OT:Morgellons disease: A rapport-enhancing term for delusions of parasitosis

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Morgellons disease: A rapport-enhancing term for delusions of parasitosis

Jenny E. Murase, MDa, Jashin J. Wu, MDa, John Koo, MDb

 

Article Outline

• References

• Copyright

 

To the Editor: A 45-year-old female presented to our clinic in March of

2005

armed with several small plastic bags filled with “fibers,†her magnifying

 

glass in hand. She had been to seven physicians the past four months, three

of

whom were dermatologists.

“Doctor, have you heard of Morgellons disease?â€

I explained that I had, and to my surprise, she burst into tears. She spent

the first few minutes of our conversation sobbing, relieved to have found a

physician who had heard of Morgellons disease.

 

Morgellons disease is not located in modern medical texts or online

journals. But a Goggle search will produce approximately 15,400 hits. Our

patient had

made this self-diagnosis by performing an internet search on “bugs in the

skin.†Patients regularly request information on Morgellons disease from

academic centers.

 

The Morgellons Research Foundation Web site can be found at

www.morgellons.org. This site describes the foundation's mission: “dedicated

to finding the

cause of an emerging infectious disease, which mimics scabies and lice.†On

this Web page, you will find pictures of the “mysterious fibers,†a

patient

registration page, a distinguished medical advisory board including six

doctorates, a description of the current research efforts of scientists in

Oklahoma,

and a request for donations to fund this research. The website claims over

3300 registrants.

 

They also have proposed an association with Lyme disease and encourage

patients to have Lyme titers drawn. The site further explains the history

behind

the term Morgellons, coined in 1674 by Sir Thomas Browne in his monograph

entitled “De vermiculis capillaribus infantium.â€1 To the layperson, the

information on this Web site is deceptive, particularly to someone who

suffers from

delusions of parasitosis.2, 3 However, because the term “Morgellons

diseaseâ€

 

does not have the word “delusions†embedded in the term, it is a useful

way

to communicate with patients regarding their disease. As a case in point, I

have established a close relationship with the patient described above by

referring to her delusions of parasitosis as Morgellons disease. After

taking

cultures and a biopsy, I reassured her that there were no bacterial, fungal,

or

parasitic infections. I emphasized that I did not doubt the authenticity of

the sensations she was experiencing, and I empathized with how

disconcerting it

must be to feel bugs crawling and stinging her skin. I explained that

sometimes medications that psychiatrists use to calm nerve signals help

patients

with Morgellons disease.

 

She is currently on the anti-psychotic risperidone, followed by both

dermatology and psychiatry.4 As is the case with the majority of patients

with

delusions of parasitosis, she will likely need anti-psychotic medications

long-term to keep her disease under control.

We caution that the use of the term “Morgellons disease†should not

validate an association with an infectious disease process. Further, in

order to

practice ethical patient care and to serve our patients honestly and as

best we

can, we stress the importance of clarifying to all delusions of parasitosis

patients that their condition is not a result of an infectious agent.

 

However, we found the term to be of paramount importance in establishing

patient confidence

and in developing patient–physician rapport throughout this patient's care.

Morgellons disease leaves us to gently question Shakespeare's age-old

adage:

does that which we call a rose truly smell as sweet by any other name?

 

References

1. 1Kellett CE. Sir Thomas Browne and the disease called the Morgellons.

Ann

Med His. 1935;7:467–479.

2. 2Koo J, Lebwohl A. Psycho dermatology: the mind and skin connection. Am

Fam Physician. 2001;64:1873–1878. Abstract | Full Text | PDF (85 KB) |

MEDLINE

3. 3Koo J, Lee CS. Delusions of parasitosis. A dermatologist's guide to

diagnosis and treatment. Am J Clin Dermatol. 2001;2:285–290. Full Text |

PDF (91

KB) | MEDLINE | CrossRef

4. 4Elmer KB, George RM, Peterson K. Therapeutic update: use of risperidone

for the treatment of monosymptomatic hypochondriacal psychosis. J Am Acad

Dermatol. 2000;43:683–686. Abstract | Full Text | PDF (95 KB) | MEDLINE |

CrossRef

a Departments of Dermatology, University of California, Irvine, Irvine,

California

b University of California, San Francisco, San Francisco, Ca