Diagnosis and treatment of children with rare hemhidrosis and pediatrician's care experience: a case report

Diagnosis and treatment of children with rare hemhidrosis and pediatrician's care experience: a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Diagnosis and treatment of children with rare hemhidrosis and pediatrician's care experience: a case report Shasha Guo, Changxing Cao, Qiulin Liang, Chao Feng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8308429/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Hematidrosis is a rare medical phenomenon referring to the excretion of blood or blood components (e.g., hemoglobin) from the body through sweat glands, causing the sweat to appear red, pink, or rust-colored. It is often accompanied by intact skin and no bleeding tendency, and must be distinguished from sweat contaminated by skin contact with dyes, food pigments, or local bleeding. Case Report: We depicted a 9-year-old girl who had previously been healthy, experiencing a 1-month period of bleeding in the right tragus and cheek without an apparent cause. The frequency of bleeding increased with activity, and the bleeding skin was intact. Moreover, she was diagnosed with hemhidrosis. Simultaneously, psychological evaluation was conducted to rule out psychological diseases including anxiety, depression, and school bullying and intimidation. Following propranolol was given to the patient, the effect was poor, and subsequently, Yupingfeng granule was added for treatment, and the patient's bleeding condition was considerably controlled. Conclusion: Following a three-month treatment regimen, the patient's symptoms subsided. The combination of Propranolol and Yupingfeng granules demonstrates both safety and efficacy in treating pediatric patients with hemhidrosis, offering a novel approach for pediatricians to consider. Hematidrosis Skin hemorrhage Vascular disease Spontaneous disease Figures Figure 1 Figure 2 Introduction Hematidrosis is an extremely rare and enigmatic disorder characterized by recurrent episodes of self-limited bleeding from the intact skin and mucous membranes in the absence of a bleeding problem [ 1 ] . It is typically classified as an endocrine system disorder of sweat secretion, and according to current literature, 83% of the cases were observed in individuals aged 18 years or younger, suggesting a potential association with hormonal secretion during puberty. The outcome was favorable in most of the cases with medical treatment (e.g., beta-blocker, anxiolytics) as well as psychological support. Furthermore, the number of cases has increased in recent years. Hematidrosis appears to be a somatization disorder that predominantly affects children from developing countries. Its physiopathology remains largely unknown. It deserves better recognition due to the fact that it is typically a temporary condition on the condition that is managed properly [2.3] .Recently, we encountered a case of a child with hemhidrosis successfully cured by Western medicine combined with Chinese patent medicine, and it is reported below. Case Report A 9-year-old girl was admitted to the hospital due to recurrent red fluid in the right auricle for over a month, 4–5 times/day. She was diagnosed with "right ear bleeding" in the other hospital and was given drug treatment, with poor effect. The physical examination revealed that the skin color of the right tragus and auricle appeared normal, with no signs of skin defects. During bleeding, red fluid was seen in the front of the right tragus, the right auricle, as well as the right face, with an amount of about 3ml/ time, and the amount of red fluid was not substantially increased after extrusion. The patient's skin was intact following wiping and cleaning, and no skin defect occurred at night (Fig. 1 ). Blood coagulation function was normal, coagulation factor (reference normal values were 70–120%): factor Ⅱ: 76.7%; V factor: 97.6%; Factor Ⅶ: 70.5%; X factor: 68.2%; Factor Ⅷ: 132.3%; Factor IX: 66.0%; Factor XI: 103.2%; X factor: 67.8%. The electrocardiogram demonstrated a heart rate of 84bmp and sinus arrhythmia. Color Doppler echocardiography indicated normal cardiac structure and left ventricular diastolic function. The measurements of left ventricular systolic function were within normal limits. The patient's psychological evaluation yielded no concerns. However, despite the initial treatment with oral propranolol hydrochloride 10 mg twice daily, the therapeutic effect was unsatisfactory, based on taking propranolol hydrochloride plus Yupingfeng granules 5g orally three times a day, Yupingfeng granules fixed sweat, convergence, the patient's ear bleeding frequency is considerably lower than before. Following one month of continuous treatment, upon 3 months of follow-up, the bleeding disappeared. The patient had a reduction in bleeding from the right ear and face after treatment (Fig. 2 ). Discussion Hematidrosis is a condition with an unknown mechanism, marked by the secretion of blood-like fluid from intact skin and mucous membranes without any apparent skin injury. It primarily affects young girls aged 9 to 153years. It can occur on any part of the body, from the scalp to the toes, and yet mainly affects the face (especially the forehead), upper limbs (palms), and umbilicals. It predominantly occurred during the day and rarely occurred at night [ 4 ] . The diagnosis of Hematidrosis requires a thorough investigation of blood system-related diseases. It is essential to carefully examine the skin to rule out self-inflicted or secondary injuries (e.g., potentially pointing to Munchausen’s syndrome or Munchausen’s by proxy) and to likewise differentiate this entity from chromhidrosis (color pigment in sweat), vasculitis, scurvy, or other connective tissue disorders (where vascular fragility can result in easy bleeding) [ 5 ] . Its diagnosis must meet two important features: (1) excellent skin integrity without damage; (2) The spontaneous outflow of fluid from the skin surface contains red blood cells or white blood cells and other blood components [ 6 ] . Current considerations include autonomic nerve dysfunction, which may result in increased susceptibility to rupture or heightened vascular permeability in sweat glands. Additionally, heightened psychological trauma or fear can lead to increased capillary permeability in the body. Manonukul et al opined that stromal weakness may occur due to defects in the dermis. The communication of these defects with vascular spaces in the dermis will result in their dilatation and enlargement as the blood centers. Whenever the internal positive pressure within these areas reaches a sufficient level, blood will seep through follicular canals or directly onto the skin surface. Subsequently, they will collapse, leaving behind no scar. This phenomenon which acts like a balloon will wax and wane and thus explains why these bleoperations are intermittent and self-limiting [ 7 , 8 ] . The etiology proposed by Manonukul et al is more consistent with the histology results of normal skin or dermal defects filled with blood as observed in our patient and other patients in the literature [ 9 , 10 ] . Treatment of Hematidrosis consists primarily of oral beta-adrenoceptor blockers (propranolol), anxiolytic medications, and antidepressants [ 11 ] . Besides, topical treatments including atropine patches or drops of epinephrine gauze constrict the vessels. There are also psychotherapy, counseling, or relaxation therapies, which can be employed alone or in combination with medication;Some patients heal without specific treatment [ 12 , 13 ] . In this instance, we initially administered oral propranolol at a dosage of 10mg twice daily to the patient. While there was a slight improvement in the patient's bleeding compared to before, the relief was not particularly significant. Subsequently, we gave the Yupingfeng granule 5g orally three times a day, and the patient's ear bleeding was significantly improved. Moreover, Yupingfeng granule is composed of astragalus membranaceus, Atractylodes rhizoma (fried), and wind. It can benefit qi, solid surface, antiperspirant; For surface, deficiency is not solid, from sweat evil wind, white face, or body deficiency susceptible to wind evil. Conclusion Hyperhidrosis is a rare and complex disease. It is essential to improve the awareness of early detection and diagnosis of the disease and to adopt individualized treatment strategies on the basis of the etiology. For the purpose of providing a scientific and effective judgment basis for pediatric clinicians, focus on identifying the potential psychological and social pressure factors of children, eliminate artificial obstacles, as well as diagnose hematoma as soon as possible, to reduce invasive surgery and unnecessary drug treatment, and reduce part of the economic cost of children. Additionally, it is necessary to conduct basic and clinical research on hemorheohidrosis. Declarations Patient Consent Statement Written informed consent was obtained from the patient’s parents for publication of this case report and accompanying images. Funding: No funding was received for this work. Consent to Participate: Not applicable. Consent for Publication: Written informed consent for the use of clinical images was obtained from all the patients' legal representatives prior to the study initiation. Conflict of Interest: The authors declare no conflict of interest. Ethical Approval: Ethical approval was not required for this case report as per institutional guidelines. References Shafique DA, Hickman AW, Thorne A, Elwood HR, Zlotoff BJ. Pediatric hematidrosis - A case report and review of the literature and pathogenesis. Pediatr Dermatol. 2021;38(5):994-1003. doi:10.1111/pde.14792 Hoover A, Fustino N, Sparks AO, Rokes C. Sweating blood: a case series of 2 siblings with hematohidrosis. J Pediatr Hematol Oncol. 2021;43(2):70-72. doi:10.1097/MPH.0000000000001661 Alsermani M, Alzahrani H, El Fakih R. Hematidrosis: a fascinating phenomenon-case study and overview of the literature. Semin Thromb Hemost. 2018;44(3):293-295. doi:10.1055/s-0037-1608905 Shafique DA, Hickman AW, Thorne A, Elwood HR, Zlotoff BJ. Pediatric hematidrosis - A case report and review of the literature and pathogenesis. Pediatr Dermatol. 2021;38(5):994-1003. doi:10.1111/pde.14792 Kluger N. Hematidrosis (bloody sweat): a review of the recent literature (1996-2016). Acta Dermatovenerol Alp Pannonica Adriat. 2018;27(2):85-90. Murota H, Kotobuki Y, Yamaga K, Yoshioka Y. Female child with hematidrosis of the palm: Case report and published work review. J Dermatol. 2020;47(2):166-168. doi:10.1111/1346-8138.15179 Jerajani HR, Jaju B, Phiske MM, Lade N. Hematohidrosis-A rare clinical phenomenon. Indian J Dermatol. 2009;54:290–2 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； Sha Y, Yoshimura H, Saito S, Kitoh R, Takumi Y. A case of hematohidrosis successfully treated with a beta-blocker. Clin Case Rep. 2023;11(6):e7337. Published 2023 May 28. doi:10.1002/ccr3.7337. Wang Z, Yu Z, Su J, et al A case of hematidrosis successfully treated with propranolol. Am J Clin Dermatol. 2010;11(6):440-443.doi:10.2165/11531690-000000000-00000 Praveen BK, Vincent J. Hematidrosis and hemolacria: a case report. Indian J Pediatr. 2012;79(1):109-111. doi:10.1007/s12098-011-0449-2 Meyer J, Spacil K, Stehr M, Hinrichs W, Haller S, Schäfer FM. Hematidrosis After Head Injury - A Case Report. Hämhidrose nach Schädelhirntrauma – Ein Fallbericht. Klin Padiatr. 2019;231(6):326-327. doi:10.1055/a-1005-7328 Biswas D, Mondal DK, Biswas R, Halder A. Hematidrosis: A rare entity - case series and review of literature. Indian J Psychiatry. 2022;64(4):423-425. doi:10.4103/indianjpsychiatry.indianjpsychiatry_142_22. Additional Declarations No competing interests reported. Supplementary Files checklist.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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13:35:32","extension":"html","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":41173,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8308429/v1/48b093d38712664bc9189384.html"},{"id":99620879,"identity":"95137c7a-fdc7-4dde-9b51-ac0cbd161309","added_by":"auto","created_at":"2026-01-06 14:12:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":446546,"visible":true,"origin":"","legend":"\u003cp\u003e(a-b-c-d) It shows the progression map of bleeding in the tragus and face of the right ear before treatment. You can see that the amount of bleeding is gradually increasing and the area is getting larger and larger, and it is approaching the right side of the jaw.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8308429/v1/b8a41fc60f4322c6fcbf878e.png"},{"id":99794505,"identity":"90ffdb10-f339-4952-a36f-b52df6ca0a3a","added_by":"auto","created_at":"2026-01-08 13:35:09","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":433841,"visible":true,"origin":"","legend":"\u003cp\u003e(a-b-c-d) It shows the changes of the right ear screen and facial bleeding of the patient after treatment, the amount of bleeding is significantly less than that before treatment, and the scope is significantly reduced compared with that before treatment.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8308429/v1/6f2cb7f50bc1fc938285af17.png"},{"id":100356318,"identity":"e2a0c28f-fbdb-4656-96b7-0d8063049d4f","added_by":"auto","created_at":"2026-01-16 07:02:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1521129,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8308429/v1/d52fc888-7b23-4d96-9c44-cdbfff638bc5.pdf"},{"id":99794263,"identity":"c3d4ef6b-cf16-4e06-b7c6-3cda4dcc4cd3","added_by":"auto","created_at":"2026-01-08 13:34:23","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":14440,"visible":true,"origin":"","legend":"","description":"","filename":"checklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-8308429/v1/64182e228a0940b8f6c432f2.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Diagnosis and treatment of children with rare hemhidrosis and pediatrician's care experience: a case report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHematidrosis is an extremely rare and enigmatic disorder characterized by recurrent episodes of self-limited bleeding from the intact skin and mucous membranes in the absence of a bleeding problem\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. It is typically classified as an endocrine system disorder of sweat secretion, and according to current literature, 83% of the cases were observed in individuals aged 18 years or younger, suggesting a potential association with hormonal secretion during puberty. The outcome was favorable in most of the cases with medical treatment (e.g., beta-blocker, anxiolytics) as well as psychological support. Furthermore, the number of cases has increased in recent years. Hematidrosis appears to be a somatization disorder that predominantly affects children from developing countries. Its physiopathology remains largely unknown. It deserves better recognition due to the fact that it is typically a temporary condition on the condition that is managed properly\u003csup\u003e[2.3]\u003c/sup\u003e .Recently, we encountered a case of a child with hemhidrosis successfully cured by Western medicine combined with Chinese patent medicine, and it is reported below.\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eA 9-year-old girl was admitted to the hospital due to recurrent red fluid in the right auricle for over a month, 4\u0026ndash;5 times/day. She was diagnosed with \"right ear bleeding\" in the other hospital and was given drug treatment, with poor effect. The physical examination revealed that the skin color of the right tragus and auricle appeared normal, with no signs of skin defects. During bleeding, red fluid was seen in the front of the right tragus, the right auricle, as well as the right face, with an amount of about 3ml/ time, and the amount of red fluid was not substantially increased after extrusion. The patient's skin was intact following wiping and cleaning, and no skin defect occurred at night (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Blood coagulation function was normal, coagulation factor (reference normal values were 70\u0026ndash;120%): factor Ⅱ: 76.7%; V factor: 97.6%; Factor Ⅶ: 70.5%; X factor: 68.2%; Factor Ⅷ: 132.3%; Factor IX: 66.0%; Factor XI: 103.2%; X factor: 67.8%. The electrocardiogram demonstrated a heart rate of 84bmp and sinus arrhythmia. Color Doppler echocardiography indicated normal cardiac structure and left ventricular diastolic function. The measurements of left ventricular systolic function were within normal limits. The patient's psychological evaluation yielded no concerns.\u003c/p\u003e \u003cp\u003eHowever, despite the initial treatment with oral propranolol hydrochloride 10 mg twice daily, the therapeutic effect was unsatisfactory, based on taking propranolol hydrochloride plus Yupingfeng granules 5g orally three times a day, Yupingfeng granules fixed sweat, convergence, the patient's ear bleeding frequency is considerably lower than before.\u003c/p\u003e \u003cp\u003eFollowing one month of continuous treatment, upon 3 months of follow-up, the bleeding disappeared. The patient had a reduction in bleeding from the right ear and face after treatment (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eHematidrosis is a condition with an unknown mechanism, marked by the secretion of blood-like fluid from intact skin and mucous membranes without any apparent skin injury. It primarily affects young girls aged 9 to 153years. It can occur on any part of the body, from the scalp to the toes, and yet mainly affects the face (especially the forehead), upper limbs (palms), and umbilicals. It predominantly occurred during the day and rarely occurred at night\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe diagnosis of Hematidrosis requires a thorough investigation of blood system-related diseases. It is essential to carefully examine the skin to rule out self-inflicted or secondary injuries (e.g., potentially pointing to Munchausen\u0026rsquo;s syndrome or Munchausen\u0026rsquo;s by proxy) and to likewise differentiate this entity from chromhidrosis (color pigment in sweat), vasculitis, scurvy, or other connective tissue disorders (where vascular fragility can result in easy bleeding)\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Its diagnosis must meet two important features: (1) excellent skin integrity without damage; (2) The spontaneous outflow of fluid from the skin surface contains red blood cells or white blood cells and other blood components\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Current considerations include autonomic nerve dysfunction, which may result in increased susceptibility to rupture or heightened vascular permeability in sweat glands. Additionally, heightened psychological trauma or fear can lead to increased capillary permeability in the body. Manonukul et al opined that stromal weakness may occur due to defects in the dermis. The communication of these defects with vascular spaces in the dermis will result in their dilatation and enlargement as the blood centers. Whenever the internal positive pressure within these areas reaches a sufficient level, blood will seep through follicular canals or directly onto the skin surface. Subsequently, they will collapse, leaving behind no scar. This phenomenon which acts like a balloon will wax and wane and thus explains why these bleoperations are intermittent and self-limiting \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. The etiology proposed by Manonukul et al is more consistent with the histology results of normal skin or dermal defects filled with blood as observed in our patient and other patients in the literature\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTreatment of Hematidrosis consists primarily of oral beta-adrenoceptor blockers (propranolol), anxiolytic medications, and antidepressants\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Besides, topical treatments including atropine patches or drops of epinephrine gauze constrict the vessels. There are also psychotherapy, counseling, or relaxation therapies, which can be employed alone or in combination with medication;Some patients heal without specific treatment\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. In this instance, we initially administered oral propranolol at a dosage of 10mg twice daily to the patient. While there was a slight improvement in the patient's bleeding compared to before, the relief was not particularly significant. Subsequently, we gave the Yupingfeng granule 5g orally three times a day, and the patient's ear bleeding was significantly improved. Moreover, Yupingfeng granule is composed of astragalus membranaceus, Atractylodes rhizoma (fried), and wind. It can benefit qi, solid surface, antiperspirant; For surface, deficiency is not solid, from sweat evil wind, white face, or body deficiency susceptible to wind evil.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eHyperhidrosis is a rare and complex disease. It is essential to improve the awareness of early detection and diagnosis of the disease and to adopt individualized treatment strategies on the basis of the etiology. For the purpose of providing a scientific and effective judgment basis for pediatric clinicians, focus on identifying the potential psychological and social pressure factors of children, eliminate artificial obstacles, as well as diagnose hematoma as soon as possible, to reduce invasive surgery and unnecessary drug treatment, and reduce part of the economic cost of children. Additionally, it is necessary to conduct basic and clinical research on hemorheohidrosis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003ePatient Consent Statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient\u0026rsquo;s parents for publication of this case report and accompanying images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNo funding was received for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u003c/strong\u003e Written informed consent for the use of clinical images was obtained from all the patients\u0026apos; legal representatives prior to the study initiation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u0026nbsp;\u003c/strong\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u0026nbsp;\u003c/strong\u003eEthical approval was not required for this case report as per institutional guidelines.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eShafique DA, Hickman AW, Thorne A, Elwood HR, Zlotoff BJ. Pediatric hematidrosis - A case report and review of the literature and pathogenesis. Pediatr Dermatol. 2021;38(5):994-1003. doi:10.1111/pde.14792\u003c/li\u003e\n\u003cli\u003eHoover A, Fustino N, Sparks AO, Rokes C. Sweating blood: a case series of 2 siblings with hematohidrosis. J Pediatr Hematol Oncol. 2021;43(2):70-72. doi:10.1097/MPH.0000000000001661\u003c/li\u003e\n\u003cli\u003eAlsermani M, Alzahrani H, El Fakih R. Hematidrosis: a fascinating phenomenon-case study and overview of the literature. Semin Thromb Hemost. 2018;44(3):293-295. doi:10.1055/s-0037-1608905\u003c/li\u003e\n\u003cli\u003eShafique DA, Hickman AW, Thorne A, Elwood HR, Zlotoff BJ. Pediatric hematidrosis - A case report and review of the literature and pathogenesis. Pediatr Dermatol. 2021;38(5):994-1003. doi:10.1111/pde.14792\u003c/li\u003e\n\u003cli\u003eKluger N. Hematidrosis (bloody sweat): a review of the recent literature (1996-2016). Acta Dermatovenerol Alp Pannonica Adriat. 2018;27(2):85-90.\u003c/li\u003e\n\u003cli\u003eMurota H, Kotobuki Y, Yamaga K, Yoshioka Y. Female child with hematidrosis of the palm: Case report and published work review. J Dermatol. 2020;47(2):166-168. doi:10.1111/1346-8138.15179\u003c/li\u003e\n\u003cli\u003eJerajani HR, Jaju B, Phiske MM, Lade N. Hematohidrosis-A rare clinical phenomenon. Indian J Dermatol. 2009;54:290\u0026ndash;2\u003c/li\u003e\n\u003cli\u003eManonukul 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\u0026ndash;9；\u003c/li\u003e\n\u003cli\u003eSha Y, Yoshimura H, Saito S, Kitoh R, Takumi Y. A case of hematohidrosis successfully treated with a beta-blocker. Clin Case Rep. 2023;11(6):e7337. Published 2023 May 28. doi:10.1002/ccr3.7337.\u003c/li\u003e\n\u003cli\u003eWang Z, Yu Z, Su J, et al A case of hematidrosis successfully treated with propranolol. Am J Clin Dermatol. 2010;11(6):440-443.doi:10.2165/11531690-000000000-00000\u003c/li\u003e\n\u003cli\u003ePraveen BK, Vincent J. Hematidrosis and hemolacria: a case report. Indian J Pediatr. 2012;79(1):109-111. doi:10.1007/s12098-011-0449-2\u003c/li\u003e\n\u003cli\u003eMeyer J, Spacil K, Stehr M, Hinrichs W, Haller S, Sch\u0026auml;fer FM. Hematidrosis After Head Injury - A Case Report. H\u0026auml;mhidrose nach Sch\u0026auml;delhirntrauma \u0026ndash; Ein Fallbericht. Klin Padiatr. 2019;231(6):326-327. doi:10.1055/a-1005-7328\u003c/li\u003e\n\u003cli\u003eBiswas D, Mondal DK, Biswas R, Halder A. Hematidrosis: A rare entity - case series and review of literature. Indian J Psychiatry. 2022;64(4):423-425. doi:10.4103/indianjpsychiatry.indianjpsychiatry_142_22.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hematidrosis, Skin hemorrhage, Vascular disease, Spontaneous disease","lastPublishedDoi":"10.21203/rs.3.rs-8308429/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8308429/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Hematidrosis is a rare medical phenomenon referring to the excretion of blood or blood components (e.g., hemoglobin) from the body through sweat glands, causing the sweat to appear red, pink, or rust-colored. It is often accompanied by intact skin and no bleeding tendency, and must be distinguished from sweat contaminated by skin contact with dyes, food pigments, or local bleeding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Report:\u003c/strong\u003e We depicted a 9-year-old girl who had previously been healthy, experiencing a 1-month period of bleeding in the right tragus and cheek without an apparent cause. The frequency of bleeding increased with activity, and the bleeding skin was intact. Moreover, she was diagnosed with hemhidrosis. Simultaneously, psychological evaluation was conducted to rule out psychological diseases including anxiety, depression, and school bullying and intimidation. Following propranolol was given to the patient, the effect was poor, and subsequently, Yupingfeng granule was added for treatment, and the patient's bleeding condition was considerably controlled.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eFollowing a three-month treatment regimen, the patient's symptoms subsided. The combination of Propranolol and Yupingfeng granules demonstrates both safety and efficacy in treating pediatric patients with hemhidrosis, offering a novel approach for pediatricians to consider.\u003c/p\u003e","manuscriptTitle":"Diagnosis and treatment of children with rare hemhidrosis and pediatrician's care experience: a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-06 14:12:46","doi":"10.21203/rs.3.rs-8308429/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3ba798f5-b2ed-44f6-b5d0-15d616dc9d14","owner":[],"postedDate":"January 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-13T12:38:15+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-06 14:12:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8308429","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8308429","identity":"rs-8308429","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}