Psychiatric Profile and Response to Combined Pharmacologic and Psychotherapeutic Treatment in Psychogenic Purpura.

Objective

Psychogenic purpura is a rare psychocutaneous entity characterized by painful atraumatic, ecchymotic, and purpuric lesions that commonly occur in young women. The objective of this study is to describe the clinical presentation, psychiatric profile, and response to therapy (pharmacologic and psychotherapeutic) in patients with psychogenic purpura.

Methods

Twenty-three patients, referred from various clinical departments with unexplained purpura or ecchymotic lesions, were assessed in the department of psychiatry of a tertiary care institute in eastern India over a period of 3 years (May 1, 2017, to April 30, 2020). Relevant systemic evaluation and routine biochemical and laboratory tests including complete blood count, bleeding time, clotting time, prothrombin time, coagulation profile, and platelet function test were conducted for all patients to rule out an underlying organic cause. Associated psychiatric comorbidities were diagnosed as per the International Classification of Diseases, 10th edition. All patients who were eventually diagnosed with psychogenic purpura received appropriate treatment (pharmacologic and psychotherapy) and were followed up for 1 year.

Results

Seven female patients (age range, 14-70 years, mean age = 30.28 ± 17.42 years) were diagnosed with psychogenic purpura. All patients had significant stressors prior to the appearance of lesions. Facial involvement was reported in 2 patients (28.6%). Multiple sites were affected in 4 patients (57.1%). The underlying psychiatric conditions diagnosed were depressive disorder (42.9%), generalized anxiety disorder (28.6%), dissociative convulsion disorder (14.3%), and panic disorder (14.3%). Associated personality disorder was noted in 2 patients (28.6%). All patients were started on selective serotonin reuptake inhibitors and concurrent psychotherapy. A short course of benzodiazepine was used in all patients and was subsequently tapered off. At 1-year follow-up, 2 patients reported recurrences, while others continued to do well with no similar episodes.

Conclusions

Appropriate psychiatric evaluation and necessary intervention in patients with psychogenic purpura lead to improved patient outcomes.