A case series on psychoimmunological exploration of psychogenic purpura – An enigmatic psychosomatic condition

Abstract

Psychogenic purpura is a rare but interesting psychosomatic condition where there are transient dermatohematological manifestations in response to antecedent psychological disturbances most commonly depression, whose pathophysiology is still an enigma. The objective of this case series is finding out the missing link between antecedent psychological disturbances and resultant purpura through psychoimmunologic exploration. In all four cases, patients were female, aged between third–fifth decade with depression being the common diagnosis, where transient painful bruising appeared only during antecedent stressful conditions. Immune-cytokine work-up in all the patients showed type 1/type 2 cytokine shift during bruises. With psychiatric treatment, there was not only improvement in depression and bruises, cytokine alterations were also normalized. Rise in pro-inflammatory cytokines with type 1/type 2 shift during stresses may cause these bruises by increasing the vascular permeability.

Keywords

• psychogenic purpura
• psychoimmunology
• stress–depression
• type 1/type 2-cytokines