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CNS Spectr 2019 Feb;24(1):175-176

4Smell and Taste Treatment and Research Foundation,Chicago,IL.

Study ObjectiveDelusional parasitosis, or Ekbom syndrome, is a fixed false belief of being infested by parasites [Bellanger 2009]. With easy accessibility of the internet, serving as a vital tool in acquiring myriad information, these delusions typically arise and can be fueled by external sources as self-research [Bell2005]. For instance, garlic (allium sativum) has been reported to exhibit anthelmintic activity against cestodes (tapeworms), proving to be a natural treatmentoption [Abdel-Ghaffar 2010]. Read More

G Ital Dermatol Venereol 2019 Feb 14. Epub 2019 Feb 14.

University of California Riverside School of Medicine, Riverside, CA, USA.

Dermatol Online J 2018 Nov 15;24(11). Epub 2018 Nov 15.

Center for Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina.

Morgellons disease is a disfiguring and distressing condition. Patients commonly present with multiple, non-healing, cutaneous wounds. Patients report protruding fibers or other objects as the source and often provide samples to the clinician. Read More

Int J Womens Dermatol 2018 Dec 7;4(4):227-229. Epub 2018 Jul 7.

Henry Ford Medical Center, Department of Dermatology, Detroit, Michigan, United States.

The association between psychiatric and dermatologic disorders has been well characterized in the present literature with estimates of up to 40% of dermatology patients having concomitant psychiatric problems that are often related to their skin condition. Here, we present our experience regarding the implementation of a psychodermatology clinic in Detroit, Michigan. The most commonly referred conditions were delusions of parasitosis, neurotic excoriations, and isotretinoin initiation for patients with a history of psychiatric conditions. Read More

J Am Acad Dermatol 2019 May 11;80(5):1428-1434. Epub 2018 Dec 11.

Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina.

Delusional parasitosis is a monosymptomatic hypochondriacal state that causes great suffering for the patient and great suffering for those around them. Dermatologists are experts in the diagnosis of cutaneous disease and frequently encounter such patients. This review provides an overview of the diagnosis and management of delusional parasitosis and the differential diagnosis. Read More

Clin Dermatol 2018 Nov - Dec;36(6):748-755. Epub 2018 Aug 16.

Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA. Electronic address:

Dermatologists often find themselves treating patients with psychiatric disorders, most commonly anxiety and depression, in the context of skin disease. The psychiatric condition may either be present before the skin condition developed and exacerbate it or, in some cases, even create it (eg, delusions of parasitosis). Alternatively, the psychiatric condition may occur subsequent to the development of the dermatologic condition. Read More

Cureus 2018 Aug 8;10(8):e3120. Epub 2018 Aug 8.

Psychiatry, West Virginia School of Osteopathic Medicine, Martinsburg, USA.

This is a case report of delusional parasitosis in a 70-year-old woman. Delusional parasitosis, or delusional infestation, is a rare disorder typified by the false belief that an individual is infected with insects or parasites. Management focuses on developing a strong, caring relationship with the patient. Read More

Dermatol Online J 2018 Jan 15;24(1). Epub 2018 Jan 15.

Resident Medical Officer, Sir Charles Gairdner Hospital, Nedlands, Western Australia.

A large proportion of patients seen in dermatology practices have underlying psychological issues associated with their skin diseases. One of the most flagrant examples of this are patients with delusions of parasitosis. These patients have false fixed beliefs that they are infested by parasites and experience cutaneous sensations of crawling, biting, and stinging associated with their delusions. Read More

Prog Neuropsychopharmacol Biol Psychiatry 2018 03 24;82:115-122. Epub 2017 Nov 24.

Department of Psychiatry and Psychotherapy III, Ulm University, Germany.

Background: Monothematic delusional disorders are characterized by a single tenacious belief. They provide a great opportunity to study underlying brain structures in the absence of confounding symptoms that accompany delusions in schizophrenia. Delusional beliefs include persecution, jealousy or somatic delusions including infestation. Read More

JAMA Dermatol 2017 11;153(11):1136

Dermatology Clinic of Iowa, Cedar Rapids.

JAAD Case Rep 2017 Sep 30;3(5):390-391. Epub 2017 Aug 30.

Department of Dermatology, University of California San Francisco, San Francisco, California.

BJPsych Open 2017 May 9;3(3):154-158. Epub 2017 Jun 9.

, MD, FRCPsych, Departments of Psychiatry, Neurology, and Anaesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.

Background: Delusional parasitosis is infrequently seen in hospital-based consultation-liaison psychiatry.

Aims: Although there are many publications on delusional parasitosis, this report reviews a unique case that was diagnosed during a hospital admission and treated over the next 36 months.

Method: Case report and literature review. Read More

Clin Dermatol 2017 May - Jun;35(3):246-251. Epub 2017 Jan 22.

Department of Dermatology, Oregon Health & Science University School of Medicine, Portland, Oregon.

Somatic symptom disorder (SSD) is defined by the prominence of somatic symptoms associated with abnormal thoughts, feelings, and behaviors related to the symptoms, resulting in significant distress and impairment. Individuals with these disorders are more commonly encountered in primary care and other medical settings, including dermatology practice, than in psychiatric and other mental health settings. What defines the thoughts, feelings, and behaviors as abnormal is that they are excessive, that is, out of proportion to other patients with similar somatic symptoms, and that they result in significant distress and impairment. Read More

Clin Exp Dermatol 2017 Jan 9;42(1):41-45. Epub 2016 Dec 9.

Royal London Hospital, London, UK.

Background: Patients with delusional infestation (DI) believe that their skin is infested with organisms or inanimate particles, despite objective evidence to the contrary. Previous studies indicate a higher rate of recreational drug use among patients with DI. It is known that symptoms of infestation such as formication can be secondary to use of recreational drugs and alcohol. Read More

Am J Emerg Med 2017 Feb 29;35(2):357-360. Epub 2016 Oct 29.

Dermatology Service, Hospital do Meixoeiro and University of Vigo, Spain; Postdoctoral researcher, University of Vigo, Spain.

J Dermatolog Treat 2017 Jun 24;28(4):342-346. Epub 2016 Oct 24.

b Department of Dermatology, Psoriasis and Skin Treatment Center , University of California San Francisco , San Francisco , CA , USA.

Individuals with obsessive-compulsive features frequently visit dermatologists for complaints of the skin, hair or nails, and often progress towards a chronic relapsing course due to the challenge associated with accurate diagnosis and management of their psychiatric symptoms. The current DSM-5 formally recognizes body dysmorphic disorder, trichotillomania, neurotic excoriation and body focused repetitive behavior disorder as psychodermatological disorders belonging to the category of Obsessive-Compulsive and Related Disorders. However there is evidence that other relevant skin diseases such as delusions of parasitosis, dermatitis artefacta, contamination dermatitis, AIDS phobia, trichotemnomania and even lichen simplex chronicus possess prominent obsessive-compulsive characteristics that do not necessarily fit the full diagnostic criteria of the DSM-5. Read More

J Biosoc Sci 2016 09;48 Suppl 1:S116-47

†Department of Global Health and Development,London School of Hygiene and Tropical Medicine,UK.

Recent debates about deworming school-aged children in East Africa have been described as the 'Worm Wars'. The stakes are high. Deworming has become one of the top priorities in the fight against infectious diseases. Read More

Acta Derm Venereol 2016 Aug;96(217):58-63

Department of Psychiatry, Academic Medical Centre (AMC), PO Box 1105 AZ, 1106 AZ Amsterdam, The Netherlands.

Patients with a delusional infestation (DI) have an overwhelming conviction that they are being infested with (non) pathogens without any medical proof. The patients need a systematic psychiatric and dermatological evaluation to assess any possible underlying cause that could be treated. Because they avoid psychiatrists, a close collaboration of dermatologists and psychiatrists, who examine the patient together, seems to be a promising solution. Read More

Australas J Dermatol 2017 Aug 1;58(3):e113-e116. Epub 2016 Jun 1.

Deptartment of Psychiatry, Institute of Human Behaviour and Allied Sciences, Delhi, India.

Delusion of parasitosis is a rare condition characterised by an individual harbouring the delusion of being infested with insects or parasites. We report a rare and interesting case of delusion of parasitosis presenting as folie a deux, that is, the delusion is shared by both the parents of an 18-month-old child, with proxy projection of parental delusion on the child. The case highlights the rare concomitant occurrence of two psychocutaneous disorders and emphasizes the importance of early recognition and appropriate intervention to safeguard the well-being of the child. Read More

Rom J Intern Med 2016 Jan-Mar;54(1):66-9

Acquired perforating disorders are a group of uncommon skin conditions characterized by transepidermal extrusion of altered dermal material, most often associated with diabetes mellitus and chronic kidney failure. Delusional parasitosis is a primary psychiatric disorder in which affected patients have fixed, false beliefs that their skin is infested by parasites, in the absence of any evidence supporting their statements. A 69 year old malepatient addressed the Dermatology Department for a skin eruption consisting of multiple umbilicated keratotic papules with a generalized distribution. Read More

Australas Psychiatry 2016 Oct 13;24(5):462-5. Epub 2016 Apr 13.

Emeritus Professor of Clinical Psychology, Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia.

Objectives: Delusional infestation may present as a primary disorder or secondary to another disorder (e.g. schizophrenia). Read More

Environ Toxicol Pharmacol 2016 Apr 9;43:103-4. Epub 2016 Mar 9.

Department of Dermatology, Nicolina Medical Center, Iasi, Romania; Department of Dermato-Physiology, Apollonia University, Iasi, Romania. Electronic address:

We report a case of necrosis caused by the use of prallethrin (mosquito repellent) on the skin in a 67-year-old diabetic female patient suffering from delusions of parasitosis. Cutaneous toxicity due to pyrethroids is less known or reported, despite well-documented pyrethroid poisoning involving the gastrointestinal, respiratory, cardiac, and nervous systems. Skin irritation has been described after acute accidental exposure but, as far as we know, no data have been published on the effects of pyrethroids when applied directly to the skin. Read More

Acta Med Croatica 2016 ;70 Suppl 1:35-8

Psychodermatologic disorders are conditions involving an interaction between the mind and the skin. Correlation between psychiatric and dermatological disorders is a highly complex relation considering etiology, diagnostic procedures and treatment. There are three major groups of psychodermatological disorders: psychosomatic (psychophysiologic) disorders, primary psychiatric disorders and secondary psychiatric disorders. Read More

Int J Dermatol 2016 Aug 16;55(8):864-8. Epub 2015 Oct 16.

Department of Dermatology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.

Background: Monosymptomatic hypochondriac psychosis (MHP) patients present with a delusional ideation that revolves around one particular hypochondriac concern. Delusional infestation is the most common type of MHP seen by the dermatologist.

Objectives: This study was designed to retrospectively investigate a group of patients with delusions of infestation seen in an academic medical center in São Paulo, Brazil. Read More

Acta Dermatovenerol Croat 2015 ;23(2):87-95

Professor Aleksandra Basta-Juzbašić, MD, PhD, Department of Dermatology and Venereology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Šalata 4, 10000 Zagreb, Croatia;

Primary psychiatric disorders where skin changes appear most frequently include: delusions of parasitosis, body dysmorphic disorder, neurotic excoriations, dermatitis artefacta, and trichotillomania. In all these diseases the primary pathologic condition is of psychiatric nature, and the skin changes are secondary and self-induced. In this review we wanted to present the epidemiology, clinical pictures, and treatment options for these disorders. Read More

Clin Ophthalmol 2015 2;9:967-70. Epub 2015 Jun 2.

Department of Ophthalmology, Prince of Wales Hospital, Sydney, NSW, Australia.

This case report documents a 58-year-old male who presented to the clinic with a 12-month history of a burrowing sensation in his eyelids that he attributed to a parasitic infestation. After being extensively investigated and reviewed by relevant specialties, no evidence of parasitic infestation was found. He was diagnosed with and treated for blepharitis. Read More

G Ital Dermatol Venereol 2016 Oct 9;151(5):525-9. Epub 2015 Apr 9.

Department of Mental and Physical Health and Preventive Medicine, Second University of Naples, Naples, Italy -

Skin diseases (atopic eczema, psoriasis, idiopathic urticaria), systemic diseases (chronic hepatic or renal failure, morbus Hodgkin, diabetes mellitus) and psychiatric disorders (obsessive compulsive disorders, depression, delusions of parasitosis) can occur with itching. The aim of this review is to clarify the link between pruritus and psychiatric morbidity and emphasize the importance of a psychiatric consultation for patients with a chronic itching, without a skin disease. In the last years, there is a growing awareness regarding psychogenic itch, although these types of itch are significantly less studied in comparison to other types of pruritus. Read More

Pediatr Dermatol 2015 May-Jun;32(3):397-400. Epub 2015 Feb 2.

Department of Dermatology, Whipps Cross Hospital, Barts Health National Health Service Trust, Leytonstone, London, UK.

Delusional infestation (DI) is a reportedly uncommon psychocutaneous condition in which an individual holds a fixed, false belief of pathogenic infestation of the skin or body contrary to medical evidence. There are reports of such a delusion being shared with family members or close friends (folie a deux/famillie), but the implications of DI induced in children have not been discussed. We describe the case of a mother with DI whose children subsequently shared her belief. Read More

Case Rep Infect Dis 2014 25;2014:458028. Epub 2014 Dec 25.

Department of Infectious Diseases, Mater Health Services and Mater Medical Research Institute, Brisbane, QLD 4101, Australia ; School of Medicine, University of Queensland, Brisbane, QLD 4101, Australia ; The QIMR Berghofer Medical Research Institute, Brisbane, QLD 4101, Australia.

Introduction. Delusional infestation is a rare monosymptomatic hypochondriacal psychosis according to The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). Read More

J Dermatolog Treat 2015 Oct 20;26(5):456-60. Epub 2015 Jan 20.

b Department of Dermatology , Psoriasis and Skin Treatment Center, University of California , San Francisco , CA , USA.

Delusions of parasitosis (DoP) is a psychocutaneous condition characterized by a fixed false belief that one is infested by skin parasites. Patients afflicted with DoP generally experience sensations of biting, stinging or crawling in the absence of any objective evidence of infestation. The most definitive treatment for DoP is antipsychotic agents. Read More

J La State Med Soc 2014 Jul-Aug;166(4):154-9. Epub 2014 Aug 12.

Department of Dermatology, School of Medicine, Louisiana State University Health Sciences Center in New Orleans.

Physicians are not infrequently consulted by distraught patients with delusions of infestation who believe that they are infested with external or internal parasites and describe a crawling sensation of bugs or worms on or under their skin. Internet search engines were queried with the keywords as search terms to examine the latest articles on delusional infestations in order to describe presenting manifestations, differential diagnoses, and effective management strategies. The demographic and behavioral features of delusional infestations have remained constant and include: (1) onset in well-educated, middle-aged adults who are pet owners; (2) production of purported specimens of causative parasites; (3) pesticide overtreatment of themselves, their households, and pets; (4) excessive cleaning or vacuuming of households; (5) intense anger and resentment directed at physicians failing to confirm their self-diagnoses; and (6) sharing delusional symptoms with spouses or relatives. Read More

Can Vet J 2014 Sep;55(9):887-91

Veterinary Information Network, 777 West Covell Blvd, Davis, California, (Rishniw); Centre for Mental Health and Society, Bangor University, United Kingdom; Central Wrexham Community Mental Health Team, Betsi Cadwaladr University Health Board, Tŷ Derbyn, Wrexham Maelor Hospital, Croesnewydd Road, Wrexham LL13 7TD, Wales (Lepping); Department of Psychiatry and Psychotherapy, University of Ulm, Leimgrubenweg 12, D-89075 Ulm, Germany (Freudenmann).

Ned Tijdschr Geneeskd 2014 ;158:A7548

Koninklijke Luchtmacht.

Delusional infestation, formally known as delusional parasitosis, poses a therapeutic challenge. This article provides tools to engage these patients with psychiatric treatment. We present two men aged 49 and 48 who saw the dermatologist with skin symptoms due to primary and secondary delusional infestation, respectively. Read More

Cutis 2013 Dec;92(6):291-6

Department of Dermatology, 3301 C St, #1400, Sacramento, CA 95816, USA.

Trigeminal trophic syndrome (TTS) is a rare condition that results from a prior injury to the sensory distribution of the trigeminal nerve. Patients typically respond to the altered sensation with self-mutilation, most often of the nasal ala. We describe 3 patients with TTS who presented with self-induced ulcerations primarily involving the scalp. Read More

Semin Cutan Med Surg 2013 Jun;32(2):73-7

Department of Dermatology, University of California, 515 Spruce Street, San Francisco, CA 94118, USA.

The most common monosymptomatic hypochondriacal psychosis encountered by a dermatologist is delusions of parasitosis. In this condition, patients have an "encapsulated" fixed, false belief that they are infested with parasites or have foreign objects extruding from their skin. The patient will often experience feelings of biting, crawling and stinging related to the delusion. Read More

Dermatol Online J 2013 May 15;19(5):18169. Epub 2013 May 15.

UCSF Psoriasis and Skin Treatment Center, San Fancisco, CA 94118, USA.

When patients with psychodermatologic disorders present in clinic, the dermatologist can refer them to psychiatrists or other mental health care professionals. However, it is often the case that these patients will refuse a psychiatric referral because they either do not believe they have a disorder of psychiatric nature or they feel there is societal stigma associated with psychiatric illness. Therefore, it is essential for dermatologists to understand the common classifications for psychodermatological cases and to know how to optimally treat these patients with pharmacotherapy. Read More

Cutis 2012 Oct;90(4):E1-4

Asian J Psychiatr 2013 Aug 26;6(4):344-6. Epub 2013 Feb 26.

Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Chandigarh 160012, India.

Background: Neurocysticercosis (NCC) is the most serious form of cysticercal infection and is a major public health problem in the developing world. NCC presents with a range of psychiatric symptoms besides neurological symptoms. There have been few reports from the Asian continent describing the neuropsychiatric manifestations. Read More

Int J Dermatol 2013 Jul;52(7):838-9

Department of Dermatology, Duke University Medical Center, Durham, NC 27710, USA.

Int J Dermatol 2013 Jul;52(7):775-83

Transitional Year Medicine Program, Harbor-UCLA, Los Angeles, CA, USA.

Patients with delusional infestations (DI), previously named delusions of parasitosis, have a fixed, false belief that they are infested with living or non-living pathogens. Patients have abnormal cutaneous symptoms such as itching, biting, or crawling sensations. They often demonstrate self-destructive behavior in an effort to rid the pathogens from under their skin, leading to excoriations, ulcerations, and serious secondary infections. Read More

Prog Neuropsychopharmacol Biol Psychiatry 2013 Oct 19;46:19-24. Epub 2013 Jun 19.

Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Germany.

Little is known about the neural basis of delusional infestation (DI), the delusional belief to be infested with pathogens. Case series and the response to anti-dopaminergic medication indicate disruptions in dopaminergic neurotransmission in the striatum (caudate, putamen), but did not allow for population-based inference. Here, we report the first whole-brain structural neuroimaging study to investigate gray and white matter abnormalities in DI compared to controls. Read More

J Am Acad Dermatol 2013 Jul;69(1):156-9

Division of Dermatology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

Parkinsonism Relat Disord 2013 Aug 14;19(8):751-4. Epub 2013 May 14.

Movement Disorders Unit, Neurology Service, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil.

Background: Unusual delusional syndromes are rare protean diseases with speculative etiopathogenic mechanisms.

Methods: Seven consecutive patients with advanced PD were evaluated over a 15-year period at the Movement Disorders Unit in the Neurology Service, Hospital de Clínicas, Federal University of Paraná, and the Paraná State Parkinson's Patients Association.

Results: We describe advanced Parkinson's disease patients presenting with unusual delusional syndromes, including cases of Ekbom, Othello, Capgras' and Diogenes syndromes, reduplicative paramnesia and mirrored-self misidentification. Read More

Br J Dermatol 2013 Sep;169(3):607-10

Department of Dermatology, Royal London Hospital, Whitechapel, London, E1 1BB, U.K.

Background: Delusional infestation (DI) is the persistent belief of pathogenic infestation of the skin or body, without objective medical evidence. Treatment for symptoms of delusions can be particularly challenging, especially when patients are difficult to engage and adverse to the possibility of a nonskin disorder. To date there has been no study to evaluate patient adherence to DI treatment. Read More

Asian J Psychiatr 2013 Apr 3;6(2):124-7. Epub 2012 Nov 3.

Department of Psychiatry, UCMS & GTB Hospital, Delhi 110095, India.

Objective: Delusional infestation or delusional parasitosis is a form of monodelusional disorder, a condition sometimes encountered in psychiatric or primary care practice. The outcome of this condition is good when compliance can be ensured.

Patients And Methods: In the present study, a series of 50 consecutive cases of delusional infestation is reported. Read More

J Clin Psychopharmacol 2013 Apr;33(2):272-3

Arq Neuropsiquiatr 2013 Feb;71(2):131-2

J Drugs Dermatol 2012 Dec;11(12):1506-7

Department of Dermatology, University of Texas Southwestern, Austin, TX, USA.

Delusions of parasitosis (DOP) is a somatic subtype of delusional disorder, also known as monosymptomatic hypochondriacal psychosis. The management of DOP has been discussed extensively in the medical literature. Patients with suspected DOP have a broad differential diagnosis, including skin-based or systemic medical conditions and several kinds of psychiatric disease. Read More

Appl Neuropsychol Adult 2013 20;20(1):66-72. Epub 2012 Nov 20.

Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA.

Delusional parasitosis (DP) is a rare form of somatic delusions where a person believes that he or she is infected with worms, bugs, or other parasites. In the literature, DP has been discussed as a presenting feature of cortical dementias but has not been documented as a presenting feature in subcortical dementias such as HIV-associated dementia. We present a case of a 56-year-old male referred from the dermatology clinic for neuropsychological assessment after presenting with persisting claims that he was infected with "bugs" despite evidence to the contrary. Read More

Indian J Dermatol 2013 Jan;58(1):49-52

School of Medicine, University of Utah, Salt Lake City, UT, USA ; Department of Dermatology, University of California San Francisco, CA, USA.

Patients with delusions of parasitosis (DOP) are more commonly recognized in dermatology practices today. However, dermatologists may feel uncomfortable treating these patients because of the psychiatric nature of their disorder. As a result of the fact that DOP patients strongly prefer to seek treatment from dermatologists rather than mental health professionals, it is important for dermatologists to be well equipped with a basic understanding of the disorder and with tools to assist this patient population. Read More