Morgellons disease etiology and therapeutic approach: a systematic review

Morgellons disease: a narrative review

Morgellons disease is characterized by the persistent delusion of skin infestation, ultimately inflicting wounds and impairing quality of life. There is insufficient and conflicting research pertaining to this condition, imposing challenges on clinicians in understanding, diagnosing, and treating it. In this review, we summarize the available literature on Morgellons disease including its historical evolution, epidemiology, proposed pathophysiology, underlying structural and functional brain pathologies, typical and atypical clinical presentations, diagnosis, and treatment. A comprehensive review of the literature was conducted on PubMed, Embase, and Scopus using specified keywords. Selected articles were screened by two independent reviewers based on set inclusion and exclusion criteria. Conflicts were resolved by a third reviewer as needed. No limit to the date of selected articles was set due to the scarce literature available on the subject. Morgellons disease is an underdiagnosed entity, owing mostly to the lack of an established pathophysiology and treatment guidelines. While many authors classify it as a type of delusional infestation (DI), others correlate MD with an underlying spirochetal infection, namely Lyme disease. Neuroimaging studies have revealed abnormalities in the "fronto-striato-thalamo-parietal network", a finding common to patients with DI, in addition to alterations in structures related to the "Itch Processing Pathway". Patients tend to extract fibers from their skin lesions and place them in a match box hence the term "match box sign". The diagnosis is that of exclusion, requiring extensive work up to rule out secondary causes and differential diagnoses. Treatment is largely based on the use of antipsychotics, with or without cognitive behavioral therapy. Despite being a diagnosis of exclusion, clinicians must be aware of this entity and have a profound understanding of the pathogenesis underlying it. Upon clinical suspicion, secondary Morgellons should always be ruled out through a thorough history taking, physical examination, and laboratory exams. Despite the challenges brought by the heterogeneous presentation of the condition and the paucity of research revolving around it, the great impact that Morgellons disease has on patients' quality of life forms a pressing need for its adequate detection, diagnosis, and treatment.

Sears C, N. Karlin J. Perceived Conjunctival Foreign Material Egress in Morgellons Disease: A Case Study

The purpose of this report is to present a case of a 63-year-old man with orbital Morgellons disease. A 63-year-old man presented reporting 15 years of daily egress of different foreign bodies apparently found in the superior fornices of both eyes, exhibiting a classic manifestation known as the matchbox sign. He described the symptoms starting after a facial trauma. The patient stated that at several points over the 15-year course of his condition, he was so distressed that he had contemplated suicide. On multiple exams by a range of ophthalmic professionals, there was no evidence of foreign body. Further investigation involving MRI and plain radiographs demonstrated similar lack of findings. A trial of gabapentin was performed without improvement in symptoms. He discontinued care 5 months later. Morgellons disease is a poorly understood condition, particularly ophthalmic presentations of the disease. Despite extensive investigation, the exact cause of Morgellons disease remains unclear, and there is no definitive treatment for the condition. We highlight the importance of empathetic listening in building trust, as a means of helping the patient to seek psychological help.

Review of literature and clinical practice experience for the therapeutic management of Morgellons disease

Morgellons disease (MD) is a rare and contentious health condition characterized by dermatological symptoms including slow-healing skin lesions 'attributed' to fibres emerging from or under the skin. Patients also report sensations of crawling, biting and infestation with inanimate objects. This review examines the aetiology, patient characteristics, epidemiology, historical context, correlation with Lyme disease, role of internet, impact on quality of life and treatment approaches for MD. Despite ongoing debate, MD is not officially recognized in medical classifications, with differing views on its aetiology. Some link MD to Lyme disease, while others view it as a variant of delusional infestation. The literature suggests both psychiatric and environmental factors may contribute. The manuscript explores the association with substance abuse, psychiatric comorbidities, infectious agents and the role of internet communities in shaping perceptions. MD's impact on quality of life is significant, yet often overlooked. Treatment approaches are varied due to limited evidence, with low-dose antipsychotics being considered effective, but patient beliefs may influence adherence. A patient-centred, multidisciplinary approach is emphasized, considering both the physical and psychological dimensions of MD. Addressing the controversies surrounding MD while focusing on patient well-being remains a critical challenge for healthcare professionals.

“Doctor, You Must Examine My Creature Collection!”: A Case Report of Delusional Infestation

Delusional infestation--either secondary when attributed to a medical condition (including a bon-a-fide parasite infestation) or a pharmacologic agent (prescribed or illicit) or primary when secondary etiologies have been excluded--is a psychosis in which, for at least one month duration, the patient not only has a delusion that an animate organism or an inanimate pathogen has infested them, but also has abnormal tactile sensation (such as pruritus) of their skin caused by the etiology of their delusion. In patients over the age of 50 years, a delusional infestation is three times more common in women than men; however, delusional infestation in younger patients is often secondary, associated with illicit drug exposure, and equally common in women and men. Primary skin lesions are typically absent in delusional infestation patients; however, secondary skin lesions--resulting from the patient’s efforts to remove the parasite from their skin--can be observed, such as excoriations, prurigo nodules, scars, and ulcers. Delusional infestation patients typically strive to convince the person evaluating them that their infestation is valid and many of these individuals do this by collecting the parasites in a container. Presentation of the pathogen-filled containers is a pathognomonic feature of delusional infestation that has been referred to as either a positive creature collection sign, match box sign, parasite preservation sign, pillbox sign, or specimen sign. Morgellons disease--in which the pathogen being extruded from the skin is a fiber--has several features (including an excellent response to treatment with antipsychotic agents) in common with delusional infestation; therefore, most investigators consider Morgellons disease to be a variant of delusional infestation. Delusional infestation can be associated with numerous diseases, including comorbid psychiatric conditions. Indeed, up to 15 percent of delusional infestation patients have one (folie a deux) or more individuals with similar symptoms. A man with delusional infestation is described who had a positive creature collection sign, a fixed belief that his symptoms were caused by the infesting organism, and refusal to accept that he had a psychiatric disorder. He insisted that the evaluating dermatologist examine the pathogens in the clear plastic container he brought with him to his appointment. He was convinced that the pruritus of his scalp, eyebrows, and eyelashes was associated with a non-existent lice infestation. Secondary delusional infestation was excluded and his concurrent mild seborrheic dermatitis was treated topically; however, his itching did not resolve. He eventually agreed to seek treatment with a psychiatrist. The management of delusional infestation is based on its etiology; resolving the underlying medical condition or discontinuing the causative pharmacologic agent is the treatment approach for secondary delusional infestation, whereas low-dose antipsychotic agents are the intervention of choice for treating primary delusional infestation.