COMMENTARY

How to Manage Patients With Dermatologic Delusional Disorders

Mio Nakamura, MD; John Y.M. Koo, MD

Disclosures

August 11, 2015

In This Article

Dermatologic delusional disorders are characterized by a fixed false belief that there are parasites or foreign objects on the skin, which manifest as cutaneous dysesthesia or abnormal sensations of the skin. The most common type of dermatologic delusional disorder is parasitosis, in which patients believe that there are parasites living on their skin. The delusion is associated with a sensation of stinging, biting, or crawling.

Patients often have skin findings consistent with scratching or manipulation of the skin. Many patients bring to the provider "evidence" of infestation, most commonly pieces of lint or dirt they have found on their skin that they believe are parasites.[1] Most patients have gone to many doctors to find a cause of their skin disease, only to be discouraged at the lack of adequate treatment.[2]

Although controversial, another example of a delusional disorder may be Morgellons disease. In this condition, patients believe that fibers are emerging from the skin, which in turn cause somatic, psychiatric, and neurologic symptoms.[2] Some small studies have suggested that Morgellons disease may be an illness associated with spirochete infection[3,4]; however, many physicians, as well as the Centers for Disease Control and Prevention, believe that it falls in the realm of delusional disorder.[1,2]

Regardless of the controversy surrounding this issue, patients and providers can all agree that dermatologic delusional disorders can be extremely debilitating. As healthcare providers, the main goal should be to improve the well-being of the patients; therefore, it is essential that the practitioner and patient work together to find adequate treatment.

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