Morgellons Research Articles

Morgellons disease shows a lower quality of life than psoriasis, atopic dermatitis, and prurigo nodularis.

Morgellons disease (MD) greatly affects a patient’s quality of life (QoL). Therefore, we aimed to measure the disease burden of MD on QoL and compare it with well-funded dermatological conditions, including prurigo nodularis (PN), atopic dermatitis (AD) and psoriasis. This qualitative cross-sectional survey, comprising Dermatology Life Quality Index (DLQI), Pittsburgh Sleep Quality Index (PSQI) and 5-D itch scale questionnaires, was distributed to patients with untreated MD seen at the Oregon Health and Science University Dermatology clinic from July 2022 to July 2023. When comparing mean scores across dermatological conditions, MD had significantly higher DLQI scores than PN, AD and psoriasis, and significantly higher PSQI scores than AD and psoriasis.

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.

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.

Dermatology urgent care model reduces costs and healthcare utilization for psychodermatology patients - a retrospective chart review.

Patients with psychiatric dermatoses may be high users of healthcare, especially emergency services. A dermatology urgent care model may reduce healthcare utilization in this population. To determine whether a dermatology urgent care model can reduce healthcare utilization among patients with psychiatric dermatoses. We conducted a retrospective chart review of patients seen in dermatology urgent care at Oregon Health and Science University between 2018 and 2020 with diagnoses of Morgellons disease and neurotic excoriations. Rates of diagnosis-related healthcare visits and emergency department visits were annualized before and during engagement with the dermatology department. Rates were compared using paired t-tests. We found an 88.0% reduction in annual rates of healthcare visits (P<0.001) and 77.0% reduction in emergency room visits (P<0.003). Results were unchanged when controlled for gender identity, diagnosis, and substance use. We could not account for healthcare use not included in electronic health record. Urgent care models in dermatology may reduce overuse of healthcare and emergency services among patients with psychiatric dermatoses.

Management of delusions of parasitosis: an interview with experts in psychodermatology.

Delusions of parasitosis (DOP), which is also called Morgellons disease or delusional infestation, can be one of the most challenging clinical encounters in a dermatologist’s practice. One reason for this is lack of education during dermatology residency and a paucity of resources for the practicing dermatologist such as specialized psychodermatology clinics for these patients. To help close this knowledge gap, an interview was conducted with 3 experts in the field of psychodermatology and their responses were recorded and edited with goal of improving care for patients suffering from DOP by educating the busy, practicing dermatologist. The experts discussed many topics regarding DOP including the difference between primary and secondary DOP, how to build a good rapport with DOP patients, why the condition is seen mostly in older woman, and which medications are effective for treatment. The interview ends with a few high-yield practical treatment tips.

Demystifying Morgellons Disease

Morgellons disease is an understudied complex of physical and psychological symptoms that requires further research because medical authorities have diagnosed and treated patients’ symptoms as delusional. In contrast, other studies have demonstrated a connection between the hallmark subcutaneous fibers and spirochetal infection. The literature includes case reports of Morgellons treated as delusional infestation with antipsychotic drugs to a certain degree of success, reinforcing the thesis of Morgellons as a purely psychological disease but not addressing the etiology of the somatic symptoms. An under-designed CDC study has similarly concluded that no single joint infectious agent exists in Morgellons disease patients. However, other small sample size case reports identified a common microorganism, Borrelia, and concluded it could cause symptoms as a single species of a more extensive polymicrobial infection. Much literature exists discussing the difficulty in diagnosing polymicrobial infections and the role that they may play in neurodegenerative diseases. This literature review aims to find common ground between these seemingly opposing schools of thought by demonstrating that their findings are not mutually exclusive. The efficacy of antipsychotic drugs does not exclude the possibility of Morgellons having organic pathophysiology. Similarly, studies demonstrating a lack of a single common microorganism in Morgellons patients do not prove that Morgellons disease is not infectious in origin. Establishing that these theories coexist is the aim of this review and demonstrating that further studies, case reports, and clinical trials are necessary to develop a common diagnosis and effective treatments.

Morgellons disease etiology and therapeutic approach: a systematic review.

Morgellons disease is characterized by patient reports of fibers embedded in and protruding from the skin. Etiologies from infection to delusion have been endorsed, and treatment guidelines are not well-defined. The objective of this manuscript is to evaluate the existing evidence regarding the etiology and treatment of Morgellons disease in an effort to better inform clinical management. A PubMed search including key words "Morgellons," "delusional parasitosis and fibers," "delusions of parasitosis and fibers," or "delusional infestation and fibers" was completed. Original publications directly assessing etiology or treatment methods of Morgellons disease published between January, 2010 and the time of manuscript preparation were reviewed and evaluated. Sixteen articles regarding etiology were reviewed. All studies were correlative in nature with various limitations. Support for a psychiatric etiology was more widespread than support for an infectious etiology. Eleven articles regarding treatment efficacy were reviewed. Antipsychotic regimens have the most evidence of efficacy. Existing data regarding Morgellons disease suggests a psychiatric etiology and supports treatment with a low-dose antipsychotic agent once non-psychiatric causes have been excluded.

Risk of Neurodegeneration in Patients with Morgellons Disease: A Focus on the Potential Risk of Developing Alzheimer’s

Morgellons disease is a distressing dermatologic condition that typically presents with multiple, non-healing skin lesions with filamentous protrusions. Initial presentation of the condition can often include various neurological symptoms with dermatologic symptoms. Common neurological symptoms include neuropathy, cognitive impairment, and dementia. Recent studies reveal that spirochetes are a causative agent of Morgellons disease. Chronic spirochete infection is strongly associated with neurodegeneration seen in dementia and Alzheimer’s disease. This paper will provide a brief overview of Morgellons and Alzheimer’s disease and will explore the possible risk of developing Alzheimer’s in Morgellons patients.

Morgellons Disease: The Spread of a Mass Psychogenic Illness via the Internet and Its Implications in Hand Surgery.

Somatic manifestations of mental illness sometimes occur in patients presenting to hand specialists. These conversion disorders can also occur in groups, a phenomenon known as "mass psychogenic illness." The increasing penetrance of the Internet and social media in modern society has greatly facilitated the interaction of patients with others with similar disorders. One example relevant to hand surgery is "Morgellons disease," a disorder popularized in 2002 and characterized by a firm belief in foreign material extruding from the skin, leading to nonhealing, self-inflicted ulcerations and excoriations. A series of 4 patients collected through an informal survey of hand surgeons regarding experience with Morgellons disease is reviewed and discussed. All patients in the series presented with a chief complaint of foreign material extruding from the hand. In 1 case, the complaint was made by a young patient's mother. In none of the patients were foreign bodies identified, although 2 patients demonstrated significant ulcerations and scars from self-excoriation. Three patients had a somatic condition affecting the hand or upper extremity, 1 directly related to self-excoriation and 2 unrelated. Treatments, workups, and ultimate outcomes varied among patients. Patients presenting with Morgellons disease often undergo multiple unnecessary tests and are at risk of inappropriate procedures. It is therefore important that providers have a compassionate understanding of the involved psychology. Herein, we offer an approach to the recognition of and treatment strategies for these patients.

Dissociating Delusional Disorders and Infections from Dermatologic and Neurologic Effects of Morgellons Disease

Morgellons disease (MD) is a multi-system disorder characterized by multicolor filaments extruding out of the skin along with an array of dermatologic and neuropsychiatric symptoms. It was previously termed Delusional parasitosis. However, published scientific data found the association of MD symptoms with the systemic manifestations of Lyme disease, caused by Borrelia spirochete. In a retrospective study of 122 MD patients, skin specimens were examined and 96% of them showed Borrelia spirochete in their histology sample. Hence, this association suggests that spirochete infection could be a possible cause of chronic illness in MD patients, and this rejected the physician’s perception that MD lesions might be self-inflicted. A cohort study reported tick-borne co-infections among MD patients, which could also be an etiological factor for dermopathy in MD patients. Some literature also discussed neuropsychiatric manifestations like cognitive impairment, dementia anxiety, depression, paranoia, and sensory hallucinations in Lyme disease and associated tick-borne infection. The objectives of this review are to identify the differences in the past and current perception regarding the pathogenesis of MD and determine the associations of spirochetal and tick-borne diseases with MD and psychiatric illnesses. More than 50 new research articles and case reports were reviewed and only 31 articles were shortlisted and used as references. This review has a detailed discussion on Morgellons disease and its association with Spirochete infection.

Association between Piscine Mycobacteriosis and Morgellons Disease: A Review of Literature

Piscine mycobacteriosis is a fatal fish illness that affects a variety of species globally. It affects over 200 species of freshwater and marine fish. Several species of Mycobacterium are responsible among them Mycobacterium marinum is the comment. It also affects humans when exposed to contaminated water. In fishes, the symptoms include eroded fins, body surface coated with heavy mucus, changing pigmentation, swelling of abdomen, ulcerative dermal necrosis, and scale loss. In humans, the infection is classified into three clinical groups. Type I is a self-limiting, verruca lesion. Type II is single or numerous subcutaneous granulomas in the presence or absence of ulceration. Type III is deep infections of the tenosynovium, bones, bursa, or joints, resulting in tenosynovitis, osteomyelitis, and septic arthritis. The diagnosis is made by Ziehl-Neelsen acid-fast staining, culture, biochemical reaction, and PCR being the most reliable approach. Piscine mycobacteriosis is treated by antibiotics and vaccination has been considered for its long-term prevention in order to reduce morbidity and mortality. Morgellons disease (MD) is a filamentous dermopathy in which lesions with strange filamentous inclusions appear out of nowhere. Furthermore, formication may accompany dermopathy. The identification of Borrelia spirochetes directly in Morgellons disease patient specimen is constant and repeatable when sensitive and precise detection techniques are utilized. It has been diagnosed by microscopy, histology and molecular diagnostic techniques which are highly sensitive and specific. Morgellons disease is still a myth therefore its treatment is evolving, up to date it has been treated symptomatically.

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

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.

Classification and Staging of Morgellons Disease: Lessons from Syphilis.

IntroductionMorgellons disease (MD) is a contested dermopathy that is associated with Borrelia spirochetal infection. A simple classification system was previously established to help validate the disease based on clinical features (classes I-IV).MethodsDrawing on historical and pathological parallels with syphilis, we formulated a more detailed staging system based on clinical features as well as severity of skin lesions and corresponding histopathological infection patterns, as determined by anti-Borrelia immunohistochemical staining.ResultsClinical classes I-IV of MD are further categorized as mild, moderate and severe, or stages A, B and C, respectively, based on histopathological findings. Stage A lesions demonstrated little or no immune infiltrates and little or no disorganization of cells; macrophages were not present, and hemorrhage was negligible. Extracellular isolated spirochetes and intracellular staining of keratinocytes in the lower epidermis was occasionally seen. Stage C lesions demonstrated positive staining of keratinocytes in the stratum basale and stratum spinosum and positive intracellular staining of macrophages for Borrelia. Aggregate Borrelia colonies were frequently encountered, hemorrhage was frequent, and intracellularly stained fibroblasts were occasionally seen. Stage B lesions demonstrated a pattern intermediate between Stages A and C.ConclusionThe enhanced staging system provides objective criteria to assess the severity of dermopathy in MD. Further studies are needed to determine the optimal treatment for MD based on this staging system related to Borrelia infection.

Morgellons disease: A mysterious & controversial entity with homoeopathic approach

Morgellons Disease is a dermopathy described by colorful fibers that lie under, are implanted in, or venture from skin. It is logically unverified skin condition in which people have wounds that they accept contains of stringy material. Morgellons disease isn't well understood, however it is the type of Delusional parasitosis. This article presents a concise review of the history of the mysterious disease, histopathology, symptomatology, prevalence, diagnostic approach and what Homoeopathy done for this controversial disease. Homoeopathy interconnect both mental and physical sphere, which helps the patient to recover soon. Morgellons disease treatment in modern medicine are antipsychotic medication, antidepressants and cognitive behavioural therapy. Morgellons disease is classified as a Delusion disorder in the Diagnostic and statistical Manuel of Mental disorders (DSM5). So, these article stress on the different point in concise manner and how Morgellons disease is managed by Homoeopathy, special stress on Sensation of the patient which is more important symptoms of this disease.

Mixed Borrelia burgdorferi and Helicobacter pylori Biofilms in Morgellons Disease Dermatological Specimens.

Background: Morgellons disease (MD) is a dermopathy that is associated with tick-borne illness. It is characterized by spontaneously developing skin lesions containing embedded or projecting filaments, and patients may also experience symptoms resembling those of Lyme disease (LD) including musculoskeletal, neurological and cardiovascular manifestations. Various species of Borrelia and co-infecting pathogens have been detected in body fluids and tissue specimens from MD patients. We sought to investigate the coexistence of Borrelia burgdorferi (Bb) and Helicobacter pylori (Hp) in skin specimens from MD subjects, and to characterize their association with mixed amyloid biofilm development. Methods: Testing for Bb and Hp was performed on dermatological specimens from 14 MD patients using tissue culture, immunohistochemical (IHC) staining, polymerase chain reaction (PCR) testing, fluorescent in situ hybridization (FISH) and confocal microscopy. Markers for amyloid and biofilm formation were investigated using histochemical and IHC staining. Results: Bb and Hp were detected in dermatological tissue taken from MD lesions. Bb and Hp tended to co-localize in foci within the epithelial tissue. Skin sections exhibiting foci of co-infecting Bb and Hp contained amyloid markers including β-amyloid protein, thioflavin and phosphorylated tau. The biofilm marker alginate was also found in the sections. Conclusions: Mixed Bb and Hp biofilms containing β-amyloid and phosphorylated tau may play a role in the evolution of MD.

Detection of tick-borne infection in Morgellons disease patients by serological and molecular techniques.

BackgroundMorgellons disease (MD) is a skin condition associated with Lyme disease (LD) and tick-borne illness. Patients with this skin disorder experience ulcerative lesions that contain multicolored filamentous collagen and keratin inclusions. Infection with various species of Borrelia and other tick-borne pathogens has been detected in tissue and body fluid specimens from MD patients. We sought to explore this association further in a cohort of MD patients.Patients and methodsSera from 30 patients with MD were tested for antibody reactivity to antigens from the Borrelia burgdorferi (Bb) group and the relapsing fever Borrelia (RFB) group of spirochetes. Tissue and/or body fluid specimens from these patients were also tested for the presence of Bb and RFB infection using PCR technology. In addition, tissue and body fluid specimens were tested for the presence of Bartonella henselae using PCR, and formalin-fixed skin sections from a subset of patients were tested using fluorescent in situ hybridization (FISH) with B. henselae-specific DNA probes.ResultsSeroreactivity to Bb, RFB or both was detected in 63% of the cohort, while positive PCR testing for Bb, RFB or both was detected in 53% of the cohort. Overall, 90% of patients tested positive for exposure and/or infection with Borrelia spirochetes. B. henselae infection was detected by PCR in skin sections or body fluids from 20% of the subjects, and B. henselae FISH testing was positive in 30% of the dermatological specimens submitted for study.ConclusionThe study demonstrates an association between MD and positive tests for both Bb and RFB spirochetes. In conjunction with previous studies, our study provides corroborative evidence linking MD to Borrelia infection and tick-borne illness.

Reframing delusional infestation: perspectives on unresolved puzzles.

Delusional infestation (DI), a debilitating psychocutaneous condition, featured as a false fixed belief of being infested accompanied by somatosensory abnormality, behavior alteration, and cognitive impairment. Although management of primary causes and pharmacotherapy with antipsychotics and/or antidepressants can help to alleviate symptoms in most patients, the underlying etiology of DI still remains unclear. Morgellons disease (MD), characterized by the presence of cutaneous filaments projected from or embedded in skin, is also a polemic issue because of its relationship with spirochetal infection. This review aims to discuss the following topics that currently confuse our understandings of DI: 1) the relationship of real/sham “infestation” with DI/MD; 2) behavior alterations, such as self-inflicted trauma; 3) neuroimaging abnormality and disturbance in neurotransmitter systems; and 4) impaired insight in patients with this disease. In discussion, we try to propose a multifactorial approach to the final diagnosis of DI/MD. Future studies exploring the neurobiological etiology of DI/MD are warranted.

Delusional infestation versus Morgellons disease

Delusional infestation is the conviction that one is infested with pathogens—either animate or inanimate—despite medical or microbiologic evidence to the contrary. Infestation with inanimate pathogens, specifically fibers or filaments, has been controversially termed Morgellons disease by the patients themselves, who believe that this is not a psychiatric disease but rather a new organic condition or a skin manifestation of an infection, such as Lyme disease. A large-scale study by the Centers of Disease Control and Prevention on patients presenting with Morgellons clinical manifestations did not find evidence of fibers in the skin nor an association with any infection, including Lyme disease. Once the diagnosis of delusional infestation is made, the cornerstone of treatment is antipsychotics, although this is often quite challenging, as patients are reluctant to take these medications.

Clinical evaluation of Morgellons disease in a cohort of North American patients.

Morgellons disease (MD) is a dermatological condition characterized by aberrant production of keratin and collagen fibers in skin. Although infection with Borrelia burgdorferi, the causative agent of Lyme disease (LD), has been associated with MD, relatively few studies have hitherto provided epidemiological evidence regarding this association. A cohort of 1000 seropositive North American LD patients was evaluated for the presence of MD. Patients were diagnosed with MD based on detection of microscopic fibers in skin lesions or under unbroken skin. Demographic and clinical features of MD patients were analyzed, and laboratory testing for tickborne coinfections and other infectious agents, was performed. Subjective and objective features of MD were analyzed using statistical methods. Of 1000 seropositive LD patients, 60 (6%) were diagnosed with MD. Of these 60 patients, 75% were female and 78% presented in the late disseminated stage of MD. All 60 patients (100%) were seropositive for B. burgdorferi infection. Tickborne coinfections in these patients included Babesia spp (62%), Bartonella and Rickettsia (25% each), Ehrlichia (15%) and Anaplasma (10%). Helicobacter pylori was detected in 12% of MD patients. In all, 77% of MD patients had one or more coinfections. This study confirms recent findings that MD occurs in a limited subset of LD patients. The clinical and genetic determinants of MD in LD patients require further study.

History of Morgellons disease: from delusion to definition.

Morgellons disease (MD) is a skin condition characterized by the presence of multicolored filaments that lie under, are embedded in, or project from skin. Although the condition may have a longer history, disease matching the above description was first reported in the US in 2002. Since that time, the condition that we know as MD has become a polemic topic. Because individuals afflicted with the disease may have crawling or stinging sensations and sometimes believe they have an insect or parasite infestation, most medical practitioners consider MD a purely delusional disorder. Clinical studies supporting the hypothesis that MD is exclusively delusional in origin have considerable methodological flaws and often neglect the fact that mental disorders can result from underlying somatic illness. In contrast, rigorous experimental investigations show that this skin affliction results from a physiological response to the presence of an infectious agent. Recent studies from that point of view show an association between MD and spirochetal infection in humans, cattle, and dogs. These investigations have determined that the cutaneous filaments are not implanted textile fibers, but are composed of the cellular proteins keratin and collagen and result from overproduction of these filaments in response to spirochetal infection. Further studies of the genetics, pathogenesis, and treatment of MD are warranted.