ABSTRACT
Morgellons disease (MD) is a rare and contentious health condition characterized by dermatological symptoms including slow-healing skin lesions 'attributed' to fibres emerging from or under the skin. Patients also report sensations of crawling, biting and infestation with inanimate objects. This review examines the aetiology, patient characteristics, epidemiology, historical context, correlation with Lyme disease, role of internet, impact on quality of life and treatment approaches for MD. Despite ongoing debate, MD is not officially recognized in medical classifications, with differing views on its aetiology. Some link MD to Lyme disease, while others view it as a variant of delusional infestation. The literature suggests both psychiatric and environmental factors may contribute. The manuscript explores the association with substance abuse, psychiatric comorbidities, infectious agents and the role of internet communities in shaping perceptions. MD's impact on quality of life is significant, yet often overlooked. Treatment approaches are varied due to limited evidence, with low-dose antipsychotics being considered effective, but patient beliefs may influence adherence. A patient-centred, multidisciplinary approach is emphasized, considering both the physical and psychological dimensions of MD. Addressing the controversies surrounding MD while focusing on patient well-being remains a critical challenge for healthcare professionals.
Subject(s)
Morgellons Disease , Humans , Morgellons Disease/therapy , Morgellons Disease/psychology , Quality of LifeABSTRACT
Psychodermatological problems are prevalent in dermatology practices. Among those, delusional infestation (DI) is the subject of one of the most challenging patient encounters practicing dermatologists may experience. This difficulty arises, at least partly, from the unavailability of psychiatric knowledge and skillset necessary to properly manage these patients, reflecting that most dermatology residency programs are unable to provide training in psychodermatology. This relates to the lack of faculty available with such expertise. This article reviews various suggestions made in the medical literature to try to improve this current unfortunate situation. However, the more common suggestion regarding organizing a multidisciplinary psychodermatologic clinic may be difficult to achieve as reflected by the scarcity of such clinics in the U.S. The authors offer alternative suggestions beyond the idea of organizing a multidisciplinary clinic.
Subject(s)
Delusional Parasitosis/therapy , Dermatology , Interdisciplinary Communication , Morgellons Disease/therapy , Psychiatry , Clinical Competence , Delusional Parasitosis/psychology , Dermatology/organization & administration , Humans , Morgellons Disease/psychology , Psychiatry/organization & administrationABSTRACT
BACKGROUND: Morgellons disease is a controversial condition characterised by a great variety of skin-related symptoms such as wounds, itch and pain and whereby the patient strongly believes these are caused by threads or fibres penetrating the skin. The subject is often discussed in social media, which leads to increasing numbers of patients who think they have the condition. CASE DESCRIPTION: A 56-year-old woman had been suffering for three years of compulsive behaviour involving her hair and scratching her skin. She was convinced there were threads running under her skin. She had self-diagnosed 'Morgellons disease'. Psychodermatological treatment led to reduced symptoms. CONCLUSION: The majority of medical practitioners believe that Morgellons disease is a type of delusional infestation. Even though there are some medical and non-medical practitioners who take the position that there is an infectious cause, such a cause has never been found.
Subject(s)
Dermatologic Agents/therapeutic use , Morgellons Disease , Psychological Techniques , Compulsive Behavior/physiopathology , Compulsive Behavior/therapy , Female , Humans , Middle Aged , Morgellons Disease/physiopathology , Morgellons Disease/psychology , Morgellons Disease/therapy , Skin Diseases/etiology , Skin Diseases/psychology , Skin Diseases/therapy , Treatment OutcomeABSTRACT
Delusional infestations are psychodermatologic disorders in which those affected have a false belief they are infested by parasites and/or "growing" inanimate objects from cutaneous surfaces. Individuals with delusional parasitosis (DP) believe parasites, bacteria, worms, mites, or other living organisms are the source of cutaneous symptoms, while those with Morgellons disease (MD) attribute their symptoms to growth of small fibers or inorganic material. In both DP and MD, self-inflicted, non-healing cutaneous lesions caused by scratching at the affected areas to alleviate symptoms are commonly observed. This report describes a case of oral mucosal lesions in a patient demonstrating overlapping symptoms of DP and MD. It is important for oral healthcare providers to recognize oral signs and symptoms that may be associated with psychodermatologic disorders.
Subject(s)
Morgellons Disease/diagnosis , Mouth Diseases/psychology , Mouth Diseases/therapy , Mouth Mucosa/pathology , Antipsychotic Agents/therapeutic use , Delusional Parasitosis/diagnosis , Diagnosis, Differential , Female , Humans , Lip/pathology , Middle Aged , Morgellons Disease/therapyABSTRACT
Patients with a delusional infestation (DI) have an overwhelming conviction that they are being infested with (non) pathogens without any medical proof. The patients need a systematic psychiatric and dermatological evaluation to assess any possible underlying cause that could be treated. Because they avoid psychiatrists, a close collaboration of dermatologists and psychiatrists, who examine the patient together, seems to be a promising solution. It helps to start a trustful doctor-patient relationship and motivates the patient for psychiatric treatment. We here review diagnostic criteria, classification of symptoms, pathophysiology and treatment options of DI. Antipsychotic medication is the treatment of choice when any other underlying cause or disorder is excluded. Further research is needed to assess the pathophysiology, and other treatment options for patients with DI.
Subject(s)
Delusions/parasitology , Delusions/psychology , Morgellons Disease/psychology , Antipsychotic Agents/therapeutic use , Comorbidity , Delusions/diagnosis , Delusions/therapy , Ectoparasitic Infestations/psychology , Humans , Morgellons Disease/diagnosis , Morgellons Disease/therapyABSTRACT
Morgellons is a medically contested diagnosis with foremost dermatological symptoms. Patients experience fibers emerging from the skin, together with a range of other somatic, psychiatric, and neurological complaints. Within the medical community, it is generally held to be a variation of delusional parasitosis/delusional infestation, which is usually treated with antipsychotics. Little attention has been paid in the literature to the ethical aspects of treating patients with Morgellons disease. The communicative strategies suggested in the literature display significant ethical issues, primarily the use of therapeutic privilege, i.e. withholding information from the patient. Since this limits patient autonomy, that approach is ethically problematic. Instead, the physician has an ethical obligation to respect the patient's autonomy, provide full information, and seek consent before initiating a psychiatric referral.
Subject(s)
Informed Consent , Morgellons Disease/psychology , Morgellons Disease/therapy , Personal Autonomy , Physician-Patient Relations/ethics , Antipsychotic Agents/therapeutic use , Communication , Disclosure , Humans , Referral and ConsultationABSTRACT
Head lice are transmitted by head to head contact. Optimal therapy includes malathion lotion 0.5% repeated in one week left on for 30 minutes to 8 hours. Spinosad topical suspension 0.9% repeated in one week left on for 10 minutes is another option. Scabies is transmitted mainly by direct contact but also via heavily infested fomites due to crusted scabies. Permethrin 5% cream to the body repeated in four days is often sufficient; however, scalp treatment with malathion lotion 0.5% is helpful in crusted scabies and in infested children. Oral ivermectin 200 mcg/kg is another option, repeated in four days. For scabies more than lice, fomites should be placed in a drier at 60 °C for 10 minutes to kill the arthropods. Treatment of close contacts in both cases will control outbreaks and repeated infestations. Both have been associated with methicillin-resistant Staphylococcus aureus infection. Bed bugs are a common cause for papular urticaria. Identification of the insect in the mattress or bedding confirms the diagnosis. Prevention involves encasing the mattress in a sealed plastic cover and extermination. Delusions of parasitosis is a diagnosis of exclusion that is best treated with an antipsychotic.
Subject(s)
Bedbugs , Ectoparasitic Infestations , Insect Bites and Stings , Pediculus , Animals , Diagnosis, Differential , Ectoparasitic Infestations/diagnosis , Ectoparasitic Infestations/therapy , Humans , Insect Bites and Stings/diagnosis , Insect Bites and Stings/therapy , Lice Infestations/diagnosis , Lice Infestations/therapy , Morgellons Disease/diagnosis , Morgellons Disease/therapy , Scabies/diagnosis , Scabies/therapy , Scalp Dermatoses/diagnosis , Scalp Dermatoses/therapy , Skin Diseases, Vesiculobullous/diagnosis , Skin Diseases, Vesiculobullous/therapy , Urticaria/diagnosis , Urticaria/therapyABSTRACT
Morgellons Disease is a condition involving painful skin lesions, fibrous growths protruding from the skin, and subcutaneous stinging and burning sensations, along with symptoms of anxiety, depression, fatigue, and memory and attention deficits. The etiological and physiological bases of these symptoms are unclear, making the diagnosis controversial and challenging to treat. There are currently no established treatments for Morgellons Disease. The following case example depicts treatment of a woman with Morgellons Disease using hypnotherapy. Data from this case example suggest that hypnotherapy is a promising intervention for the physical and psychological symptoms associated with Morgellons Disease.
