, Bloody sweat, Stigmata, Blood

Core Tip: This is a systematic review on hematidrosis, an entity that is still mostly unknown, even to the experts. While this is not a guide to diagnose hematidrosis, this systematic review will help clinicians understand hematidrosis, the clinical pictures, the current available treatment, as well as the next steps in hematidrosis research.