The morgellons disease, myth or reality ?
La enfermedad de Morgellons, Mito o realidad ?
EDITORIAL ENGLISH
=================
Hello friends of the DERMAGIC EXPRESS network today brings you another
interesting topic THE MORGELLON DISEASE, A REVIEW, ancestral disease that is now
being linked to LYME DISEASE, and rather challenged because some scientists
consider it a NEW ENTITY, and others firmly believe That this disease is a
variant of DELUSIONS OF PARASITOSIS, widely described in the chapter on
PSYCHODERMATOLOGY.
In other words, these patients are PSYCHOLOGICALLY affected who have and feel that "STRANGE ANIMALS, INSECTS, AND PARASITES" have colonized their skin producing DERMATOLOGICAL DISEASES, typically characterized as being in many cases" AUTO PROVOCATED "by themselves.
The patient arrives at the consultation with the FAMOUS SIGN DESIGNED "THE BOX OF MATCHES" where he shows the doctor "THE PARASITES" that has been extracted from his skin, which in reality are, SKIN, HAIR REMAINS, TEXTIL FIBERS, AND OTHER THINGS, "but the patient is firmly convinced that they are PARASITES that he has extracted from his skin.
This is where the concept of MORGELLONS comes in, which was introduced by a BIOANALYST named Mary Leitao (Pennsylvania) in the year 2.002 when her sick son told the mother that it was extracted from the skin by scratching some strange "things" similar to blue and gray fibers. She related this event to another event in the years 1.690 where a French Thomas Browne first described this entity in children who appeared in the back PUSTULES AND PILOUS CYST, known at that time popularly as "MORGELLONS"
The word MORGELLON means in ancient Provencal language, "SMALL FLY". Since 2.002, this pathology has been studied and new cases have been published by scientists, including the CDC (Center for the Control and Contagious Diseases), who concluded in 2.006 that " IN THE PATHOLOGICAL ANALYSIS PARASITES WERE NOT FOUND".
In the chapter on PSYCHODERMATOLOGY there is a topic well studied and explained in the dermatology known under the name DELUSION OF PARASITOSIS that I described above. Today there are 2 trends regarding this disease:
1.) MORGELLON'S DISEASE is a variant of the classic DELUSION OF PARASITOSIS, psychodermatosis that must be treated both the SKIN and the "PSYCHE STATUS" of the patient. In other words there is a basic psychological condition that causes the disease and must be treated on 2 fronts: THE SKIN AND THE MIND.
2.) MORGELLON'S DISEASE is a NEW ENTITY which according to some scientists is highly related to LYME DISEASE, or Borreliosis. In this case "FIBERS" of color have been described that emerge from the skin of the affected, being denominated by some scientists: FILAMENTOUS BORRELIAL DERMATITIS.
This fact has provoked new studies "searching" for the origin of these fibers and the association with BORRELIA BURGDORFERI, some of them say they are "TEXTILE FIBERS" that the patient introduces into the superficial layer of the skin, others say that HISTOPATHOLOGY are elements "SYNTHESIZED BY KERATINOCYTES AND FIBROBLASTS, skin cells, composed of KERATIN AND COLLAGEN. And as for the presence of THE BORRELIA, in some studies the association has been found, the SPIROCHETES is found in the skin by biopsies, in others not even POSITIVE TEST has been found for this organism.
Now I will give you my SCIENTIFIC OPINION on this topic, because over the years I have seen in the Hospital and private consultation several cases of this disease.
The first of them will never forget: it was a DR. 60-year-old VETERINARY, with more than 25 years of animal treatment, who told me textually that day: ... "I have mites that walk me through my skin, they come down from my head all over my body ...." I took out a matchbox and said: "here is the proof" ..... opening the box, examine it and were scraps of hair, fibers etc ... Everything you can think But not mites.
I, the son of a dermatologist who practiced 55 years of the specialty, who already knew the pathology of THE DELUSION OF PARASITOSIS, also called DELUSIONAL DISEASE, explained to the patient the best I could, and of course I did not believe, typical of this disease. And so I could tell you many more cases. I think that in the case of the VETERINARY which I examined, he worked for more than 20 years with animals, at some point the mind "broke" and there began his illness.
With regard to the association of MORGELLON DISEASE with LYME DISEASE I tell you the following. Recall that in the previous editions of DERMAGIC EXPRESS on LYME DISEASE I always emphasize that:
1.) THE BORRELIA IS A SPIROCHAETE EQUAL THAN THE SYPHILIS.
2.) SYPHILIS HAS A TERTIARY STAGE THAT AFFECTS THE MIND PRODUCING MADNESS AND PSYCHOLOGICAL CHANGES IN HUMAN BEHAVIOR. THE BORRELIA BURDORFERI ALSO HAS A FINAL STAGE THAT AFFECTS THE MIND, DENOMINATED NEUROBORRELIOSIS
3.) IN THE CUTANEOUS LESION OF SYPHILIS HAS BEEN FOUND BY BIOPSY THE SPIROCHETES, WITH THE BORRELIA BURGDORFERI HAVE OCCURRED THE SAME.
WHAT DOES THIS MEAN? That NEUROBORRELIOSIS can affect the mental capacity of those affected, producing a "psychological break" that will take the patient along the path of MORGELLONS DISEASE or DELUSION OF PARASITOSIS, as you want to call it.
And to finish I tell you the following: I DO NOT BELIEVE THAT THE SKIN OR NONE OF ITS COMPONENTS, LIKE THE KERATINOCYTES OR FIBROBLASTS, IS ABLE TO SYNTHESIZE "FIBERS OF COLORS", THAT DOES NOT EXIST IN DERMATOLOGY, human skin can manifest many conditions: Papules, pustules, hyperpigmentation, hypopigmentation, ulcers, etc. BUT TO SYNTHESIZE "FIBERS OF COLORS" NEVER, it is my opinion.
If you check the bibliographical references that I place there, you will be able to find the two points of view that explain to you about MORGELLON DISEASE. You will even find scientific studies showing the TEXTILE COLOR FIBERS "and the association with BORRELIA BURGORFERI, in others the denial of it.
I hope that having helped you to clarify this topic so much discussed today, I believe that MORGELLON'S DISEASE AND DELUSION OF PARASITOSIS, are the same disease with different names and that in both cases you must treat THE MIND and the SKIN and if the patient results Positive for BORRELIOSIS, establish the appropriate treatment.
Greetings to all.
Dr. José Lapenta.
========================================================================
In other words, these patients are PSYCHOLOGICALLY affected who have and feel that "STRANGE ANIMALS, INSECTS, AND PARASITES" have colonized their skin producing DERMATOLOGICAL DISEASES, typically characterized as being in many cases" AUTO PROVOCATED "by themselves.
The patient arrives at the consultation with the FAMOUS SIGN DESIGNED "THE BOX OF MATCHES" where he shows the doctor "THE PARASITES" that has been extracted from his skin, which in reality are, SKIN, HAIR REMAINS, TEXTIL FIBERS, AND OTHER THINGS, "but the patient is firmly convinced that they are PARASITES that he has extracted from his skin.
This is where the concept of MORGELLONS comes in, which was introduced by a BIOANALYST named Mary Leitao (Pennsylvania) in the year 2.002 when her sick son told the mother that it was extracted from the skin by scratching some strange "things" similar to blue and gray fibers. She related this event to another event in the years 1.690 where a French Thomas Browne first described this entity in children who appeared in the back PUSTULES AND PILOUS CYST, known at that time popularly as "MORGELLONS"
The word MORGELLON means in ancient Provencal language, "SMALL FLY". Since 2.002, this pathology has been studied and new cases have been published by scientists, including the CDC (Center for the Control and Contagious Diseases), who concluded in 2.006 that " IN THE PATHOLOGICAL ANALYSIS PARASITES WERE NOT FOUND".
In the chapter on PSYCHODERMATOLOGY there is a topic well studied and explained in the dermatology known under the name DELUSION OF PARASITOSIS that I described above. Today there are 2 trends regarding this disease:
1.) MORGELLON'S DISEASE is a variant of the classic DELUSION OF PARASITOSIS, psychodermatosis that must be treated both the SKIN and the "PSYCHE STATUS" of the patient. In other words there is a basic psychological condition that causes the disease and must be treated on 2 fronts: THE SKIN AND THE MIND.
2.) MORGELLON'S DISEASE is a NEW ENTITY which according to some scientists is highly related to LYME DISEASE, or Borreliosis. In this case "FIBERS" of color have been described that emerge from the skin of the affected, being denominated by some scientists: FILAMENTOUS BORRELIAL DERMATITIS.
This fact has provoked new studies "searching" for the origin of these fibers and the association with BORRELIA BURGDORFERI, some of them say they are "TEXTILE FIBERS" that the patient introduces into the superficial layer of the skin, others say that HISTOPATHOLOGY are elements "SYNTHESIZED BY KERATINOCYTES AND FIBROBLASTS, skin cells, composed of KERATIN AND COLLAGEN. And as for the presence of THE BORRELIA, in some studies the association has been found, the SPIROCHETES is found in the skin by biopsies, in others not even POSITIVE TEST has been found for this organism.
Now I will give you my SCIENTIFIC OPINION on this topic, because over the years I have seen in the Hospital and private consultation several cases of this disease.
The first of them will never forget: it was a DR. 60-year-old VETERINARY, with more than 25 years of animal treatment, who told me textually that day: ... "I have mites that walk me through my skin, they come down from my head all over my body ...." I took out a matchbox and said: "here is the proof" ..... opening the box, examine it and were scraps of hair, fibers etc ... Everything you can think But not mites.
I, the son of a dermatologist who practiced 55 years of the specialty, who already knew the pathology of THE DELUSION OF PARASITOSIS, also called DELUSIONAL DISEASE, explained to the patient the best I could, and of course I did not believe, typical of this disease. And so I could tell you many more cases. I think that in the case of the VETERINARY which I examined, he worked for more than 20 years with animals, at some point the mind "broke" and there began his illness.
With regard to the association of MORGELLON DISEASE with LYME DISEASE I tell you the following. Recall that in the previous editions of DERMAGIC EXPRESS on LYME DISEASE I always emphasize that:
1.) THE BORRELIA IS A SPIROCHAETE EQUAL THAN THE SYPHILIS.
2.) SYPHILIS HAS A TERTIARY STAGE THAT AFFECTS THE MIND PRODUCING MADNESS AND PSYCHOLOGICAL CHANGES IN HUMAN BEHAVIOR. THE BORRELIA BURDORFERI ALSO HAS A FINAL STAGE THAT AFFECTS THE MIND, DENOMINATED NEUROBORRELIOSIS
3.) IN THE CUTANEOUS LESION OF SYPHILIS HAS BEEN FOUND BY BIOPSY THE SPIROCHETES, WITH THE BORRELIA BURGDORFERI HAVE OCCURRED THE SAME.
WHAT DOES THIS MEAN? That NEUROBORRELIOSIS can affect the mental capacity of those affected, producing a "psychological break" that will take the patient along the path of MORGELLONS DISEASE or DELUSION OF PARASITOSIS, as you want to call it.
And to finish I tell you the following: I DO NOT BELIEVE THAT THE SKIN OR NONE OF ITS COMPONENTS, LIKE THE KERATINOCYTES OR FIBROBLASTS, IS ABLE TO SYNTHESIZE "FIBERS OF COLORS", THAT DOES NOT EXIST IN DERMATOLOGY, human skin can manifest many conditions: Papules, pustules, hyperpigmentation, hypopigmentation, ulcers, etc. BUT TO SYNTHESIZE "FIBERS OF COLORS" NEVER, it is my opinion.
If you check the bibliographical references that I place there, you will be able to find the two points of view that explain to you about MORGELLON DISEASE. You will even find scientific studies showing the TEXTILE COLOR FIBERS "and the association with BORRELIA BURGORFERI, in others the denial of it.
I hope that having helped you to clarify this topic so much discussed today, I believe that MORGELLON'S DISEASE AND DELUSION OF PARASITOSIS, are the same disease with different names and that in both cases you must treat THE MIND and the SKIN and if the patient results Positive for BORRELIOSIS, establish the appropriate treatment.
Greetings to all.
Dr. José Lapenta.
EDITORIAL ESPAÑOL
=================
Hola amigos de la red DERMAGIC EXPRESS hoy te trae otro tema interesante LA ENFERMEDAD DE MORGELLON, REVISION, enfermedad ancestral que hoy día está siendo relacionada con la ENFERMEDAD DE LYME, y bastante cuestionada porque algunos científicos la consideran UNA NUEVA ENTIDAD, y otros creen firmemente que esta enfermedad es una variante de la ILUSION DE PARASITOSIS, ampliamente descrita en el capítulo de las PSICODERMATOLOGIA.
=================
Hola amigos de la red DERMAGIC EXPRESS hoy te trae otro tema interesante LA ENFERMEDAD DE MORGELLON, REVISION, enfermedad ancestral que hoy día está siendo relacionada con la ENFERMEDAD DE LYME, y bastante cuestionada porque algunos científicos la consideran UNA NUEVA ENTIDAD, y otros creen firmemente que esta enfermedad es una variante de la ILUSION DE PARASITOSIS, ampliamente descrita en el capítulo de las PSICODERMATOLOGIA.
Dicho en otras palabras se trata de pacientes afectados PSICOLOGICAMENTE los
cuales tienen y sienten que “ANIMALES EXTRAÑO, INSECTOS, Y PARASITOS han
colonizado su piel produciéndoles ENFERMEDADES DERMATOLOGICAS, típicamente
caracterizadas por ser en muchos de los casos “AUTO PROVOCADAS” por ellos
mismos.
El paciente llega a la consulta con el FAMOSOS SIGNO DENOMINADO “LA CAJA DE
CERILLAS O FOSFOROS” donde le muestra al médico “LOS PARASITOS” que se ha
extraído de su piel, los cuales en realidad, son, RESTOS DE PIEL, CABELLO,
FIBRAS TEXTILES”, pero el paciente está firmemente convencido de que son
PARASITOS que ha extraído de su piel.
Aquí es donde entra el concepto de MORGELLONS, el cual fue introducido por una
BIOANALISTA llamada Mary Leitao (Pensilvania) en el año 2.002 cuando su hijo
enfermo le dijo a la madre que se extraía de la piel al rascarse unos extrañas
"cosas" similares a fibras azuladas y grises. Ella relaciono este evento con
otro lejanamente ocurrido en los años 1.690 donde un Francés Thomas Browne
describió por primera vez esta entidad en niños a quienes le aparecían en la
espalda PUSTULAS ENQUISTADAS y PILOSAS, conocidas en esa época popularmente como
“MORGELLONS”
La palabra MORGELLON significa en lenguaje provenzal antiguo, PEQUEÑA MOSCA.
Desde ese año 2.002 comenzó a estudiarse esta patología y publicarse nuevos
casos por científicos incluido el CDC ( Centro para el control de Enfermedades
Contagiosas) quien en el 2.006 concluyo que en “LOS ANALISIS DE PIEL ESTUDIADOS
NO SE ENCONTRARON PATOGENOS”.
En el capítulo de las PSICODERMATOSIS hay un tema bastante estudiado y explicado
en la dermatología conocido bajo el nombre de ILUSION DE PARASITOSIS que
describí anteriormente. Hoy día hay 2 tendencias con respecto a esta enfermedad:
1.) LA ENFERMEDAD DE MORGELLON es una variante de la clásica ILUSION DE
PARASITOSIS, psicodermatosis que debe ser tratada tanto la piel como el “ESTADO
MENTAL” del paciente. En otras palabras hay una afección psicológica de base que
provoca la enfermedad y debe ser tratada en 2 frentes: LA PIEL Y LA MENTE.
2.) LA ENFERMEDAD DE MORGELLON es una NUEVA ENTIDAD la cual según algunos
científicos está altamente relacionada con LA ENFERMEDAD DE LYME, o Borreliosis.
En este caso se han descrito “FIBRAS” de color que emergen de la piel de los
afectados, siendo denominada por algunos científicos: DERMATITIS BORRELIOSA
FILAMENTOSA.
Este hecho ha provocado nuevos estudios “buscando” el origen de esas fibras y la
asociación con LA BORRELIA BURGDORFERI, algunos de ellos dicen que son “FIBRAS
TEXTILES” que el paciente introduce en la capa superficial de la piel, otros
dicen que HISTOPATOLOGICAMENTE son elementos “SINTETIZADOS POR LOS
QUERATINOCITOS Y FIBROBLASTOS, células de la piel. compuestos por QUERATINA Y
COLAGENO. Y en cuanto a la presencia de LA BORRELIA, en algunos estudios se ha
encontrado la asociación, encontrándose LA ESPIROQUETA EN LA PIEL mediante
biopsias, en otros no se ha encontrado ni siquiera TEST POSITIVO para este
organismo.
Ahora te voy a dar MI OPINION científica sobre este tema, pues a lo largo de
estos años he visto en el Hospital y consulta privada varios casos de esta
enfermedad.
El primero de ellos nunca lo olvidare: se trataba de un DR. VETERINARIO de 60
años de edad, con más de 25 años tratando animales, el cual me dijo textualmente
aquel día: ...” tengo ácaros que me caminan por la piel, me bajan desde la
cabeza por todo el cuerpo....” saco de su bolsillo una CAJA DE CERILLAS" y me
dijo:....” aquí esta la prueba”..... abriendo la caja. La examine y eran restos
de cabello, fibras etc... Todo lo que puedas pensar pero no ácaros.
Yo, hijo de un dermatólogo que ejerció 55 años la especialidad, que ya me
conocía la patología de LA ILUSION DE PARASITOSIS, le explique al paciente lo
mejor que pude, y por supuesto no me creyó, típico de esta enfermedad. Y así les
podría contar muchos otros casos más. Pienso que en el caso del VETERINARIO, el
cual examino y trabajo por más de 20 años con animales, en algún momento se “le
quebró la mente” y allí comenzó su enfermedad.
Con respecto a la asociación de LA ENFERMEDAD DEMORGELLON con LA ENFERMEDAD DE
LYME les digo lo siguiente. Recordemos que en las previas ediciones del DERMAGIC
EXPRESS sobre la ENFERMEDAD DE LYME siempre hago énfasis que:
1.) LA BORRELIA ES UNA ESPIROQUETA IGUAL QUE LA SIFILIS.
2.) LA SIFILIS TIENE UNA ETAPA TERCIARIA QUE AFECTA LA MENTE PRODUCIENDO HASTA
LOCURA Y CAMBIOS PSICOLOGICOS EN EL COMPORTAMIENTO HUMANO. LA BORRELIA
BURDORFERI TAMBIEN TIENE UNA ETAPA FINAL QUE AFECTA LA MENTE, DENOMINADA
NEUROBORRELIOSIS
3.) EN LESIONES DE SIFILIS CUTANEAS SE HA ENCONTRADO POR BIOPSIA A LA
ESPIROQUETA, CON LA BORRELIA BURGDORFERI HA OCURRIDO LO MISMO.
QUE SIGNIFICA ESTO? Que la NEUROBORRELIOSIS puede afectar la capacidad mental de
los afectados, produciendo un “quiebre psicológico” que te va a llevar por el
camino de la ENFERMEDAD DE MORGELLONS o ILUSION DE PARASITOSIS, como tú quieras
denominarla.
Y para finalizar te digo lo siguiente: NO CREO QUE LA PIEL NI NINGUNO DE SUS
COMPONENTES, COMO LOS QUERATINOCITOS O FIBROBLASTOS, SEA CAPAZ DE SINTETIZAR
"FIBRAS DE COLORES" , ESO NO EXISTE EN LA DERMATOLOGIA, la piel humana puede
manifestar muchas condiciones: pápulas, pústulas, hiperpigmentacion, hipo
pigmentación, ulceras, etc. PERO SINTETIZAR "FIBRAS DE COLORES" JAMAS, es mi
opinión.
Si tú revisas bien las referencias bibliográficas que allí te coloque, podrás
encontrar los dos puntos de vista que te explique sobre la ENFERMEDAD DE
MORGELLONS. Incluso te encontraras estudios científicos donde se demuestra lo de
las FIBRAS DE COLORES" y la asociación con LA BORRELIA BURGORFERI. En otros la
negación de ello.
Espero que haberte ayudado en algo a aclarar este TEMA tan discutido hoy día,
creo que LA ENFERMEDAD DE MORGELLON e ILUSION DE PARASITOSIS, son la misma
enfermedad con diferentes nombres y que en ambos casos debes tratar LA MENTE y
la PIEL y si el paciente resulta positivo para BORRELIOSIS, instaurar el
tratamiento adecuado.
Saludos a Todos.
Dr. José Lapenta.
=======================================================================
REFERENCIAS BIBLIOGRAFICAS/ BIBLIOGRAPHICAL REFERENCES
=======================================================================
1.) Morgellons Disease; experiences of an integrated multidisciplinary dermatology team to achieve positive outcomes.
2.) Morgellons Disease.
3.) History of Morgellons disease: the same name for different psychodermatologic diseases?
4. ) Morgellons disease, illuminating an undefined illness: a case series.
5.) Morgellons disease: a filamentous borrelial dermatitis.
6.) Disorder or delusion? Living with Morgellons disease.
7.) Morgellons: contested illness, diagnostic compromise and medicalisation.
8.) The first investigative science-based evidence of Morgellons psychogenesis.
9.) Exploring the association between Morgellons disease and Lyme disease: identification of Borrelia burgdorferi in Morgellons disease patients.
10.) Characterization and evolution of dermal filaments from patients with Morgellons disease.
11.) First isolation and molecular identification of Borrelia burgdorferi sensu stricto and Borrelia afzelii from skin biopsies of patients in Taiwan.
12.) The mystery of Morgellons disease: infection or delusion?
13.) Morgellons disease?
14.) Morgellons in dermatology.
15.) Intraoral Morgellons disease or delusional parasitosis: a first case report.
16.) Morgellons disease and delusions of parasitosis.
17.) Delusional infestation, including delusions of parasitosis: results of histologic examination of skin biopsy and patient-provided skin specimens.
18.) Association of spirochetal infection with Morgellons disease.
19.) Morgellons disease: Analysis of a population with clinically confirmed microscopic subcutaneous fibers of unknown etiology.
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==================================================================
1.) Morgellons Disease; experiences of an integrated multidisciplinary dermatology team to achieve positive outcomes.
===================================================================
J Dermatolog Treat. 2017 Jun 30:1-21. doi: 10.1080/09546634.2017.1349868. [Epub ahead of print]
Mohandas P1,2, Bewley A2, Taylor R2.
Author information
1
a Department of Dermatology , The Royal Derby Hospital , Derby DE 22 3NE.
2
b Department of Dermatology , The Royal London Hospital , London E11 1NR.
Abstract
BACKGROUND:
In recent years, there has been a reported increase in affliction of the skin with small fibres or other particles. The condition has been referred to as Morgellons disease. Patients present with stinging, burning or crawling sensations of the skin, with perceived extrusion of inanimate material alongside fatigue and other systemic symptoms. Sufferers often experience significant morbidity and reduction in quality of life.
OBJECTIVES:
We aimed to explore the various clinical presentations, management strategies and outcomes employed to treat this condition in our patients.
METHODS:
We conducted a retrospective case notes review of 35 patients referred to our multidisciplinary psycho-dermatology clinic at the Royal London Hospital between January 2004 and January 2017.
RESULTS:
The majority of patients were women (25) 71.4%, with a mean age of 54.6 years (26-80 years). Most (26) 74.2% were living alone. The average duration of illness prior to presentation was 3.8 years (4 months-20 years). Many patients had perceived precipitating factors (54.2%) and often self-diagnosed (28.5%). Psychiatric co-morbidities included 42.8% with depressive symptoms and 25.7% with anxiety. Substance misuse was elicited in five patients (14%). Management of patients included both the treatment of skin disease and psychosocial co-morbidities. Out of the 35 patients who attended (14) 40% cleared or showed significant improvement. Sixteen (45.7%) patients were stable and under review. One patient declined treatment and three did not attend review. One patient died from disease unrelated to her skin condition.
CONCLUSIONS:
Morgellons disease is a condition which is widely discussed on the internet and patients often self-diagnose. The course of the disease can be chronic and debilitating. For a positive outcome, it is important that a strong physican-patient relationship is cultivated. As demonstrated in this case series, managing patients holistically in an integrated multidisciplinary dermatology setting helps achieve positive outcomes.
================================================================
2.) Morgellons Disease.
================================================================
Ann Dermatol. 2017 Apr;29(2):223-225. doi: 10.5021/ad.2017.29.2.223. Epub 2017 Mar 24.
Ohn J1, Park SY1, Moon J1, Choe YS1, Kim KH1.
Author information
1
Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.
Abstract
Morgellons disease is a rare disease with unknown etiology. Herein, we report the first case of Morgellons disease in Korea. A 30-year-old woman presented with a 2-month history of pruritic erythematous patches and erosions on the arms, hands, and chin. She insisted that she had fiber-like materials under her skin, which she had observed through a magnifying device. We performed skin biopsy, and observed a fiber extruding from the dermal side of the specimen. Histopathological examination showed only mild lymphocytic infiltration, and failed to reveal evidence of any microorganism. The polymerase chain reaction for Borrelia burgdorferi was negative in her serum.
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3.) History of Morgellons disease: the same name for different psychodermatologic diseases?
===============================================================
Wien Med Wochenschr. 2017 Mar 15. doi: 10.1007/s10354-017-0552-8. [Epub ahead of print]
Ferreira BR1, Roccia MG2, Cardoso JC1, França K3,4, Wollina U5, Lotti T6, Fioranelli M7.
Author information
1
Dermatology Department, Coimbra Hospital and University Centre, Coimbra, Portugal.
2
University B.I.S. Group of Institutions, Punjab Technical University, Punjab, India.
3
Centro Studi per la Ricerca Multidisciplinare e Rigenerativa, Università Degli Studi "G. Marconi", Rome, Italy. k.franca@med.miami.edu.
4
Department of Dermatology and Cutaneous Surgery, Department of Psychiatry and Behavioral Sciences; Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, 1600 NW 10th Ave, 1140, 33136, Miami, FL, USA. k.franca@med.miami.edu.
5
Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany.
6
Centro Studi per la Ricerca Multidisciplinare e Rigenerativa, Università Degli Studi "G. Marconi", Rome, Italy.
7
Department of Nuclear Physics, Subnuclear and Radiation, Università Degli Studi "G. Marconi", Rome, Italy.
Abstract
"Morgellons disease" has been a controversial topic in the history of psychodermatology. The most consensual scientific opinion is that it is a primary psychiatric disorder, particularly, a delusional disorder, although others were also pointed out. Some authors have suggested that it may correspond to a common dermatosis with secondary psychopathology. The Morgellons Research Foundation has advocated that it is "an emerging infectious" entity. This paper intends to critically review the main ideas and controversies, since its first description.
===============================================================
4. ) Morgellons disease, illuminating an undefined illness: a case series.
==============================================================
Harvey WT, Bransfield RC, Mercer DE, Wright AJ, Ricchi RM, Leitao MM.
Abstract
INTRODUCTION:
This review of 25 consecutive patients with Morgellons disease (MD) was undertaken for two primary and extremely fundamental reasons. For semantic accuracy, there is only one "proven" MD patient: the child first given that label. The remainder of inclusive individuals adopted the label based on related descriptions from 1544 through 1884, an internet description quoted from Sir Thomas Browne (1674), or was given the label by practitioners using similar sources. Until now, there has been no formal characterization of MD from detailed examination of all body systems. Our second purpose was to differentiate MD from Delusions of Parasitosis (DP), another "informal" label that fit most of our MD patients. How we defined and how we treated these patients depended literally on factual data that would determine outcome. How they were labeled in one sense was irrelevant, except for the confusing conflict rampant in the medical community, possibly significantly skewing treatment outcomes.
CASE PRESENTATION:
Clinical information was collected from 25 of 30 consecutive self-defined patients with Morgellons disease consisting of laboratory data, medical history and physical examination findings. Abnormalities were quantified and grouped by system, then compared and summarized, but the numbers were too small for more complex mathematical analysis. The quantification of physical and laboratory abnormalities allowed at least the creation of a practical clinical boundary, separating probable Morgellons from non-Morgellons patients. All the 25 patients studied meet the most commonly used DP definitions.
CONCLUSIONS:
These data suggest Morgellons disease can be characterized as a physical human illness with an often-related delusional component in adults. All medical histories support that behavioral aberrancies onset only after physical symptoms. The identified abnormalities include both immune deficiency and chronic inflammatory markers that correlate strongly with immune cytokine excess. The review of 251 current NLM DP references leads us to the possibility that Morgellons disease and DP are grossly truncated labels of the same illness but with the reversal of the cause-effect order. Further, the patients' data suggest that both illnesses have an infectious origin.
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5.) Morgellons disease: a filamentous borrelial dermatitis.
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Middelveen MJ1, Stricker RB1.
Author information
1
International Lyme and Associated Diseases Society, Bethesda, MD, USA.
Abstract
Morgellons disease (MD) is a dermopathy characterized by multicolored filaments that lie under, are embedded in, or project from skin. Although MD was initially considered to be a delusional disorder, recent studies have demonstrated that the dermopathy is associated with tickborne infection, that the filaments are composed of keratin and collagen, and that they result from proliferation of keratinocytes and fibroblasts in epithelial tissue. Culture, histopathological and molecular evidence of spirochetal infection associated with MD has been presented in several published studies using a variety of techniques. Spirochetes genetically identified as Borrelia burgdorferi sensu stricto predominate as the infective agent in most of the Morgellons skin specimens studied so far. Other species of Borrelia including Borrelia garinii, Borrelia miyamotoi, and Borrelia hermsii have also been detected in skin specimens taken from MD patients. The optimal treatment for MD remains to be determined.
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6.) Disorder or delusion? Living with Morgellons disease.
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J Psychosoc Nurs Ment Health Serv. 2009 Aug;47(8):36-41. doi: 10.3928/02793695-20090706-03.
Simpson L1, Baier M.
Author information
1
DePaul Health Center, Bridgeton, MO, USA. lsimpso85@yahoo.com
Abstract
Whether Morgellons disease is a delusional disorder or even a disease has been a mystery for more than 300 years. Symptoms of Morgellons include crawling and stinging sensations, feeling of "bugs" and/or fiber-like material beneath the skin, disabling fatigue, and memory loss. The cause, transmission, and treatment are unknown. Research about Morgellons is staggeringly sparse and limited in scope. However, in recent years, discussion about Morgellons has become more common because of the Internet and online support groups. Mental health professionals and the general public need to be aware of the signs, symptoms, and treatment of this disease. Focusing on the disease and listening to patients can make a difference in the way health care professionals provide the best possible care for people with Morgellons.
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7.) Morgellons: contested illness, diagnostic compromise and medicalisation.
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Fair B1.
Author information
1
Department of Sociology, Brandeis University, Waltham, MA 02453-2728, USA. bpf@brandeis.edu
Abstract
The case of Morgellons illustrates how the emergence of a new medically contested illness intersected with and impacted on the diagnostic processes of an existing uncontested psychiatric condition, Delusional Parasitosis (DP). More specifically, the sociopolitical processes at play in the contested illness, Morgellons, dubiously reflect patient empowerment, as well the resilience and power of medical jurisdiction. This research offers insights into the contested illness and medicalisation literatures, and aims to bridge these two approaches towards the relationship between patient empowerment and medical authority, which I do through the notion of doctor-patient compromise. The data for this research come from a comprehensive qualitative analysis of Morgellons discourse through four key sources: the pro-Morgellons website Morgellons.org; the anti-Morgellons website Morgellonswatch.com; the popular media's portrayal of Morgellons; and the DP and Morgellons articles published in peer-reviewed medical journals, as made available on PubMed.
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8.) The first investigative science-based evidence of Morgellons psychogenesis.
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Ultrastruct Pathol. 2016 Sep-Oct;40(5):249-53. doi: 10.1080/01913123.2016.1190434. Epub 2016 Jun 7.
Roncati L1,2, Gatti AM3, Pusiol T2, Piscioli F2, Barbolini G1, Maiorana A1.
Author information
1
a Department of Diagnostic and Clinical Medicine and of Public Health , University of Modena and Reggio Emilia , Modena , Italy.
2
b Provincial Health Care Services , Institute of Pathology, Santa Maria del Carmine Hospital , Rovereto , Italy.
3
c National Research Council , Institute of Science and Technology for Ceramics , Faenza , Italy.
Abstract
Morgellons disease is an infrequent syndromic condition, that typically affects middle-aged white women, characterized by crawling sensations on and under the skin, associated with itchy rashes, stinging sores, fiber-like filaments emerging from the sores, severe fatigue, concentrating difficulty, and memory loss. The scientific community is prone to believe that Morgellons is the manifestation of various psychiatric syndromes (Munchausen, Munchausen by proxy, Ekbom, Wittmaack-Ekbom). Up until now, no investigative science-based evidence about its psychogenesis has ever been provided. In order to close this gap, we have analyzed the filaments extracted from the skin lesions of a 49-year-old Caucasian female patient, by using a Field Emission Gun-Environmental Electron Scanning Microscope equipped with an X-ray microprobe, for the chemico-elemental characterization of the filaments, comparing them with those collected during a detailed indoor investigation, with careful air monitoring, in her apartment. Our results prove the self-introduction under the epidermis of environmental filaments. For the first time in the literature, we have scientifically demonstrated the self-induced nature of Morgellons disease, thereby wiping out fanciful theories about its etiopathogenesis.
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9.) Exploring the association between Morgellons disease and Lyme disease: identification of Borrelia burgdorferi in Morgellons disease patients.
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BMC Dermatol. 2015 Feb 12;15:1. doi: 10.1186/s12895-015-0023-0.
Middelveen MJ1, Bandoski C2, Burke J3, Sapi E4, Filush KR5, Wang Y6, Franco A7, Mayne PJ8, Stricker RB9,10.
Author information
1
International Lyme and Associated Diseases Society, Bethesda, MD, USA. middel@telus.net.
2
Department of Biology and Environmental Science, University of New Haven, West Haven, CT, USA. cbandoski@forsyth.org.
3
Australian Biologics, Sydney, NSW, Australia. Jennie.burke@australianbiologics.com.au.
4
Department of Biology and Environmental Science, University of New Haven, West Haven, CT, USA. unh@evasapi.net.
5
Department of Biology and Environmental Science, University of New Haven, West Haven, CT, USA. KFilu1@unh.newhaven.edu.
6
Australian Biologics, Sydney, NSW, Australia. techinfo@australianbiologics.com.au.
7
Australian Biologics, Sydney, NSW, Australia. agustin.franco@optusnet.com.au.
8
International Lyme and Associated Diseases Society, Bethesda, MD, USA. LaurietonMedical@gmail.com.
9
International Lyme and Associated Diseases Society, Bethesda, MD, USA. rstricker@usmamed.com.
10
, 450 Sutter Street, Suite 1504, San Francisco, CA, 94108, USA. rstricker@usmamed.com.
Abstract
BACKGROUND:
Morgellons disease (MD) is a complex skin disorder characterized by ulcerating lesions that have protruding or embedded filaments. Many clinicians refer to this condition as delusional parasitosis or delusional infestation and consider the filaments to be introduced textile fibers. In contrast, recent studies indicate that MD is a true somatic illness associated with tickborne infection, that the filaments are keratin and collagen in composition and that they result from proliferation and activation of keratinocytes and fibroblasts in the skin. Previously, spirochetes have been detected in the dermatological specimens from four MD patients, thus providing evidence of an infectious process.
METHODS & RESULTS:
Based on culture, histology, immunohistochemistry, electron microscopy and molecular testing, we present corroborating evidence of spirochetal infection in a larger group of 25 MD patients. Irrespective of Lyme serological reactivity, all patients in our study group demonstrated histological evidence of epithelial spirochetal infection. Strength of evidence based on other testing varied among patients. Spirochetes identified as Borrelia strains by polymerase chain reaction (PCR) and/or in-situ DNA hybridization were detected in 24/25 of our study patients. Skin cultures containing Borrelia spirochetes were obtained from four patients, thus demonstrating that the organisms present in dermatological specimens were viable. Spirochetes identified by PCR as Borrelia burgdorferi were cultured from blood in seven patients and from vaginal secretions in three patients, demonstrating systemic infection. Based on these observations, a clinical classification system for MD is proposed.
CONCLUSIONS:
Our study using multiple detection methods confirms that MD is a true somatic illness associated with Borrelia spirochetes that cause Lyme disease. Further studies are needed to determine the optimal treatment for this spirochete-associated dermopathy.
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10.) Characterization and evolution of dermal filaments from patients with Morgellons disease.
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Clin Cosmet Investig Dermatol. 2013;6:1-21. doi: 10.2147/CCID.S39017. Epub 2013 Jan 8.
Middelveen MJ1, Mayne PJ, Kahn DG, Stricker RB.
Author information
1
International Lyme and Associated Diseases Society, Bethesda, MD, USA;
Abstract
Morgellons disease is an emerging skin disease characterized by formation of dermal filaments associated with multisystemic symptoms and tick-borne illness. Some clinicians hypothesize that these often colorful dermal filaments are textile fibers, either self-implanted by patients or accidentally adhering to lesions, and conclude that patients with this disease have delusions of infestation. We present histological observations and electron microscopic imaging from representative Morgellons disease samples revealing that dermal filaments in these cases are keratin and collagen in composition and result from proliferation and activation of keratinocytes and fibroblasts in the epidermis. Spirochetes were detected in the dermatological specimens from our study patients, providing evidence that Morgellons disease is associated with an infectious process.
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11.) First isolation and molecular identification of Borrelia burgdorferi sensu stricto and Borrelia afzelii from skin biopsies of patients in Taiwan.
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Int J Infect Dis. 2011 Mar;15(3):e182-7. doi: 10.1016/j.ijid.2010.11.002. Epub 2010 Dec 13.
Chao LL1, Chen YJ, Shih CM.
Author information
1
Department of Parasitology and Tropical Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.
Abstract
OBJECTIVES:
In order to clarify the transmission cycle and genetic identity of Borrelia spirochetes in the non-endemic country of Taiwan, the causative agents responsible for human borreliosis were isolated from skin biopsies of patients and their genetic identities were determined.
METHODS:
Serum samples and skin biopsy specimens were collected from 95 patients: 85 with suspected Lyme disease and 10 controls. Infection with Borrelia burgdorferi was verified by Western immunoblot analysis and isolation of the Borrelia spirochetes from skin biopsy specimens. The genetic identities of these isolated spirochetes were determined by analyzing the gene sequences amplified by polymerase chain reaction assay based on the 5S (rrf)-23S (rrl) intergenic spacer amplicon gene of B. burgdorferi sensu lato.
RESULTS:
Serological evidence of B. burgdorferi infection was confirmed by elevated IgG and IgM antibodies against the major protein antigens of B. burgdorferi. Borrelia spirochetes were isolated from the skin biopsies of two patients. Phylogenetic analysis revealed that these detected spirochetes were genetically affiliated to the genospecies Borrelia burgdorferi sensu stricto and Borrelia afzelii, with a high sequence homology within the genospecies of B. burgdorferi sensu stricto (98.7-100%) and B. afzelii (100%), respectively.
CONCLUSIONS:
This study provides convincing evidence of B. burgdorferi sensu stricto and B. afzelii isolated and identified for the first time in Taiwan, and highlights the significance of genetic diversity of Borrelia spirochetes among patients in Taiwan.
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12.) The mystery of Morgellons disease: infection or delusion?
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Am J Clin Dermatol. 2006;7(1):1-5.
Savely VR1, Leitao MM, Stricker RB.
Author information
1
South Austin Family Practice Clinic, Austin, Texas, USA.
Abstract
Morgellons disease is a mysterious skin disorder that was first described more than 300 years ago. The disease is characterized by fiber-like strands extruding from the skin in conjunction with various dermatologic and neuropsychiatric symptoms. In this respect, Morgellons disease resembles and may be confused with delusional parasitosis. The association with Lyme disease and the apparent response to antibacterial therapy suggest that Morgellons disease may be linked to an undefined infectious process. Further clinical and molecular research is needed to unlock the mystery of Morgellons disease.
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13.) Morgellons disease?
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Dermatol Ther. 2008 Jan-Feb;21(1):8-12. doi: 10.1111/j.1529-8019.2008.00164.x.
Accordino RE1, Engler D, Ginsburg IH, Koo J.
Author information
1
Department of Medical Education, Mount Sinai School of Medicine, New York, NY 10029, USA. Robert.accordino@mssm.edu
Abstract
Morgellons disease, a pattern of dermatologic symptoms very similar, if not identical, to those of delusions of parasitosis, was first described many centuries ago, but has recently been given much attention on the internet and in the mass media. The present authors present a history of Morgellons disease, in addition to which they discuss the potential benefit of using this diagnostic term as a means of building trust and rapport with patients to maximize treatment benefit. The present authors also suggest "meeting the patient halfway" and creating a therapeutic alliance when providing dermatologic treatment by taking their cutaneous symptoms seriously enough to provide both topical ointments as well as antipsychotic medications, which can be therapeutic in these patients.
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14.) Morgellons in dermatology.
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J Dtsch Dermatol Ges. 2010 Apr;8(4):234-42. doi: 10.1111/j.1610-0387.2009.07219.x. Epub 2009 Oct 29.
[Article in English, German]
Harth W1, Hermes B, Freudenmann RW.
Author information
1
Department of Dermatology and Allergology, Vivantes Klinikum Berlin Spandau, Germany. wolfgang.harth@vivantes.de
Abstract
Delusional parasitosis (DP) is the most frequent delusional disorder in dermatology. In DP there is a fixed belief of a usually skin-related invasion or infestation by a number of alleged infectious species (usually parasites and bacteria), whose identity has varied over the decades. Since 2002 worldwide an increasing number of patients have complained of unverifiable fibers and filaments in or on the skin, associated with numerous nonspecific complaints (arthralgias, altered cognitive function and extreme fatigue). This entity has been named "Morgellons disease" by the patients themselves, although medical evidence for its existence is lacking. As an example, we discuss a 55-year-old woman who complained of Morgellons disease and was treated as if she had DP. Currently the delusional assumption of infestation with Morgellons should be considered as a new type of DP with some kind of inanimate material. We therefore recommend in case of DP including Morgellons the use of the broader term "delusional infestation".
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15.) Intraoral Morgellons disease or delusional parasitosis: a first case report.
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Dovigi AJ1.
Author information
1
Midwestern University School of Dental Medicine, Glendale, AZ 85308, USA. adovig@midwestern.edu
Abstract
Morgellons disease is a new emerging disease that is still controversial and believed to be, by some practitioners, as nothing more than delusional parasitosis. The Center for Disease Control has recently launched an epidemiological investigation into this disease due to the increased number of reports. A first case is reported of an oral lesion and symptoms consistent with Morgellons disease. The nature of the characteristic fibers associated with the intraoral lesion is investigated. Research has started at a number of institutions to elucidate the nature of this emerging disease.
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16.) Morgellons disease and delusions of parasitosis.
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Am J Clin Dermatol. 2011 Feb 1;12(1):1-6. doi: 10.2165/11533150-000000000-00000.
Robles DT1, Olson JM, Combs H, Romm S, Kirby P.
Author information
1
Department of Medicine, University of Washington School of Medicine, Seattle, 98105-6524, USA.
Abstract
Morgellons disease is a controversial and poorly defined symptom cluster of skin lesions and somatic symptoms, most notably 'fibers' in the skin. Because of widespread coverage in the media and on the Internet, there are an increasing number of patients presenting to dermatologists. We present three patients who believed that they had fibers in their skin. We offer a discussion of delusions of parasitosis to demonstrate similarities between these conditions. It has been suggested by a limited number of healthcare providers that an unknown infectious agent underlies this symptom complex yet no available evidence supports this assertion. Laboratory values that would be reflective of an infectious process (e.g. elevated white blood cells, sedimentation rate, C reactive protein) are routinely normal and biopsies often reflect only nonspecific findings such as acute and chronic inflammation with erosion or ulceration. Patients with Morgellons disease generally lack insight into their disease and reject the need for psychiatric help. The goal is to build trust and refrain from minimizing what the patient experiences. Attentive examination of the patient's skin and fragments they present is necessary to rule out a true underlying pathologic process and to establish a trusting relationship. A supportive, non-confrontational approach is ideal. The patient is best treated by a team of practitioners of several specialties, including dermatologists, psychiatrists, and counselors.
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17.) Delusional infestation, including delusions of parasitosis: results of histologic examination of skin biopsy and patient-provided skin specimens.
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Arch Dermatol. 2011 Sep;147(9):1041-5. doi: 10.1001/archdermatol.2011.114. Epub 2011 May 16.
Hylwa SA1, Bury JE, Davis MD, Pittelkow M, Bostwick JM.
Author information
1
Department of Dermatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Abstract
OBJECTIVE:
To review the results of skin biopsies and patient-provided specimens from patients whose assessment was consistent with delusional infestation, including delusions of parasitosis.
DESIGN:
Retrospective medical record review.
SETTING:
Mayo Clinic, Rochester, Minnesota.
PATIENTS:
The study population comprised all patients who were seen at Mayo Clinic and had a diagnosis of delusional skin infestation, including delusions of parasitosis, between 2001 and 2007, and who underwent biopsies as part of their dermatologic evaluations or brought samples to their clinical consultations.
MAIN OUTCOME MEASURES:
The results of examination of these biopsy and patient-provided specimens.
RESULTS:
A total of 108 patients met inclusion criteria for this study: 80 received biopsies, 80 had self-procured skin specimens, and 52 patients received biopsies and provided specimens. No biopsy specimen (0 of 80) provided evidence to support skin infestation. The most common interpretations in the 80 biopsy specimens were dermatitis in 49 of 80 (61%); excoriation, ulceration, or erosion in 38 (48%); and nonspecific dermal inflammation in 25 (31%). Patient-provided specimens were most frequently assessed by the physician (generally a dermatologist) evaluating the patient, although 20 of the 80 samples (25%) were submitted for pathologic evaluation. Of these 80 specimens, 10 (13%) contained insects. All but 1 of the insects were noninfesting varieties; 1 (1%) was a pubic louse. The remaining findings consisted of cutaneous debris, environmental detritus, or plant material.
CONCLUSION:
In patients with suspected delusional infestation, neither skin biopsies nor examination of patient-provided specimens provided objective evidence of skin infestation.
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18.) Association of spirochetal infection with Morgellons disease.
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F1000Res. 2013 Jan 28;2:25. doi: 10.12688/f1000research.2-25.v1. eCollection 2013.
Middelveen MJ1, Burugu D2, Poruri A2, Burke J3, Mayne PJ1, Sapi E2, Kahn DG4, Stricker RB1.
Author information
1
International Lyme and Associated Diseases Society, Bethesda, MD, 20827, USA.
2
Department of Biology and Environmental Science, University of New Haven, West Haven, CT, 06516, USA.
3
Australian Biologics, Sydney, 2000, Australia.
4
Department of Pathology, Olive View-UCLA Medical Center, Sylmar, CA, 91342, USA.
Abstract
Morgellons disease (MD) is an emerging multisystem illness characterized by skin lesions with unusual filaments embedded in or projecting from epithelial tissue. Filament formation results from abnormal keratin and collagen expression by epithelial-based keratinocytes and fibroblasts. Recent research comparing MD to bovine digital dermatitis, an animal infectious disease with similar skin features, provided clues that spirochetal infection could play an important role in the human disease as it does in the animal illness. Based on histological staining, immunofluorescent staining, electron microscopic imaging and polymerase chain reaction, we report the detection of Borrelia spirochetes in dermatological tissue of four randomly-selected MD patients. The association of MD with spirochetal infection provides evidence that this infection may be a significant factor in the illness and refutes claims that MD lesions are self-inflicted and that people suffering from this disorder are delusional. Molecular characterization of the Borrelia spirochetes found in MD patients is warranted.
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19.) Morgellons disease: Analysis of a population with clinically confirmed microscopic subcutaneous fibers of unknown etiology.
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Clin Cosmet Investig Dermatol. 2010 May 13;3:67-78.
Savely VR1, Stricker RB.
Author information
1
TBD Medical Associates, San Francisco, CA, USA;
Abstract
BACKGROUND:
Morgellons disease is a controversial illness in which patients complain of stinging, burning, and biting sensations under the skin. Unusual subcutaneous fibers are the unique objective finding. The etiology of Morgellons disease is unknown, and diagnostic criteria have yet to be established. Our goal was to identify prevalent symptoms in patients with clinically confirmed subcutaneous fibers in order to develop a case definition for Morgellons disease.
METHODS:
Patients with subcutaneous fibers observed on physical examination (designated as the fiber group) were evaluated using a data extraction tool that measured clinical and demographic characteristics. The prevalence of symptoms common to the fiber group was then compared with the prevalence of these symptoms in patients with Lyme disease and no complaints of skin fibers.
RESULTS:
The fiber group consisted of 122 patients. Significant findings in this group were an association with tick-borne diseases and hypothyroidism, high numbers from two states (Texas and California), high prevalence in middle-aged Caucasian women, and an increased prevalence of smoking and substance abuse. Although depression was noted in 29% of the fiber patients, pre-existing delusional disease was not reported. After adjusting for nonspecific symptoms, the most common symptoms reported in the fiber group were: crawling sensations under the skin; spontaneously appearing, slow-healing lesions; hyperpigmented scars when lesions heal; intense pruritus; seed-like objects, black specks, or "fuzz balls" in lesions or on intact skin; fine, thread-like fibers of varying colors in lesions and intact skin; lesions containing thick, tough, translucent fibers that are highly resistant to extraction; and a sensation of something trying to penetrate the skin from the inside out.
CONCLUSIONS:
This study of the largest clinical cohort reported to date provides the basis for an accurate and clinically useful case definition for Morgellons disease.
REFERENCIAS BIBLIOGRAFICAS/ BIBLIOGRAPHICAL REFERENCES
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1.) Morgellons Disease; experiences of an integrated multidisciplinary dermatology team to achieve positive outcomes.
2.) Morgellons Disease.
3.) History of Morgellons disease: the same name for different psychodermatologic diseases?
4. ) Morgellons disease, illuminating an undefined illness: a case series.
5.) Morgellons disease: a filamentous borrelial dermatitis.
6.) Disorder or delusion? Living with Morgellons disease.
7.) Morgellons: contested illness, diagnostic compromise and medicalisation.
8.) The first investigative science-based evidence of Morgellons psychogenesis.
9.) Exploring the association between Morgellons disease and Lyme disease: identification of Borrelia burgdorferi in Morgellons disease patients.
10.) Characterization and evolution of dermal filaments from patients with Morgellons disease.
11.) First isolation and molecular identification of Borrelia burgdorferi sensu stricto and Borrelia afzelii from skin biopsies of patients in Taiwan.
12.) The mystery of Morgellons disease: infection or delusion?
13.) Morgellons disease?
14.) Morgellons in dermatology.
15.) Intraoral Morgellons disease or delusional parasitosis: a first case report.
16.) Morgellons disease and delusions of parasitosis.
17.) Delusional infestation, including delusions of parasitosis: results of histologic examination of skin biopsy and patient-provided skin specimens.
18.) Association of spirochetal infection with Morgellons disease.
19.) Morgellons disease: Analysis of a population with clinically confirmed microscopic subcutaneous fibers of unknown etiology.
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1.) Morgellons Disease; experiences of an integrated multidisciplinary dermatology team to achieve positive outcomes.
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J Dermatolog Treat. 2017 Jun 30:1-21. doi: 10.1080/09546634.2017.1349868. [Epub ahead of print]
Mohandas P1,2, Bewley A2, Taylor R2.
Author information
1
a Department of Dermatology , The Royal Derby Hospital , Derby DE 22 3NE.
2
b Department of Dermatology , The Royal London Hospital , London E11 1NR.
Abstract
BACKGROUND:
In recent years, there has been a reported increase in affliction of the skin with small fibres or other particles. The condition has been referred to as Morgellons disease. Patients present with stinging, burning or crawling sensations of the skin, with perceived extrusion of inanimate material alongside fatigue and other systemic symptoms. Sufferers often experience significant morbidity and reduction in quality of life.
OBJECTIVES:
We aimed to explore the various clinical presentations, management strategies and outcomes employed to treat this condition in our patients.
METHODS:
We conducted a retrospective case notes review of 35 patients referred to our multidisciplinary psycho-dermatology clinic at the Royal London Hospital between January 2004 and January 2017.
RESULTS:
The majority of patients were women (25) 71.4%, with a mean age of 54.6 years (26-80 years). Most (26) 74.2% were living alone. The average duration of illness prior to presentation was 3.8 years (4 months-20 years). Many patients had perceived precipitating factors (54.2%) and often self-diagnosed (28.5%). Psychiatric co-morbidities included 42.8% with depressive symptoms and 25.7% with anxiety. Substance misuse was elicited in five patients (14%). Management of patients included both the treatment of skin disease and psychosocial co-morbidities. Out of the 35 patients who attended (14) 40% cleared or showed significant improvement. Sixteen (45.7%) patients were stable and under review. One patient declined treatment and three did not attend review. One patient died from disease unrelated to her skin condition.
CONCLUSIONS:
Morgellons disease is a condition which is widely discussed on the internet and patients often self-diagnose. The course of the disease can be chronic and debilitating. For a positive outcome, it is important that a strong physican-patient relationship is cultivated. As demonstrated in this case series, managing patients holistically in an integrated multidisciplinary dermatology setting helps achieve positive outcomes.
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2.) Morgellons Disease.
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Ann Dermatol. 2017 Apr;29(2):223-225. doi: 10.5021/ad.2017.29.2.223. Epub 2017 Mar 24.
Ohn J1, Park SY1, Moon J1, Choe YS1, Kim KH1.
Author information
1
Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.
Abstract
Morgellons disease is a rare disease with unknown etiology. Herein, we report the first case of Morgellons disease in Korea. A 30-year-old woman presented with a 2-month history of pruritic erythematous patches and erosions on the arms, hands, and chin. She insisted that she had fiber-like materials under her skin, which she had observed through a magnifying device. We performed skin biopsy, and observed a fiber extruding from the dermal side of the specimen. Histopathological examination showed only mild lymphocytic infiltration, and failed to reveal evidence of any microorganism. The polymerase chain reaction for Borrelia burgdorferi was negative in her serum.
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3.) History of Morgellons disease: the same name for different psychodermatologic diseases?
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Wien Med Wochenschr. 2017 Mar 15. doi: 10.1007/s10354-017-0552-8. [Epub ahead of print]
Ferreira BR1, Roccia MG2, Cardoso JC1, França K3,4, Wollina U5, Lotti T6, Fioranelli M7.
Author information
1
Dermatology Department, Coimbra Hospital and University Centre, Coimbra, Portugal.
2
University B.I.S. Group of Institutions, Punjab Technical University, Punjab, India.
3
Centro Studi per la Ricerca Multidisciplinare e Rigenerativa, Università Degli Studi "G. Marconi", Rome, Italy. k.franca@med.miami.edu.
4
Department of Dermatology and Cutaneous Surgery, Department of Psychiatry and Behavioral Sciences; Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, 1600 NW 10th Ave, 1140, 33136, Miami, FL, USA. k.franca@med.miami.edu.
5
Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany.
6
Centro Studi per la Ricerca Multidisciplinare e Rigenerativa, Università Degli Studi "G. Marconi", Rome, Italy.
7
Department of Nuclear Physics, Subnuclear and Radiation, Università Degli Studi "G. Marconi", Rome, Italy.
Abstract
"Morgellons disease" has been a controversial topic in the history of psychodermatology. The most consensual scientific opinion is that it is a primary psychiatric disorder, particularly, a delusional disorder, although others were also pointed out. Some authors have suggested that it may correspond to a common dermatosis with secondary psychopathology. The Morgellons Research Foundation has advocated that it is "an emerging infectious" entity. This paper intends to critically review the main ideas and controversies, since its first description.
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4. ) Morgellons disease, illuminating an undefined illness: a case series.
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Harvey WT, Bransfield RC, Mercer DE, Wright AJ, Ricchi RM, Leitao MM.
Abstract
INTRODUCTION:
This review of 25 consecutive patients with Morgellons disease (MD) was undertaken for two primary and extremely fundamental reasons. For semantic accuracy, there is only one "proven" MD patient: the child first given that label. The remainder of inclusive individuals adopted the label based on related descriptions from 1544 through 1884, an internet description quoted from Sir Thomas Browne (1674), or was given the label by practitioners using similar sources. Until now, there has been no formal characterization of MD from detailed examination of all body systems. Our second purpose was to differentiate MD from Delusions of Parasitosis (DP), another "informal" label that fit most of our MD patients. How we defined and how we treated these patients depended literally on factual data that would determine outcome. How they were labeled in one sense was irrelevant, except for the confusing conflict rampant in the medical community, possibly significantly skewing treatment outcomes.
CASE PRESENTATION:
Clinical information was collected from 25 of 30 consecutive self-defined patients with Morgellons disease consisting of laboratory data, medical history and physical examination findings. Abnormalities were quantified and grouped by system, then compared and summarized, but the numbers were too small for more complex mathematical analysis. The quantification of physical and laboratory abnormalities allowed at least the creation of a practical clinical boundary, separating probable Morgellons from non-Morgellons patients. All the 25 patients studied meet the most commonly used DP definitions.
CONCLUSIONS:
These data suggest Morgellons disease can be characterized as a physical human illness with an often-related delusional component in adults. All medical histories support that behavioral aberrancies onset only after physical symptoms. The identified abnormalities include both immune deficiency and chronic inflammatory markers that correlate strongly with immune cytokine excess. The review of 251 current NLM DP references leads us to the possibility that Morgellons disease and DP are grossly truncated labels of the same illness but with the reversal of the cause-effect order. Further, the patients' data suggest that both illnesses have an infectious origin.
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5.) Morgellons disease: a filamentous borrelial dermatitis.
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Middelveen MJ1, Stricker RB1.
Author information
1
International Lyme and Associated Diseases Society, Bethesda, MD, USA.
Abstract
Morgellons disease (MD) is a dermopathy characterized by multicolored filaments that lie under, are embedded in, or project from skin. Although MD was initially considered to be a delusional disorder, recent studies have demonstrated that the dermopathy is associated with tickborne infection, that the filaments are composed of keratin and collagen, and that they result from proliferation of keratinocytes and fibroblasts in epithelial tissue. Culture, histopathological and molecular evidence of spirochetal infection associated with MD has been presented in several published studies using a variety of techniques. Spirochetes genetically identified as Borrelia burgdorferi sensu stricto predominate as the infective agent in most of the Morgellons skin specimens studied so far. Other species of Borrelia including Borrelia garinii, Borrelia miyamotoi, and Borrelia hermsii have also been detected in skin specimens taken from MD patients. The optimal treatment for MD remains to be determined.
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6.) Disorder or delusion? Living with Morgellons disease.
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J Psychosoc Nurs Ment Health Serv. 2009 Aug;47(8):36-41. doi: 10.3928/02793695-20090706-03.
Simpson L1, Baier M.
Author information
1
DePaul Health Center, Bridgeton, MO, USA. lsimpso85@yahoo.com
Abstract
Whether Morgellons disease is a delusional disorder or even a disease has been a mystery for more than 300 years. Symptoms of Morgellons include crawling and stinging sensations, feeling of "bugs" and/or fiber-like material beneath the skin, disabling fatigue, and memory loss. The cause, transmission, and treatment are unknown. Research about Morgellons is staggeringly sparse and limited in scope. However, in recent years, discussion about Morgellons has become more common because of the Internet and online support groups. Mental health professionals and the general public need to be aware of the signs, symptoms, and treatment of this disease. Focusing on the disease and listening to patients can make a difference in the way health care professionals provide the best possible care for people with Morgellons.
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7.) Morgellons: contested illness, diagnostic compromise and medicalisation.
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Fair B1.
Author information
1
Department of Sociology, Brandeis University, Waltham, MA 02453-2728, USA. bpf@brandeis.edu
Abstract
The case of Morgellons illustrates how the emergence of a new medically contested illness intersected with and impacted on the diagnostic processes of an existing uncontested psychiatric condition, Delusional Parasitosis (DP). More specifically, the sociopolitical processes at play in the contested illness, Morgellons, dubiously reflect patient empowerment, as well the resilience and power of medical jurisdiction. This research offers insights into the contested illness and medicalisation literatures, and aims to bridge these two approaches towards the relationship between patient empowerment and medical authority, which I do through the notion of doctor-patient compromise. The data for this research come from a comprehensive qualitative analysis of Morgellons discourse through four key sources: the pro-Morgellons website Morgellons.org; the anti-Morgellons website Morgellonswatch.com; the popular media's portrayal of Morgellons; and the DP and Morgellons articles published in peer-reviewed medical journals, as made available on PubMed.
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8.) The first investigative science-based evidence of Morgellons psychogenesis.
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Ultrastruct Pathol. 2016 Sep-Oct;40(5):249-53. doi: 10.1080/01913123.2016.1190434. Epub 2016 Jun 7.
Roncati L1,2, Gatti AM3, Pusiol T2, Piscioli F2, Barbolini G1, Maiorana A1.
Author information
1
a Department of Diagnostic and Clinical Medicine and of Public Health , University of Modena and Reggio Emilia , Modena , Italy.
2
b Provincial Health Care Services , Institute of Pathology, Santa Maria del Carmine Hospital , Rovereto , Italy.
3
c National Research Council , Institute of Science and Technology for Ceramics , Faenza , Italy.
Abstract
Morgellons disease is an infrequent syndromic condition, that typically affects middle-aged white women, characterized by crawling sensations on and under the skin, associated with itchy rashes, stinging sores, fiber-like filaments emerging from the sores, severe fatigue, concentrating difficulty, and memory loss. The scientific community is prone to believe that Morgellons is the manifestation of various psychiatric syndromes (Munchausen, Munchausen by proxy, Ekbom, Wittmaack-Ekbom). Up until now, no investigative science-based evidence about its psychogenesis has ever been provided. In order to close this gap, we have analyzed the filaments extracted from the skin lesions of a 49-year-old Caucasian female patient, by using a Field Emission Gun-Environmental Electron Scanning Microscope equipped with an X-ray microprobe, for the chemico-elemental characterization of the filaments, comparing them with those collected during a detailed indoor investigation, with careful air monitoring, in her apartment. Our results prove the self-introduction under the epidermis of environmental filaments. For the first time in the literature, we have scientifically demonstrated the self-induced nature of Morgellons disease, thereby wiping out fanciful theories about its etiopathogenesis.
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9.) Exploring the association between Morgellons disease and Lyme disease: identification of Borrelia burgdorferi in Morgellons disease patients.
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BMC Dermatol. 2015 Feb 12;15:1. doi: 10.1186/s12895-015-0023-0.
Middelveen MJ1, Bandoski C2, Burke J3, Sapi E4, Filush KR5, Wang Y6, Franco A7, Mayne PJ8, Stricker RB9,10.
Author information
1
International Lyme and Associated Diseases Society, Bethesda, MD, USA. middel@telus.net.
2
Department of Biology and Environmental Science, University of New Haven, West Haven, CT, USA. cbandoski@forsyth.org.
3
Australian Biologics, Sydney, NSW, Australia. Jennie.burke@australianbiologics.com.au.
4
Department of Biology and Environmental Science, University of New Haven, West Haven, CT, USA. unh@evasapi.net.
5
Department of Biology and Environmental Science, University of New Haven, West Haven, CT, USA. KFilu1@unh.newhaven.edu.
6
Australian Biologics, Sydney, NSW, Australia. techinfo@australianbiologics.com.au.
7
Australian Biologics, Sydney, NSW, Australia. agustin.franco@optusnet.com.au.
8
International Lyme and Associated Diseases Society, Bethesda, MD, USA. LaurietonMedical@gmail.com.
9
International Lyme and Associated Diseases Society, Bethesda, MD, USA. rstricker@usmamed.com.
10
, 450 Sutter Street, Suite 1504, San Francisco, CA, 94108, USA. rstricker@usmamed.com.
Abstract
BACKGROUND:
Morgellons disease (MD) is a complex skin disorder characterized by ulcerating lesions that have protruding or embedded filaments. Many clinicians refer to this condition as delusional parasitosis or delusional infestation and consider the filaments to be introduced textile fibers. In contrast, recent studies indicate that MD is a true somatic illness associated with tickborne infection, that the filaments are keratin and collagen in composition and that they result from proliferation and activation of keratinocytes and fibroblasts in the skin. Previously, spirochetes have been detected in the dermatological specimens from four MD patients, thus providing evidence of an infectious process.
METHODS & RESULTS:
Based on culture, histology, immunohistochemistry, electron microscopy and molecular testing, we present corroborating evidence of spirochetal infection in a larger group of 25 MD patients. Irrespective of Lyme serological reactivity, all patients in our study group demonstrated histological evidence of epithelial spirochetal infection. Strength of evidence based on other testing varied among patients. Spirochetes identified as Borrelia strains by polymerase chain reaction (PCR) and/or in-situ DNA hybridization were detected in 24/25 of our study patients. Skin cultures containing Borrelia spirochetes were obtained from four patients, thus demonstrating that the organisms present in dermatological specimens were viable. Spirochetes identified by PCR as Borrelia burgdorferi were cultured from blood in seven patients and from vaginal secretions in three patients, demonstrating systemic infection. Based on these observations, a clinical classification system for MD is proposed.
CONCLUSIONS:
Our study using multiple detection methods confirms that MD is a true somatic illness associated with Borrelia spirochetes that cause Lyme disease. Further studies are needed to determine the optimal treatment for this spirochete-associated dermopathy.
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10.) Characterization and evolution of dermal filaments from patients with Morgellons disease.
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Clin Cosmet Investig Dermatol. 2013;6:1-21. doi: 10.2147/CCID.S39017. Epub 2013 Jan 8.
Middelveen MJ1, Mayne PJ, Kahn DG, Stricker RB.
Author information
1
International Lyme and Associated Diseases Society, Bethesda, MD, USA;
Abstract
Morgellons disease is an emerging skin disease characterized by formation of dermal filaments associated with multisystemic symptoms and tick-borne illness. Some clinicians hypothesize that these often colorful dermal filaments are textile fibers, either self-implanted by patients or accidentally adhering to lesions, and conclude that patients with this disease have delusions of infestation. We present histological observations and electron microscopic imaging from representative Morgellons disease samples revealing that dermal filaments in these cases are keratin and collagen in composition and result from proliferation and activation of keratinocytes and fibroblasts in the epidermis. Spirochetes were detected in the dermatological specimens from our study patients, providing evidence that Morgellons disease is associated with an infectious process.
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11.) First isolation and molecular identification of Borrelia burgdorferi sensu stricto and Borrelia afzelii from skin biopsies of patients in Taiwan.
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Int J Infect Dis. 2011 Mar;15(3):e182-7. doi: 10.1016/j.ijid.2010.11.002. Epub 2010 Dec 13.
Chao LL1, Chen YJ, Shih CM.
Author information
1
Department of Parasitology and Tropical Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.
Abstract
OBJECTIVES:
In order to clarify the transmission cycle and genetic identity of Borrelia spirochetes in the non-endemic country of Taiwan, the causative agents responsible for human borreliosis were isolated from skin biopsies of patients and their genetic identities were determined.
METHODS:
Serum samples and skin biopsy specimens were collected from 95 patients: 85 with suspected Lyme disease and 10 controls. Infection with Borrelia burgdorferi was verified by Western immunoblot analysis and isolation of the Borrelia spirochetes from skin biopsy specimens. The genetic identities of these isolated spirochetes were determined by analyzing the gene sequences amplified by polymerase chain reaction assay based on the 5S (rrf)-23S (rrl) intergenic spacer amplicon gene of B. burgdorferi sensu lato.
RESULTS:
Serological evidence of B. burgdorferi infection was confirmed by elevated IgG and IgM antibodies against the major protein antigens of B. burgdorferi. Borrelia spirochetes were isolated from the skin biopsies of two patients. Phylogenetic analysis revealed that these detected spirochetes were genetically affiliated to the genospecies Borrelia burgdorferi sensu stricto and Borrelia afzelii, with a high sequence homology within the genospecies of B. burgdorferi sensu stricto (98.7-100%) and B. afzelii (100%), respectively.
CONCLUSIONS:
This study provides convincing evidence of B. burgdorferi sensu stricto and B. afzelii isolated and identified for the first time in Taiwan, and highlights the significance of genetic diversity of Borrelia spirochetes among patients in Taiwan.
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12.) The mystery of Morgellons disease: infection or delusion?
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Am J Clin Dermatol. 2006;7(1):1-5.
Savely VR1, Leitao MM, Stricker RB.
Author information
1
South Austin Family Practice Clinic, Austin, Texas, USA.
Abstract
Morgellons disease is a mysterious skin disorder that was first described more than 300 years ago. The disease is characterized by fiber-like strands extruding from the skin in conjunction with various dermatologic and neuropsychiatric symptoms. In this respect, Morgellons disease resembles and may be confused with delusional parasitosis. The association with Lyme disease and the apparent response to antibacterial therapy suggest that Morgellons disease may be linked to an undefined infectious process. Further clinical and molecular research is needed to unlock the mystery of Morgellons disease.
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13.) Morgellons disease?
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Dermatol Ther. 2008 Jan-Feb;21(1):8-12. doi: 10.1111/j.1529-8019.2008.00164.x.
Accordino RE1, Engler D, Ginsburg IH, Koo J.
Author information
1
Department of Medical Education, Mount Sinai School of Medicine, New York, NY 10029, USA. Robert.accordino@mssm.edu
Abstract
Morgellons disease, a pattern of dermatologic symptoms very similar, if not identical, to those of delusions of parasitosis, was first described many centuries ago, but has recently been given much attention on the internet and in the mass media. The present authors present a history of Morgellons disease, in addition to which they discuss the potential benefit of using this diagnostic term as a means of building trust and rapport with patients to maximize treatment benefit. The present authors also suggest "meeting the patient halfway" and creating a therapeutic alliance when providing dermatologic treatment by taking their cutaneous symptoms seriously enough to provide both topical ointments as well as antipsychotic medications, which can be therapeutic in these patients.
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14.) Morgellons in dermatology.
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J Dtsch Dermatol Ges. 2010 Apr;8(4):234-42. doi: 10.1111/j.1610-0387.2009.07219.x. Epub 2009 Oct 29.
[Article in English, German]
Harth W1, Hermes B, Freudenmann RW.
Author information
1
Department of Dermatology and Allergology, Vivantes Klinikum Berlin Spandau, Germany. wolfgang.harth@vivantes.de
Abstract
Delusional parasitosis (DP) is the most frequent delusional disorder in dermatology. In DP there is a fixed belief of a usually skin-related invasion or infestation by a number of alleged infectious species (usually parasites and bacteria), whose identity has varied over the decades. Since 2002 worldwide an increasing number of patients have complained of unverifiable fibers and filaments in or on the skin, associated with numerous nonspecific complaints (arthralgias, altered cognitive function and extreme fatigue). This entity has been named "Morgellons disease" by the patients themselves, although medical evidence for its existence is lacking. As an example, we discuss a 55-year-old woman who complained of Morgellons disease and was treated as if she had DP. Currently the delusional assumption of infestation with Morgellons should be considered as a new type of DP with some kind of inanimate material. We therefore recommend in case of DP including Morgellons the use of the broader term "delusional infestation".
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15.) Intraoral Morgellons disease or delusional parasitosis: a first case report.
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Dovigi AJ1.
Author information
1
Midwestern University School of Dental Medicine, Glendale, AZ 85308, USA. adovig@midwestern.edu
Abstract
Morgellons disease is a new emerging disease that is still controversial and believed to be, by some practitioners, as nothing more than delusional parasitosis. The Center for Disease Control has recently launched an epidemiological investigation into this disease due to the increased number of reports. A first case is reported of an oral lesion and symptoms consistent with Morgellons disease. The nature of the characteristic fibers associated with the intraoral lesion is investigated. Research has started at a number of institutions to elucidate the nature of this emerging disease.
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16.) Morgellons disease and delusions of parasitosis.
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Am J Clin Dermatol. 2011 Feb 1;12(1):1-6. doi: 10.2165/11533150-000000000-00000.
Robles DT1, Olson JM, Combs H, Romm S, Kirby P.
Author information
1
Department of Medicine, University of Washington School of Medicine, Seattle, 98105-6524, USA.
Abstract
Morgellons disease is a controversial and poorly defined symptom cluster of skin lesions and somatic symptoms, most notably 'fibers' in the skin. Because of widespread coverage in the media and on the Internet, there are an increasing number of patients presenting to dermatologists. We present three patients who believed that they had fibers in their skin. We offer a discussion of delusions of parasitosis to demonstrate similarities between these conditions. It has been suggested by a limited number of healthcare providers that an unknown infectious agent underlies this symptom complex yet no available evidence supports this assertion. Laboratory values that would be reflective of an infectious process (e.g. elevated white blood cells, sedimentation rate, C reactive protein) are routinely normal and biopsies often reflect only nonspecific findings such as acute and chronic inflammation with erosion or ulceration. Patients with Morgellons disease generally lack insight into their disease and reject the need for psychiatric help. The goal is to build trust and refrain from minimizing what the patient experiences. Attentive examination of the patient's skin and fragments they present is necessary to rule out a true underlying pathologic process and to establish a trusting relationship. A supportive, non-confrontational approach is ideal. The patient is best treated by a team of practitioners of several specialties, including dermatologists, psychiatrists, and counselors.
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17.) Delusional infestation, including delusions of parasitosis: results of histologic examination of skin biopsy and patient-provided skin specimens.
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Arch Dermatol. 2011 Sep;147(9):1041-5. doi: 10.1001/archdermatol.2011.114. Epub 2011 May 16.
Hylwa SA1, Bury JE, Davis MD, Pittelkow M, Bostwick JM.
Author information
1
Department of Dermatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Abstract
OBJECTIVE:
To review the results of skin biopsies and patient-provided specimens from patients whose assessment was consistent with delusional infestation, including delusions of parasitosis.
DESIGN:
Retrospective medical record review.
SETTING:
Mayo Clinic, Rochester, Minnesota.
PATIENTS:
The study population comprised all patients who were seen at Mayo Clinic and had a diagnosis of delusional skin infestation, including delusions of parasitosis, between 2001 and 2007, and who underwent biopsies as part of their dermatologic evaluations or brought samples to their clinical consultations.
MAIN OUTCOME MEASURES:
The results of examination of these biopsy and patient-provided specimens.
RESULTS:
A total of 108 patients met inclusion criteria for this study: 80 received biopsies, 80 had self-procured skin specimens, and 52 patients received biopsies and provided specimens. No biopsy specimen (0 of 80) provided evidence to support skin infestation. The most common interpretations in the 80 biopsy specimens were dermatitis in 49 of 80 (61%); excoriation, ulceration, or erosion in 38 (48%); and nonspecific dermal inflammation in 25 (31%). Patient-provided specimens were most frequently assessed by the physician (generally a dermatologist) evaluating the patient, although 20 of the 80 samples (25%) were submitted for pathologic evaluation. Of these 80 specimens, 10 (13%) contained insects. All but 1 of the insects were noninfesting varieties; 1 (1%) was a pubic louse. The remaining findings consisted of cutaneous debris, environmental detritus, or plant material.
CONCLUSION:
In patients with suspected delusional infestation, neither skin biopsies nor examination of patient-provided specimens provided objective evidence of skin infestation.
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18.) Association of spirochetal infection with Morgellons disease.
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F1000Res. 2013 Jan 28;2:25. doi: 10.12688/f1000research.2-25.v1. eCollection 2013.
Middelveen MJ1, Burugu D2, Poruri A2, Burke J3, Mayne PJ1, Sapi E2, Kahn DG4, Stricker RB1.
Author information
1
International Lyme and Associated Diseases Society, Bethesda, MD, 20827, USA.
2
Department of Biology and Environmental Science, University of New Haven, West Haven, CT, 06516, USA.
3
Australian Biologics, Sydney, 2000, Australia.
4
Department of Pathology, Olive View-UCLA Medical Center, Sylmar, CA, 91342, USA.
Abstract
Morgellons disease (MD) is an emerging multisystem illness characterized by skin lesions with unusual filaments embedded in or projecting from epithelial tissue. Filament formation results from abnormal keratin and collagen expression by epithelial-based keratinocytes and fibroblasts. Recent research comparing MD to bovine digital dermatitis, an animal infectious disease with similar skin features, provided clues that spirochetal infection could play an important role in the human disease as it does in the animal illness. Based on histological staining, immunofluorescent staining, electron microscopic imaging and polymerase chain reaction, we report the detection of Borrelia spirochetes in dermatological tissue of four randomly-selected MD patients. The association of MD with spirochetal infection provides evidence that this infection may be a significant factor in the illness and refutes claims that MD lesions are self-inflicted and that people suffering from this disorder are delusional. Molecular characterization of the Borrelia spirochetes found in MD patients is warranted.
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19.) Morgellons disease: Analysis of a population with clinically confirmed microscopic subcutaneous fibers of unknown etiology.
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Clin Cosmet Investig Dermatol. 2010 May 13;3:67-78.
Savely VR1, Stricker RB.
Author information
1
TBD Medical Associates, San Francisco, CA, USA;
Abstract
BACKGROUND:
Morgellons disease is a controversial illness in which patients complain of stinging, burning, and biting sensations under the skin. Unusual subcutaneous fibers are the unique objective finding. The etiology of Morgellons disease is unknown, and diagnostic criteria have yet to be established. Our goal was to identify prevalent symptoms in patients with clinically confirmed subcutaneous fibers in order to develop a case definition for Morgellons disease.
METHODS:
Patients with subcutaneous fibers observed on physical examination (designated as the fiber group) were evaluated using a data extraction tool that measured clinical and demographic characteristics. The prevalence of symptoms common to the fiber group was then compared with the prevalence of these symptoms in patients with Lyme disease and no complaints of skin fibers.
RESULTS:
The fiber group consisted of 122 patients. Significant findings in this group were an association with tick-borne diseases and hypothyroidism, high numbers from two states (Texas and California), high prevalence in middle-aged Caucasian women, and an increased prevalence of smoking and substance abuse. Although depression was noted in 29% of the fiber patients, pre-existing delusional disease was not reported. After adjusting for nonspecific symptoms, the most common symptoms reported in the fiber group were: crawling sensations under the skin; spontaneously appearing, slow-healing lesions; hyperpigmented scars when lesions heal; intense pruritus; seed-like objects, black specks, or "fuzz balls" in lesions or on intact skin; fine, thread-like fibers of varying colors in lesions and intact skin; lesions containing thick, tough, translucent fibers that are highly resistant to extraction; and a sensation of something trying to penetrate the skin from the inside out.
CONCLUSIONS:
This study of the largest clinical cohort reported to date provides the basis for an accurate and clinically useful case definition for Morgellons disease.
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