Imaginary bugs flummox dermatologists

It is known that some people have the “delusional bug syndrome” and are convinced that bugs, worms, germs, or other creepy crawlers are infesting their skin and often see skin doctor after skin doctor to find out what is causing the infestation. Often, patients bring in samples of the insect and request a skin biopsy.

Whether delusional infestation -- also known as Morgellons Disease -- is a psychiatric condition, or whether people who complain of the mysterious skin symptoms might have an underlying physical disease continues to be debated and investigated. According to the Centers for Disease Control and Prevention, which is looking into the condition, sufferers have also reported fatigue, joint pain, and short term memory loss.

However according to a new study published online in the Archives of Dermatology it is found that the cases of delusional skin infestation are just that – delusions. Neither samples nor biopsies show any evidence of skin infestation.

The study comes from researchers at the Mayo Clinic in Rochester, Minn. They reviewed 108 people with symptoms resembling delusions of parasitosis (infection with a parasite). Some of the patients brought samples, others had biopsies of their skin, and some had both.

Study author Mark Davis, a professor of dermatology at the Mayo Clinic said, “When we looked at what they brought in and when we looked under the microscope, we never found a parasite.” Of 80 self-procured specimens, 10 were insects, but nine of them were not capable of infestation. One person brought in a sample of pubic lice, which is technically capable of infestation, but not the type that could cause head-to-toe itching. The other specimens were dead skin, plant material, or environmental debris.

Slightly more than 60% of these patients were diagnosed with dermatitis, which is characterized by inflamed, itchy skin, the study revealed. There are no exact numbers on how many people have delusional skin infestation, but it is “relatively frequent,” Davis said.

This is a psychiatric condition, but people with a “delusional bug syndrome” typically see a dermatologist say experts. “The patient refuses to believe it is a psychiatric disorder because they have a false, fixed belief, so even if you present them all of the evidence, they still believe they have parasites invading their skin,” Davis said. “They travel from center to center for another opinion because they really believe their skin is infected.”

He explained, “They are very upset because they believe their skin is infested with all sorts of nasty things and we don’t see anything or find anything with a biopsy and yet they are in our office, their lives are ruined, and they want treatment,” Davis says. “Patients say ‘you are just missing it and not looking carefully enough,’ and just walk out.”

According to Bruce Strober, an assistant professor of dermatology at New York University Langone Medical Center in New York City, may dermatologists are faced with this problem. “People with delusions of parasitosis are a great challenge to us,” he said. “It's clearly a psychiatric disorder that requires psychiatric medication and counselling. Unfortunately, these patients are rarely amenable to those approaches.”

Donald S. Waldorf, a dermatologist in Nanuet, N.Y., said he has developed his own approach to treating these patients. “They often come in with a bag of stuff, including threads and dead skin, but nothing real and capable of infestation,” he said. “They also dig at and scratch their skin.” Waldorf often prescribes topical agents to prevent infections from scratching and may suggest steroids to reduce inflammation. Sometimes, he prescribes psychiatric medications. “They won’t go to a psychiatrist,” he said. “If tell them to go, I will have lost them, so I basically give them support and prevent infection,” he said.

While there are no published estimates of how common delusional infestation is, the CDC has been researching that question, as well as what type of people tend to report symptoms. Researchers there prefer the term “unexplained dermopathy.”

“It is an unexplained and debilitating illness of unknown cause,” a CDC spokesperson said. “We recognize that...healthcare providers are perplexed and frustrated” and patients and their families are suffering, the spokesperson added.

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.

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Comments

  1. Ed S. Ed S. United States says:

    Does an albino helminthic worm living in a lesion on the medial surface of the upper thigh, photographed, presented in vivo as a specimen (which a dermatologist refused to look at or even perform the most perfunctory or examinations), substantiated by one or more third partes constitute proof?  What about peripheral blood smears with microfilariae surrounded by eosinophils?  How about a clean catch urine culture which grows what appear to be some species of schistosome, visible to the naked eye and by microscopy, again photographed and verified by testimony of a third party, and reproducible by an in office microscopic examination which a physician refuses to perform?  How about multiple positive parasitology blood, urine and stool cultures, in which positive for parasites taxonomy says "unidentiafiable organism?"  If you believe that these and a plethora of other empirically validated infectious diseases qualify as delusional, stick your head back in the sand and continue to claim the sky is falling.  Chances are 10,000:1 that my I.Q. is higher than yours and my powers of observation and ability to operate a lab microscope, mount slides, prepare specimens, etc., are adequate to document parasitosis.  I was educated in molecular biology and recruited by a prestigious medical school but did not attend, after experiencing the myopathy of "scientists" such as you.  Yes, the burden of proof lies with the claimant but when "medical scientists" refuse to perform comprehensive H&P exams, refuse to order lab tests, and disbelieve multiple confirmatory lab test results enough is enough.  Furthermore, some of these physicians cavalierly prescribe Orap as an anti-psychotic without a lab test or psych evaluation .  Ignoring clinical and laboratory findings because of a fixation on the bell curve is unconscienable and is certainly inconsitent with "First, do no harm." There are throngs of people suffering terribly in the world and in particular the so called first world because of malignant negligence by the medical community as dominated by the I.D.S.A. and its stranglehold on public health policy.  People without empathy for the suffering of others are diagnosed as having anti-social-personality-disorder(s) per the DSM-V, psychopathologies popularly called sociopathy/psychopathy.  Engaging in behaviors that cause harm to others, even through neglect, without empathy and/or remorse support this.  Using medical credentials to wholesale diagnose a group in the population that is suffering terribly as having a delusional illness then refusing them real diagnosis and treatment is one more example of why many people are mistrustful of doctors and other biomedical scientists.  If you had a mechanism whereby attachments could be made I would forward you photographic evidence of these claims, including those taken using microscopy, simple photography, etc.  People need to start standing up and challenging the claims of people entrusted with the health of others, no matter how prestigious their affiliated institutions or claims of evidence negating infection.  All you have to do is urinate into a sterile container and watch things visible to the naked eye swimming on or in the urine immediately after or during urination, or prepare a blood smear, examine and photograph it to see what appear to be living microfilariae surrounded by eosinophils as an indicator of an infectious process.  While I do not doubt there are people suffering with DOP, it does not justify medical negligence by blanket diagnosis and refusal to treat people with easily verifiable parasitic infections as having psychopathologies rather than infectious diseases, by virtue of placing statistics above clinical and laboratory evidence.  Being hospitalized due to profound edema of the lower legs, profound difficulty breathing and being diagnosed with bilateral DVT and bilateral PE, without coagulopathy, and having that edema and breathing difficulty persist after heparin and Xarelto therapy for months is needless suffering, and almost resulted in my death.  When a few days of filaricides abated that edema and breathing difficulty it is a positive indicator that pathogens, not coagulopathies were more likely to be the cause of the life threatening illnesses, along with the positive lab findings and microscopy evidence.  Again, some of us are denied appropriate diagnosis and treatment. Others find highly respected board certified physicians who bother to look further and reach positive diagnoses of parasitosis yet the infections are so advanced as a result of medical negligence aggressive treatment is only partially effective.  Part of this is because the first physician we consulted refused to look at our specimens, perform a comprehensive H&P, labeled us as delusional then prescribed anti-psychotic drugs, painting us with a scarlet letter to all future physicians.  When we finally do find a physician who cares enough to thoroughly examine and test us and discovers an advanced parasitic infection, treatment becomes a matter of reducing the parasite load to abate suffering to a point.  Had it been diagnosed and treated earlier a cure may have been possible.  Parasites and their ova in one's tissues and bodily fluids as well as lab tests confirming the same are proof of infection.  A physician's ignore inborn prejudices and refusal to evaluate the suffering patient in front of her due to fixation on a contrived bell curve contributes to the suffering of patients.  Shame on you.

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