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.