Literature reports suggest that up to 30% of dermatology patients have associated psychiatric co-morbidity. A psychodermatology liaison (PD) clinic is essential to deal with such patients, which is almost non-existent in the Indian scenario. In order to report the working pattern of such a clinic and to determine its efficacy with the help of Dermatology Life Quality Index (DLQI) and Short Assessment of Patient Satisfaction (SAPS) questionnaires, we investigated patients with suspected psychocutaneous diseases in an open-labelled two-year prospective study. Of 236 patients, 86 had psychiatric co-morbidity, 19 had primary psychiatric disorders, 144 were advised psychological interventions and 98 were prescribed psychotropics. A statistically significant fall in DLQI scores at follow-up indicated improvement in quality of life. SAPS scales demonstrated 87.3% of patients in our PD clinic were satisfied with their management in contrast to 53.8% patients in the normal standard dermatology clinic. Nearly 33% of the patients attending our PD clinic had psychiatric co-morbidity, the commonest being an adjustment disorder.

Immune thrombocytopenia (ITP) is an auto-immune condition that results in isolated thrombocytopenia associated with possibly lethal haemorrhage. In its secondary form, ITP can be triggered by many infectious and non-infectious conditions. Secondary ITP associated with tuberculosis (TB) has rarely been described in the literature. We report on a 22-year-old patient presenting with hypermenorrhoea and petechiae due to ITP secondary to tuberculous lymphadenitis. Normalisation of thrombocytopenia was only achieved after initiation of anti-tuberculosis treatment following failure of thrombocyte substitution and immune-modulatory treatment. A search of the literature available on TB-associated ITP identified 50 cases published between 1964 and 2016. We reviewed all cases using suggested case definitions on the likelihood of association between ITP and TB. A broad spectrum of TB sites was reported to be associated with ITP, and anti-tuberculosis treatment was the most effective therapy for platelet count normalisation. Time from initiation of anti-tuberculosis treatment to platelet count recovery ranged from 2 days to 3 months. In endemic regions, TB should be considered as an underlying cause of ITP. Early diagnosis of TB and initiation of anti-tuberculosis treatment appears crucial for rapid platelet count recovery, and can reduce the risks associated with long-term immunosuppression, transfusions and the time at risk for haemorrhage.

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