Delusions of parasitosis. An approach to the problem

Abstract

One of the most frustrating problems in clinical dermatology is the patient with a delusion of parasitosis. Over the years, very little realistic and practical advice has been offered to the perplexed dermatologists. We describe an approach that is based on the thesis that dermatologists can and often should treat such patients. By considering each patient as an individual, and by working to build rapport, the dermatologist is in the best position to offer help. We report two illustrative cases and discuss guidelines to treatment.

Delusional Infestation

“…A patient with DI is easy to recognize (117). It is usually a bigger challenge to exclude the multitude of possible associated illnesses and to evaluate their causative role.…”

“…According to the first specific paper on the management of patients with DI, by Gould and Gragg, "(t)here is probably no disorder in dermatology that is so difficult to treat and for which the published advice is so inappropriate and impossible to follow" as DI (117). Basic communication is difficult (a "single false word" insinuating a psychiatric disorder too early will enrage patients).…”

“…This caused most patients never to return but not to engage in meaningful treatment either. Gould and Gragg were the first who tried to keep patients in dermatology and suggested guidelines "preferable to no treatment or to neglect" which "may be used by most physicians" (117). These guidelines were explained based on only two cases, but they were a starting point for refined suggestions over the years (280, 300, 351).…”

Primer Psikiyatrik Hastalıklar

“…Nadir olarak iflitsel varsan›lar ve kendine zarar verici davran›fllar (t›r-naklar›n anormal kesilmesi, saçlar›n ve vücut k›llar›n›n kaz›n-mas› ve vücuda pestisit uygulanmas›) gözlenir. Kibrit kutusu belirtisinde hasta saç, deri, t›rnak gibi çeflitli vücut parçalar›n› küçük bir tafl›y›c› kap, kutu, bez vs. içinde doktora getirir 11 . 12 .…”

“…Delüzyon benzeri bu olay kokain için çok tipik olup "Kokain Böcekleri" olarak an›l›r. Ayr›ca Phenilsine, metil phenidate, atropin ve zaman zaman da kortikosteroid ve alkolün delüzyon benzeri belirtiler yapabilece¤i bildirilmifltir 10,11,15,16,19,20 . Olgular flikayetlerinin bedensel bir hastal›ktan kaynakland›¤›-na ve psikiyatrik tedavinin bedensel olan hastal›klar›na çözüm getirmeyece¤ine inan›rlar ve genelde aile hekimi, dermatolog gibi psikiyatri d›fl› hekimlere baflvururlar 12,13,21 .…”