Delusional Parasitosis: More Than Just Skin-Deep - A Case Report

Abstract

Delusional parasitosis is an uncommon disorder and is probably underdiagnosed - several factors contribute including lack of recognition/difficulty in arriving to a conclusion by a clinician, or the reluctance to seek help or even rejection of the diagnosis by a patient. Patients present with pruritus, excoriations, stinging or formication for which no physical explanation can be found. There is the belief on the part of the patient that their skin is infested by insects or inanimate objects. It is estimated that a dermatologist may see one case every 7 years (Suh, 2018). Morgellons disease is a disputed condition which may fall under the umbrella term of delusional parasitosis. In this condition any areas of concern on the skin are believed to contain foreign material, usually coloured fibres. There is often an overlap of delusional parasitosis with other mental health problems such as depression and anxiety. Successful treatment requires a multi-modal approach in the form of medication (usually antipsychotics), psychotherapy and the input of various specialists (dermatology and psychiatry). Primary care -general practitioners in particular - has a central role to play by orchestrating this process so that a satisfactory outcome is achieved.