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

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 Sep;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

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

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 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

Ann Dermatol Venereol 2013 Jan 20;140(1):59-62. Epub 2012 Dec 20.

Service de dermatologie, CHU de Brest, 2, avenue Foch, 29200 Brest, France.

J Med Case Rep 2013 Jan 10;7:17. Epub 2013 Jan 10.

Department of Psychiatry, Uskudar University Medical Faculty, Istanbul, Turkey.

Unlabelled:

Introduction: Delusional parasitosis is a rare, monosymptomatic psychosis involving a delusion of being infested with parasites. It is commonly observed among female patients over the age of 50. It is classified as a 'delusional disorder' according to the 10th revision of the International Classification of Diseases and as a 'delusional disorder - somatic type' according to the Diagnostic and Statistical Manual, Fourth Edition. Read More

Singapore Med J 2012 Dec;53(12):789-93

Department of Dermatology, Changi General Hospital,Singapore.

Introduction: Recognising and appropriately treating psychosomatic factors in dermatological conditions can have a significant positive impact on the outcomes of patients. Treatment of psychodermatological patients requires a multidisciplinary approach that involves dermatologists, psychiatrists and allied health professionals.

Methods: This was a retrospective case series of patients seen in our psychodermatology liaison conferences from November 2009 to July 2011. Read More

J Egypt Soc Parasitol 2012 Aug;42(2):417-30

Faculty of Medicine, Al-Fayoum University, Al-Fayoum, Egypt.

Entomophobia or acarophobia, parasitic dermatophobia (PD) or delusional parasitosis (DP) is a disorder in which affected individuals has the mistaken but unshakable belief (delusion) that they are infected by insects, spiders, scorpion, ticks, mites, parasitic worms, bacteria, or other living organisms. As with all delusions, this belief cannot be corrected by reasoning, persuasion, or logical argument. To avoid them, they may always be cleaning rooms, floors, doors, windows and scratching. Read More

J Parasitol 2013 Jun 30;99(3):583-5. Epub 2012 Nov 30.

Department of Entomology, University of California-Davis, 1 Shields Ave, Davis, California 95616, USA.

In 2004, an article in the Journal of the New York Entomological Society claimed that individuals with delusory parasitosis actually suffer from collembola infestations. The article has been critiqued for poor methodology and results that contradict all knowledge about collembolans. Less easily accounted for has been a figure in the article purporting to show a collembolan in a skin scraping. Read More

J Am Acad Dermatol 2013 Jan 8;68(1):41-6, 46.e1-2. Epub 2012 Oct 8.

Department of Dermatology, University of Texas Southwestern-Austin Program, Austin, Texas 78701, USA.

Background: There are few diagnostic tools available to the dermatologist to help in the diagnosis of patients with delusions of parasitosis (DOP).

Objective: We sought to find differences in presentation and clinical course between patients who received a final diagnosis of DOP and those who received a final diagnosis of a primary medical condition or other psychiatric disorder.

Methods: We performed a retrospective chart review of patients referred with a diagnosis of DOP. Read More

Case Rep Psychiatry 2012 5;2012:624235. Epub 2012 Sep 5.

University of Michigan, Ann Arbor, MI 48109, USA.

Objectives. To explore factors underlying the onset of delusional parasitosis; a condition in which an individual has a fixed, false belief that he/she is infested with insects. Case Description. Read More

Psychosomatics 2012 Sep-Oct;53(5):504-5; author reply 505-6

J Am Acad Dermatol 2013 Jan 3;68(1):47-52. Epub 2012 Sep 3.

Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.

Background: Dermatologists provide the bulk of psychocutaneous care; however, recent studies suggest that dermatologists believe they are largely underprepared to treat most psychocutaneous conditions.

Objective: We sought to identify gaps in psychodermatologic knowledge among practicing dermatologists in two academic institutions.

Methods: An online survey was sent to 59 dermatologists at the Massachusetts General Hospital (Boston, MA) and Brigham and Women's Hospital (Boston, MA) from July 2010 through October 2011. Read More

Arq Neuropsiquiatr 2012 Jul;70(7):553-4

Br J Dermatol 2012 Aug 14;167(2):247-51. Epub 2012 May 14.

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

Background: Systematic studies of delusional infestation (DI), also known as delusional parasitosis, are scarce. They lack either dermatological or psychiatric detail. Little is known about the specimens that patients provide to prove their infestation. Read More

Psychosomatics 2012 May-Jun;53(3):301-2

Skinmed 2012 Mar-Apr;10(2):72-4

Metropolitan Hospital, New York Medical College, New York, NY 10028, USA.

Two new cases are presented with delusions of parasitosis. Both were women, one middle-aged and one elderly, and exhibited classic symptoms of parasites and "strings" in the skin indicative of Morgellons disease. Each had an additional psychiatric disorder: drug addiction to cocaine and senile dementia. Read More

Int J Artif Organs 2012 May;35(5):400-3

Kyanous Stavros Patron Dialysis Unit, Patras - Greece.

Uremic pruritus is a common symptom in patients undergoing hemodialysis (HD) or peritoneal dialysis, but its exact pathogenesis remains rather unclear. However, severe or "intractable" pruritus may be the manifestation of another underlying disease or disorder other than uremia. Delusional parasitosis, or Ekbom syndrome, is a rare psychiatric disorder characterized by the false conviction of being infested with parasites, and it can be primary, or secondary to several medical and psychiatric disorders. Read More

Psychosomatics 2012 May-Jun;53(3):258-65. Epub 2012 Mar 27.

College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Objective: Delusional infestation, which encompasses both delusions of parasitosis and delusions of infestation with inanimate objects (sometimes called Morgellons disease), has been said to represent a distinct and encapsulated delusion, that is, a stand-alone diagnosis. Anecdotally, we have observed that patients with delusional infestation often have one or more psychiatric comorbid conditions and that delusional infestation should not be regarded as a stand-alone diagnosis. The purpose of this study was to identify whether patients with delusional infestation have psychiatric comorbid conditions. Read More

J Drugs Dermatol 2012 Apr;11(4):543-5

Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA.

Most dermatologists will treat at least one patient suffering from delusions of parasitosis (DP) in their career.1 These patients are memorable not only for the peculiarity of their delusions and their repeated visits to the office, but for the challenges they present in their treatment. These patients are also frustrating. Read More