Morgellons
Overview
Morgellons disease is a mysterious skin disorder characterized by disfiguring sores and crawling sensations on and under the skin. Although Morgellons disease isn't widely recognized as a medical diagnosis, experts from the Centers for Disease Control and Prevention (CDC) are investigating reports of the condition, which they refer to as unexplained dermopathy.
Symptoms
* Skin lesions, often accompanied by pain or intense itching * Fibers — which may be white, blue, red or black — in and on the lesions * Crawling sensations on and under the skin, often compared to insects moving, stinging or biting * Joint and muscle pain * Fatigue significant enough to interfere with daily activity * Inability to concentrate and difficulty with short-term memory * Behavioral changes
Diagnosis
Many dermatologists refute the suggestion that this is an actual disease but instead indicate that many of these patients have psychological problems or other common skin disorders. Given the large numbers of individuals who feel that they have this affliction, it will be most helpful over the coming years to have a valid scientific assessment of Morgellons diesease and its possible etiology (or etiologies). One of the chief criticisms by many patients has been that they feel the medical community and other scientists consulted have not been open to the idea that there is possibly an as yet undescribed infectious or physiologic causation for the disease. However it is certainly true that in fact many expert parasitologists, medical entomologists and other microbiologists have in fact carefully examined fibers and other materials expressed or extracted from such patients and found that biological organisms are not present. Although an apparent association of the condition with the presence of Lyme disease has been reported (Savely et al, 2006, Am J Clin Dermatol, 7:1–6), further research will be needed to help resolve the validity of Morgellons disease. Until then, whether Morgellons disease is another name for delusional parasitosis or a real disease entity with a biologic or physiologic basis will remain up in the air.[40
Treatment
Many dermatologists treat Morgellons as delusional parasitosis. After a thorough medical examination to rule out known organic causes for the symptoms, delusional parasitosis patients are typically prescribed one of several typical antipsychotic drugs.[58][59] In the past, pimozide was the drug of choice; in addition to antipsychotic activity, it also has antipruritic activity, meaning it inhibits the sensation of itching.[60] However, pimozide requires frequent electrocardiographic monitoring.[59] Currently, atypical antipsychotics such as olanzapine or risperidone are used as first line treatment.[59] Antipsychotics are effective at treating delusional parasitosis at doses as low as one-fifth to one-tenth the dose typically prescribed for schizophrenia.[59] It is common for patients who believe they have Morgellons to reject a physician's diagnosis of delusional parasitosis. It has been suggested that the term Morgellons should be adopted by dermatologists to enhance their rapport with their patients, allowing them to overcome this resistance.[61] A Popular Mechanics article described a dermatologist who would not allow the use of his name, citing "concern for his safety." He said he has "diagnosed 50 or so Morgellons patients" with a disorder that can result in the sensation of insects, and "typically puts a cast over the lesions to prevent further irritation and after four weeks removes it." According to the doctor, the patients' lesions heal under the cast.[48]