Published online Feb 6, 2023. doi: 10.5314/wjd.v11.i2.7
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.
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.