Morgellons Disease and Delusions of Parasitosis

Abstract

Morgellons disease is a controversial and poorly defined symptom cluster of skin lesions and somatic symptoms, most notably 'fibers' in the skin. Because of widespread coverage in the media and on the Internet, there are an increasing number of patients presenting to dermatologists. We present three patients who believed that they had fibers in their skin. We offer a discussion of delusions of parasitosis to demonstrate similarities between these conditions. It has been suggested by a limited number of healthcare providers that an unknown infectious agent underlies this symptom complex yet no available evidence supports this assertion. Laboratory values that would be reflective of an infectious process (e.g. elevated white blood cells, sedimentation rate, C reactive protein) are routinely normal and biopsies often reflect only nonspecific findings such as acute and chronic inflammation with erosion or ulceration. Patients with Morgellons disease generally lack insight into their disease and reject the need for psychiatric help. The goal is to build trust and refrain from minimizing what the patient experiences. Attentive examination of the patient's skin and fragments they present is necessary to rule out a true underlying pathologic process and to establish a trusting relationship. A supportive, non-confrontational approach is ideal. The patient is best treated by a team of practitioners of several specialties, including dermatologists, psychiatrists, and counselors.

Morgellons Disease

“…The histopathologic and immunohistochemistry analysis revealed nonspecific findings without infectious etiologies. The evidence of the black fiber observed in gross specimen was also absent, which was consistent to previous study5. It could be dissolved by the organic solvents used in the tissue preparation process.…”

“…One study5 disclosed that laboratory values associated with infection were normal in Morgellons disease patients, and that cutaneous biopsy specimens revealed only nonspecific findings. Another research2 from the Centers for Disease Control and Prevention reported that there was no common underlying medical condition or infectious organism in Morgellons disease cases, and that the fibers were composed mainly of cellulose.…”

“…B. burgdoferi serology was negative. Considering that a supportive, non-confrontational, and multi-disciplinary approach5 or antipsychotic agents are essential for the treatment of this disease, she was advised to visit the department of psychiatry and to take medication. However, the patient refused follow-up.…”

Self inflicted corneal abrasions due to delusional parasitosis

“…There is no clinical evidence to support infectious aetiology of this condition and the skin biopsies have demonstrated non-specific findings. Patients with this condition often lack insight, hold their beliefs firmly and are resistant to psychiatric treatment 11. Because of recent publicity of Morgellons disease, center for disease control (CDC) is currently investigating this condition.…”

Ekbom syndrome, an evidence based review of literature

“…The role of postsynaptic-D2 receptors (in mediating the anti-psychotics' effect) and the role of fronto-striato-thalamo-parietal brain circuits inmediating Delusional Infestation(DI), which is in the same spectrum asDP, was confirmed. 2,6,[11][12][13][14][15][16] …”