Morgellons disease: fibre or fiction?

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.