Morgellons disease: fibre or fiction?
S. Ogden and I. Coulson
Burnley General Hospital, Burnley, U.K.
A 45-year-old woman was referred to dermatology with a 3-
month history of small fibres of varying colour emanating from
her skin. She had brought to the consultation multiple microscope
slides with small coloured fibres mounted upon them that
she said had mainly arisen from underneath the skin of her
palms. She specifically denied any concerns that there was any
parasitic infestation of the skin, although she did describe her
condition as an ‘infection’ and bathed at least once daily in antiseptic.
She had diagnosed her condition as Morgellons disease
and had brought information about the disease downloaded
from the Internet. Examination was unremarkable; vitamin B12
levels and Lyme serology were checked and were normal. She
was reassured that there was no evidence of infection in her skin;
however, she declined referral to psychology or psychiatry services
and did not wish to consider treatment with antipsychotic
medication. Morgellons disease is considered by most dermatologists
to be synonymous with delusions of parasitosis a form of
monosymptomatic hypochondriacal psychosis. However, these
patients complain of fibres or granules emanating from the skin
rather than parasitic organisms. There may be an associated psychiatric
condition such as psychosis, depression or anxiety.
Patients report symptoms such as sensations of itching, burning
or things crawling on the skin as well as the production of fibres
or granules from the skin. The Morgellons Research Foundation
was formed in America in 2002 and is dedicated to ‘finding the
cause of an emerging infectious disease, which mimics scabies
and lice’. The founder of the Morgellons Research Foundation
derived the name from a condition described by Sir Thomas
Browne in the 17th century: ‘that endemial distemper of children
in Languedoc, called the morgellons, wherein they critically
break out with harsh hairs on their backs’. Management of
patients with this condition is challenging. Patients require thorough
examination and basic investigations to rule out organic
disease. It has been suggested that once organic disease has been
discounted, the use of the term ‘Morgellons disease’ when communicating
with patients about their condition may be a more
successful way of establishing a rapport, compared with the use
of the more traditional term of ‘delusion’, which is usually resisted.
Treatment options include antipsychotic medications such as
olanzapine, pimozide and risperidone. This is, to our knowledge,
the first reported British case of Morgellons disease. The case
highlights the ever-increasing role of the Internet in providing
patients with potentially misleading information that can encourage
self-diagnosis and resistance to appropriate treatments.
Dostları ilə paylaş: |