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Blood usually oozes from the forehead, nails, umbilicus, and other skin surfaces. In addition, oozing from mucocutaneous surfaces causing nosebleeds, blood stained tears, and vicarious menstruation are common. The episodes may be proceeded by intense headache and abdominal pain and are usually self-limiting. In some conditions, the secreted fluid is more dilute and appears to be blood-tinged, while others may have darker bright red secretions resembling frank blood.
Investigation such as platelets count, platelet aggregation test, coagulation profile and skin biopsy reveal no abnormalities and direct light microscopy of fluid demonstrates presence of normal red blood cells. Investigations also failed to show any vasculitis or skin appendages (i.e. sweat glands, sebaceous glands and hair follicles) abnormalities.
It may occur when a person is suffering extreme levels of stress, for example, facing his or her own death. Several historical references have been described, notably by Leonardo da Vinci describing a soldier who sweat blood before battle, and men unexpectedly given a death sentence, as well as descriptions in the Bible that Jesus sweat blood in the garden of Gethsemane (Luke 22:43-44).
The condition is very rare but there are reports in the in medical literature of successful treatment with beta blockers (propranolol 10 mg) with significant reduction in the frequency of spontaneous blood oozing. The successful use of beta blockers supports the theory that the condition is induced by stress and anxiety yet this etiology is not established yet as the high prevalence of stress and anxiety in the modern era did not change the incidence of this extremely rare disease, suggesting that other co-abnormality also play a key role in this disease. Atropine sulfate transdermal patches have also been used successfully.