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Cureus 2022 Feb 12;14(2):e22147. Epub 2022 Feb 12.

Pathology and Laboratory Medicine, Hassani Abdelkader University Hospital, Sidi Bel Abbès, DZA.

Delusional parasitosis is a psychotic illness. Patients often present to dermatologists with scars that are self-inflicted because they attempt to extract the "parasites". We report a 58 -year-old female with an eight-month history of a crawling sensation on her skin and constant generalized itching, which she believed to be caused by insects and worms crawling across her skin. Read More

Pediatr Dermatol 2022 Jan 29;39(1):12-16. Epub 2021 Dec 29.

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

Pediatric psychodermatologic conditions encompass both primary dermatologic conditions with psychiatric comorbidities and primary psychiatric conditions with self-induced dermatologic manifestations. Detection, diagnosis, and management of primary psychiatric conditions with dermatologic manifestations are challenging due to patient-perceived stigma and lack of educational opportunities for dermatology providers. This two-part series highlights the most up-to-date evidence-based data and management techniques of some of the more common dermatoses of primary psychiatric conditions in children. Read More

Pediatr Dermatol 2022 Jan 20;39(1):17-21. Epub 2021 Dec 20.

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

Pediatric psychodermatologic conditions encompass both primary dermatologic conditions with psychiatric comorbidities and primary psychiatric conditions with self-induced dermatologic manifestations. Detection, diagnosis, and management of primary psychiatric conditions with dermatologic manifestations are challenging due to patient-perceived stigma and lack of educational opportunities for dermatology providers. This two-part series highlights the most up-to-date evidence-based data and management techniques of some of the more common dermatoses of primary psychiatric conditions in children. Read More

Dermatol Online J 2021 Aug 15;27(8). Epub 2021 Aug 15.

Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC Department of Dermatology, University of Southern Denmark, Odense.

Morgellons disease is characterized by patient reports of fibers embedded in and protruding from the skin. Etiologies from infection to delusion have been endorsed, and treatment guidelines are not well-defined. The objective of this manuscript is to evaluate the existing evidence regarding the etiology and treatment of Morgellons disease in an effort to better inform clinical management. Read More

J Acad Consult Liaison Psychiatry 2021 Sep-Oct;62(5):551-552. Epub 2021 May 5.

Creighton University School of Medicine Arizona Health Education Alliance, Phoenix, AZ. Electronic address:

Enferm Infecc Microbiol Clin (Engl Ed) 2021 05 31;39(5):221-222. Epub 2021 Mar 31.

National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain. Electronic address:

J Dermatolog Treat 2022 May 30;33(3):1319-1323. Epub 2021 Mar 30.

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

Introduction: This article introduces to the dermatology provider two medications for the treatment of tardive dyskinesia (TD), which were the first medications approved by the US FDA specifically for the treatment of TD. In addition to describing these two new medications, this article will also provide a focused review of the pathogenesis of TD, as well as non-FDA-approved treatments, which have been tried prior to the advent of these medications.

Methods: A PubMed search was conducted and articles were reviewed by the senior authors and included if they were relevant for dermatologists regarding etiology, symptoms, risk, and treatment of TD. Read More

Perm J 2020 12;25:1-3

Department of Internal Medicine, Camp Springs Medical Center, Kaiser Permanente, Temple Hills, MD.

Introduction: Delusional parasitosis (DP) has been described as among the most challenging diagnosis to manage in dermatology and psychiatry literature. Patients with this perplexing and enigmatic condition present potentially to a wide range of specialties including primary or emergency care, dermatology, infectious diseases, neurology, and psychiatry. DP is probably underdiagnosed from patients' underreporting of symptoms of being infested with parasites, resulting from the associated social stigma. Read More

Cureus 2021 Jan 11;13(1):e12620. Epub 2021 Jan 11.

Psychiatry, Griffin Memorial Hospital, Norman, USA.

Opiate withdrawal-induced severe exacerbation of psychosis after the sudden withdrawal of an opiate is a known yet uncommon clinical manifestation. We present the case of opiate withdrawal-induced psychosis in a 25-year-old married male patient without any prior psychiatric history of illness, family history, or past hospitalization records. The patient presented with psychotic symptoms such as irritability, delusions of parasitosis, and auditory and visual hallucinations at the time of hospitalization. Read More

Indian Dermatol Online J 2020 May-Jun;11(3):307-318. Epub 2020 May 10.

Department of Dermatology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, India.

Psychodermatological (PD) conditions encountered in dermatologic practice include primary psychiatric conditions such as delusions of parasitosis or secondary psychiatric conditions such as anxiety and depression due to dermatologic disease. The psychotropics include antipsychotic agents, anti-anxiety agents, antidepressants, and miscellaneous drugs such as anti convulsants. Anti psychotics are further divided into first-generation and second-generation drugs. Read More

Behav Cogn Psychother 2020 Nov 6;48(6):717-724. Epub 2020 Jul 6.

Older Adult Psychological Services, Buckinghamshire Healthcare NHS Trust, UK.

Background: Delusional infestation is a condition at the interface of tactile and visual hallucinations and delusions. Individuals with this condition hold the fixed and false belief that their body or their environment is infested with parasites, insects or other organisms.

Aims: There are no guidelines or publications detailing the psychological assessment, formulation, intervention and evaluation of this presentation. Read More

Int Rev Psychiatry 2020 Aug - Sep;32(5-6):424-436. Epub 2020 May 21.

Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy.

Ekbom's syndrome represents a relatively uncommon neuropsychiatric condition characterized by the recurrent and bizarre fixed delusional belief to be infested by small organisms or even unanimated materials ('Morgellons disease'), without any objective evidence of infestation/parasitosis. The condition, mainly diagnosed in a nonpsychiatric setting, is supposed to be largely underestimated and, hence, undermanaged. The present comprehensive review aims at investigating Ekbom's syndrome, from a historical, epidemiological, clinical and therapeutic perspective, by providing diagnostic-treatment strategies in managing this condition in routine psychiatric clinical settings. Read More

Cureus 2020 Mar 25;12(3):e7419. Epub 2020 Mar 25.

Dermatology, San Diego Family Dermatology, National City, USA.

The morphology of scabies, a mite infestation of worldwide proportion, is characterized by a variety of cutaneous lesions. Patients with classic scabies present with characteristic burrows often located on the web spaces of the fingers and toes. Scabies surrepticius refers to the non-classic atypical presentation of scabies; establishing the diagnosis of scabies in these individuals can be difficult. Read More

Schizophr Res 2020 06 15;220:269-270. Epub 2020 Apr 15.

Department of Internal Medicine, AdventHealth, Orlando, FL, USA 32803.

Ann Gen Psychiatry 2019 30;18:29. Epub 2019 Dec 30.

4Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Osaka, Japan.

Background: Dementia with Lewy bodies (DLB) is characterized by fluctuating cognitive impairments, recurrent visual hallucinations, the motor symptoms of parkinsonism and REM sleep behavior disorder. Various neuropsychiatric symptoms including hallucination and delusions occur frequently; however, delusional parasitosis is rare in DLB. Here, we report a case of DLB patient with delusional parasitosis. Read More

Int J Dermatol 2020 May 27;59(5):551-560. Epub 2019 Nov 27.

Central Michigan University, Saginaw, MI, USA.

Delusional infestation (DI) is a disorder in which patients express a firm, unwavering belief that they are infested with some type of organism but otherwise have a typical grasp on reality with relatively normal cognitive functioning. Although classified as a somatic delusional disorder, DI requires special consideration due to its complicated clinical presentation, requiring attention to several possible explanations for the symptoms the patients describe. The purpose of the current review is to first summarize the clinical background and features of the diagnosis then explore treatment options. Read More

Clin Pract Cases Emerg Med 2019 Nov 14;3(4):387-389. Epub 2019 Oct 14.

Northwell Health, Emergency Department, Manhasset, New York.

Delusional parasitosis is an uncommon psychiatric disorder that manifests as having parasitic delusions. Due to its rarity, delusional parasitosis is a challenging and costly diagnosis of exclusion and proves difficult to manage for many providers. Although this syndrome is frequently discussed in psychiatric and dermatology reports, it is not commonly described in emergency medicine (EM) literature. Read More

Clin Cosmet Investig Dermatol 2019 11;12:679-681. Epub 2019 Sep 11.

Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.

Patients that suffer from factitial dermatosis mutilate their skin, often lacking any consciousness of self-injury, attributing the resulting lesions to spontaneous development. The case hereby described shows how the health providers' interventions led a patient from a baseline undiagnosed factitious disorder to frank delusions of infestation with , and a relentless search for antibiotic treatments. We highlight the need for educating health practitioners on the characteristics of psycho-cutaneous disorders. Read More

Dermatol Ther (Heidelb) 2019 Dec 13;9(4):631-638. Epub 2019 Sep 13.

Lower Silesian Mental Health Center, Wroclaw, Poland.

Delusional parasitosis, also known as delusional infestation or Ekbom syndrome, is a relatively infrequent psychotic disorder characterized by an unwavering false belief that there is a parasitic infestation of the skin, despite the absence of any medical evidence that could support this claim. Delusional parasitosis can be categorized into primary, secondary, and organic forms. Sometimes, close relatives also experience identical delusions. Read More

Am J Emerg Med 2019 10 25;37(10):1990.e3-1990.e5. Epub 2019 Jul 25.

Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.

Delusional parasitosis manifests as a fixed, false belief that an individual is infested by living organisms. Primary delusional parasitosis is a psychiatric disorder with the delusion as an isolated manifestation, whereas secondary delusional parasitosis is a delusion occurring secondary to a psychiatric disorder, substance use, or medical illness. A 62-year-old woman with no psychiatric history presented to the Emergency Department with two to three months of "whole body itching" and seeing small insects crawling on her skin and in her hair. Read More

Am J Med 2019 12 8;132(12):1401-1409. Epub 2019 Jul 8.

University of Washington, Seattle. Electronic address:

Delusional infestation is a psychiatric condition defined by a fixed belief of infestation despite contrary evidence. Diagnosis includes exclusion of organic etiologies. Treatment with antipsychotics is effective and safe in the majority of patients. Read More

Ital J Dermatol Venerol 2021 02 14;156(1):95-96. Epub 2019 Feb 14.

Riverside School of Medicine, University of California, 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

Acta Derm Venereol 2019 Mar;99(3):327-328

Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 33136 Miami, USA.

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

J Psychiatr Pract 2018 Nov;24(6):428-431

ZHU: Keck School of Medicine, University of Southern California, Los Angeles, CA WERCHAN, ESCAMILLA: Department of Psychiatry, Dell Medical School at the University of Texas, Austin, TX SEBASTIAN: Ascension Texas Research Support Services, Austin, TX HOVINGA: Ascension Texas Research Support Services and The University of Texas at Austin College of Pharmacy, Austin, TX REICHENBERG: Department of Dermatology, Dell Medical School at the University of Texas, Austin, TX.

Objective: Patients diagnosed with delusions of infestation (DOI) at a psychodermatology clinic appeared to have a higher incidence of being prescribed narcotic or stimulant medications compared with the general dermatologic clinic population with chronic pruritic conditions. A retrospective study was conducted examining the correlation between patients with DOI and prescribed psychoactive medications.

Methods: Ninety-two patients with a diagnosis of DOI, seen at our University Psychodermatology Clinic, served as the study population. 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