with just a few steps you can create something similar. I love to do these for a hobby as it keeps me occupied I love anything to do with graphics and playing with graphics to build a brand new one is just fantastic with the only thing hindering is how far your imagination will let you take the pieces.
Step 1: Step 1 Working on the Vampire
I wanted a cracked texture for her skin. I find that cracked mud or cracked clay texture works well for this as you get bold cracks and minimal texture between. For the depth of the cracking of her skin i used created a layer on top of the new background copy layer and set this layer to linear burn.
I positioned this over her shoulder and applied a layer mask and removed non destructively the crack effect where i had no use for it.
I duplicated this layer again 2 more times and changed the size for the neck then again applied a mask with the second of the duplication's I masked off and sampled a tiny bit for the other shoulder.
Step 2: Creating the Eyes
next i right clicked with rectangle selection activated and clicked on transform selection and just pulled the points slightly till i was happy the selection was great. next i filled the selections with black and whilst the selections were still active i went to refine edge and just applied a slight feather and radius to give nice fluid edges no jaggedness at all.
Now eyes look nothing without a bit of highlight to the eye ball so using a white brush i lightly painted in some highlight switching between hard and soft brush I then cloned this onto the next eye so the highlights are the same but can be moved slightly as no 2 eyes are the same. I kept the bottom line of the eyes where the tear ducts are etc just so it gives it more depth.
Step 3: Teeth
Step 4: The Blood
Now i had this it was ready to add so i added as a smart object so it would not lose data and placed over the eyes each eye having its own blood layer now i masked off using a layer mask again on each and removed the unneeded areas so that it looked like it came from the eyes I did all this again for the blood from the lip.
Step 5: The Asylum + Ghost Girl
This saved me making her ready as she was already horrid I applied a mask and took un needed parts. and sized her up for the doorway.
With the 2 images i now moved the girl out of the way Whilst I created A mist in the back doorway. To do this i used a mixture of smoke an fog ps brushes and applied with a flow of about 38% now that this had been done it was time to put the scary girl back in the doorway and using 40% opacity so the mist would show through i worked a bit more on the mask reducing her features even more she now looked ghost like.
To finish her i used the dodge and burn tool to emphasize her creepy features darkening as i went.
Now back to the asylum
Step 6: Asylum Advancement
This is a no no as she would look out of place so i cloned the pillar to the right and took samples from above the door and also to the right of the pillar to create a new wall that stayed in the perspective of the room. Once this was done and made flawless it was time to add a spooky colour cast i went with an off sepia colour which is not actually one colour i created a new adjustment layer of hue and saturation and created a brown colour then on another level i created a teabag yellowy brown and just enhanced with a curved layer and a 2 % drop shadow pushed up high then i merged the layers together and placed above both vampire and asylum but not the ghost as she would be lost into the background.
Then using the asylums own elements it was time for more dodge and burning this time i focused on the building i placed diagonal lines from the ghost forwards on the floor to portray depth. i then used single strokes in a random fashion to emphasize the dereliction of the asylum and make my image complete.
and that's it job done