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Evidence lacking for skin infestation in patients with delusions of parasitosis
Hylwa SA. Arch Dermatol.2011;doi:10.1001/archdermatol.2011.114.
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Mayo Clinic researchers observed no evidence of infesting organisms or materials in patients with suspected delusional infestation, or delusions of parasitosis, according to new study findings published in the Archives of Dermatology.
“Patients often feel that if only the doctors would look at their skin closely enough or do studies of their skin, they would see the infesting organisms and materials that they are seeing,” Mark D.P. Davis, MD, of the department of dermatology at the Mayo Clinic, told Infectious Disease News.
Minimal data describe the results of physician-obtained biopsy specimens or patient-provided specimens in patients with delusions of parasitosis.
In the current study, Davis and colleagues pooled data on medical records of patients with a diagnosis of delusional skin infestation who underwent biopsies during evaluations (n=80), brought self-procured skin specimens to consultations (n=80) or underwent biopsies and brought skin specimens (n=52) between 2001 and 2007. Seventy-five percent of patients were women; mean symptom duration was 2.3 years.
Patient reported materials infesting the skin included: bugs (79%), fibers (22%), worms (20%), speck (7%) and eggs (3%).
None of the skin biopsies indicated skin infestation. Rather, 61% of biopsies indicated dermatitis; 48% excoriation, ulceration, or erosion; and 31% displayed nonspecific dermal inflammation, according to the researchers.
Only one self-procured skin specimen was determined as an infesting parasite. “Although one specimen contained a true parasite (pubic louse), true infestation was not seen on the patient’s physical examination findings, and lice could not account for the patient’s numerous complaints, including extensive nail complaints,” the researchers wrote.
“The results of this study raise many questions concerning the value of skin biopsies in the context of a patient presenting with delusional infestation,” they wrote. “Intriguingly, the majority of skin biopsy results did show dermatitis, raising the possibility that skin inflammation and its attendant tactile discomfort might be the trigger provoking delusional symptoms in susceptible individuals.”
Disclosure: The researchers report no relevant financial disclosures.
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