Morgellons disease?

Article Outline

• References
• Copyright

To the Editor: The internet is a very valuable tool in gathering and disseminating information from a wide variety of sources from around the world; however, physicians are becoming more and more challenged by the many persons who attempt self-diagnosis on-line. In many cases, these attempts are well-intentioned, yet wrong, and a patient's belief in some of these oftentimes unscientific sites online may preclude their trust in the evidence-based approaches and treatment recommendations of their physician.

For example, we recently saw three individuals in our clinic who felt that they had “Morgellons disease.” Patient 1 was a 57-year-old white male who was accompanied by his sister (patient 2). Patient 3 was a 44-year-old white female who was acquainted with the other two. All three arrived together, and they began “picking” at their own (as well as each other's) skin using tweezers in the waiting room. This caused much discomfiture amongst other waiting patients as they discussed their “contagious” Morgellons disease.

Patient 1 had a pruritic syndrome that he felt was caused by “bugs crawling under his skin.” He diligently picked his lesions with tweezers and placed the “bugs” on a tissue. We examined these samples microscopically and found skin fragments but nothing resembling an arthropod or parasite. Examination revealed multiple superficial ulcerations, excoriations (many linear), excoriated papulonodules, and scars on his extremities and trunk, but no primary lesions or evidence of infestation.

Patient 2 was in the examination room with patient 1. She believed they had “Morgellons disease” and gave us information from Web sites that supported this diagnosis. This phenomenon of acquainted patients that share the same delusional disorder is called folie a deux and occurs in 12% of patients with delusions of parasitosis.¹

Patient 3 reported recent fire ant bites, but most of these were healing. There were multiple excoriations on her extremities but no primary lesions. She was concerned that she had acquired Morgellons disease because of “exposure” to the others.

After thorough evaluation and examination, all three individuals were diagnosed with delusions of parasitosis. They were appropriately counseled.

The information that our patients had about Morgellons disease was taken from the Web site www.morgellons.org. This is sponsored by the Morgellons Research Foundation, which is dedicated to uncovering the cause of this “emerging infectious disease.”² Most persons with this disorder report biting and crawling sensations with nonhealing skin lesions. They find “unusual structures” which can be fiber-like. Associated illnesses include chronic fatigue syndrome, fibromyalgia, mood disorders, chronic Lyme disease, obsessive-compulsive disorder, and others.²

The majority of patients concerned about having Morgellons disease are diagnosed with delusions of parasitosis.² Dermatologists have discussed with the lay press their impression that the disease actually represents delusions of parasitosis.³, ⁴ The Medical Advisory Board of the Morgellons Research Foundation has submitted a case definition of the illness to the Centers for Disease Control and Prevention in hopes that this will give patients a unified voice when dealing with physicians, politicians, and health departments.² The precise pathophysiolog(ies) that give rise to abnormal cutaneous sensations, to delusions of parasitosis, and to the clinical manifestations described as Morgellons disease remain to be determined. The latter term may prove useful in discussing and investigating it. On the other hand, unsubstantiated claims about what causes it may be incorrect and misleading.

Back to Article Outline

References 

1. Koo J, Lee CS. Delusions of parasitosis: a dermatologist's guide to diagnosis and treatment. Am J Clin Dermatol. 2001;2:285–290
   • View In Article
   • MEDLINE
   • CrossRef
2. Morgellons Research Foundation Web site. Available at: http://www.morgellons.org. Accessed January 19, 2006.
   • View In Article
3. Chertoff B. Making their skin crawl. Popular Mechanic, June 2005. Available at: http://www.popularmechanics.com/science/medicine/1662162.html. Accessed January 19, 2006.
   • View In Article
4. Mullen Jr FX. A medical mystery: delusional parasitosis. Reno Gazette-Journal Web site. May 8, 2004. Available at: http://www.rgj.com/news/stories/html/2004/05/08/70309.php. Accessed January 19, 2006.
   • View In Article