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The Mystery of Morgellons Disease
Abstract
Morgellons disease is a mysterious skin disorder that was first described more than 300 years ago. The disease is characterized by fiber-like strands extruding from the skin in conjunction with various dermatologic and neuropsychiatric symptoms. In this respect, Morgellons disease resembles and may be confused with delusional parasitosis. The association with Lyme disease and the apparent response to antibacterial therapy suggest that Morgellons disease may be linked to an undefined infectious process. Further clinical and molecular research is needed to unlock the mystery of Morgellons disease.
... Some investigators have chosen to classify these individuals as having Morgellons disease. Indeed, in modern society, the prominent influence of the internet and social media has increased the prevalence of Morgellons disease by facilitating the interaction of individuals with others who have the same symptoms and/or condition [15][16][17][18]. ...
... Sir Thomas Browne, in 1674, described endemic distemper in the Morgellons--children of Languedoc, France--who had hairs on their back that displayed the symptoms of the disease. In 1682, the physician Michael Ettmuller produced drawings of the Morgellons fibers which were considered to be a parasitic worm infesting the children [15][16][17][18]. ...
... Her son had persistent pruritus after being diagnosed with scabies and she continuously found "fibers" in his skin. Once the disease had a name, the Morgellons Research Foundation was formed; in 2002, the organization began to register patients with symptoms of the condition [15][16][17][18]. ...
Delusional infestation--either secondary when attributed to a medical condition (including a bon-a-fide parasite infestation) or a pharmacologic agent (prescribed or illicit) or primary when secondary etiologies have been excluded--is a psychosis in which, for at least one month duration, the patient not only has a delusion that an animate organism or an inanimate pathogen has infested them, but also has abnormal tactile sensation (such as pruritus) of their skin caused by the etiology of their delusion. In patients over the age of 50 years, a delusional infestation is three times more common in women than men; however, delusional infestation in younger patients is often secondary, associated with illicit drug exposure, and equally common in women and men. Primary skin lesions are typically absent in delusional infestation patients; however, secondary skin lesions--resulting from the patient's efforts to remove the parasite from their skin--can be observed, such as excoriations, prurigo nodules, scars, and ulcers. Delusional infestation patients typically strive to convince the person evaluating them that their infestation is valid and many of these individuals do this by collecting the parasites in a container. Presentation of the pathogen-filled containers is a pathognomonic feature of delusional infestation that has been referred to as either a positive creature collection sign, match box sign, parasite preservation sign, pillbox sign, or specimen sign. Morgellons disease--in which the pathogen being extruded from the skin is a fiber--has several features (including an excellent response to treatment with antipsychotic agents) in common with delusional infestation; therefore, most investigators consider Morgellons disease to be a variant of delusional infestation. Delusional infestation can be associated with numerous diseases, including comorbid psychiatric conditions. Indeed, up to 15 percent of delusional infestation patients have one (folie a deux) or more individuals with similar symptoms. A man with delusional infestation is described who had a positive creature collection sign, a fixed belief that his symptoms were caused by the infesting organism, and refusal to accept that he had a psychiatric disorder. He insisted that the evaluating dermatologist examine the pathogens in the clear plastic container he brought with him to his appointment. He was convinced that the pruritus of his scalp, eyebrows, and eyelashes was associated with a non-existent lice infestation. Secondary delusional infestation was excluded and his concurrent mild seborrheic dermatitis was treated topically; however, his itching did not resolve. He eventually agreed to seek treatment with a psychiatrist. The management of delusional infestation is based on its etiology; resolving the underlying medical condition or discontinuing the causative pharmacologic agent is the treatment approach for secondary delusional infestation, whereas low-dose antipsychotic agents are the intervention of choice for treating primary delusional infestation.
... Morgellons disease (MD) is a multi-system disease characterized by the spontaneous appearance of slowly healing ulcerating skin lesions and having multicolored filaments embedded in the skin [1] [2] [3]. Many clinicians used to categorize it as delusional parasitosis or delusional infestation previously and considered the filaments to be introduced as textile fibers [3] [4]. ...
... Recent peer-reviewed publications have found out that MD is a true somatic illness at least partly caused by Borrelia infection (although other spirochetes possibly involved are not ruled out), the causative agent of Lyme disease [1] [13] [14]. Lyme disease is estimated to affect approximately 300,000 people a year in the United States and 65,000 people a year in Europe [15]. ...
... Very little literature is found on the epidemiology of MD. In addition to dermopathy, MD patients may also exhibit debilitating musculoskeletal and neurological manifestations resembling the symptoms of Lyme disease [1]. The study done in North America also listed the most common non-skin-related symptoms among MD patients including Musculoskeletal symptoms (93%), fatigue (88%), insomnia (80%) and Cognitive Impairment (50%) [17]. ...
Morgellons disease (MD) is a multi-system disorder characterized by multi-color filaments extruding out of the skin along with an array of dermatologic and neuropsychiatric symptoms. It was previously termed Delusional parasi-tosis. However, published scientific data found the association of MD symp-toms with the systemic manifestations of Lyme disease, caused by Borrelia spirochete. In a retrospective study of 122 MD patients, skin specimens were examined and 96% of them showed Borrelia spirochete in their histology sample. Hence, this association suggests that spirochete infection could be a possible cause of chronic illness in MD patients, and this rejected the physi-cian’s perception that MD lesions might be self-inflicted. A cohort study re-ported tick-borne co-infections among MD patients, which could also be an etiological factor for dermopathy in MD patients. Some literature also dis-cussed neuropsychiatric manifestations like cognitive impairment, dementia anxiety, depression, paranoia, and sensory hallucinations in Lyme disease and associated tick-borne infection. The objectives of this review are to identify the differences in the past and current perception regarding the pathogenesis of MD and determine the associations of spirochetal and tick-borne diseases with MD and psychiatric illnesses. More than 50 new research articles and case reports were reviewed and only 31 articles were shortlisted and used as references. This review has a detailed discussion on Morgellons disease and its association with Spirochete infection.
... Morgellons disease (MD) is a dermatological condition characterized clinically by the presence of multicolored microscopic fibers in skin lesions or lying under unbroken skin. [1][2][3][4][5][6][7] The disease is associated with overproduction of keratin and collagen in cutaneous tissue. Historically, MD has been misclassified as a delusional disorder due to its sometimes bizarre symptomatology in patients who present with claims of colorful fibers or parasites protruding from or crawling within the dermis. ...
... In contrast, recent peer reviewed publications demonstrate that MD is a true somatic illness associated with Borrelia infection, and not a delusional disorder. [1][2][3][4][5][6][7] Other studies have shown that a similar dermopathy occurs in cattle and dogs, providing further evidence that MD is a dermatological condition associated with spirochetal infection. 8,9 The spirochete Borrelia burgdorferi is the etiologic agent of Lyme disease (LD). ...
... Patients were included in the study if they met the diagnostic criteria for MD through identification of fibers visible in skin lesions or under unbroken skin using a hand-held microscope, as previously described. [1][2][3][4][5][6] MD classification based on the duration of disease (early versus late) and the extent of skin involvement (localized versus disseminated) was performed as previously described. 5 All subjects were required to have LD testing and tickborne coinfection testing through a single laboratory, and they were required to have repeat testing to confirm the diagnosis of LD. ...
Morgellons disease (MD) is a dermatological condition characterized by aberrant production of keratin and collagen fibers in skin. Although infection with Borrelia burgdorferi, the causative agent of Lyme disease (LD), has been associated with MD, relatively few studies have hitherto provided epidemiological evidence regarding this association. A cohort of 1000 seropositive North American LD patients was evaluated for the presence of MD. Patients were diagnosed with MD based on detection of microscopic fibers in skin lesions or under unbroken skin. Demographic and clinical features of MD patients were analyzed, and laboratory testing for tickborne coinfections and other infectious agents, was performed. Subjective and objective features of MD were analyzed using statistical methods. Of 1000 seropositive LD patients, 60 (6%) were diagnosed with MD. Of these 60 patients, 75% were female and 78% presented in the late disseminated stage of MD. All 60 patients (100%) were seropositive for B. burgdorferi infection. Tickborne coinfections in these patients included Babesia spp (62%), Bartonella and Rickettsia (25% each), Ehrlichia (15%) and i (10%). Helicobacter pylori was detected in 12% of MD patients. In all, 77% of MD patients had one or more coinfections. This study confirms recent findings that MD occurs in a limited subset of LD patients. The clinical and genetic determinants of MD in LD patients require further study.
... Morgellons disease (MD) is a disfiguring and perplexing skin condition associated with spirochetal infection and tick-borne illness. [1][2][3][4][5][6][7] This poorly understood condition has a worldwide distribution, with estimated self-reported cases numbering over 14,000 in 2009. 5 Since that time, there has been an increasing number of individuals reported to be afflicted with this disorder (C Casey, Charles E Holman Morgellons Disease Foundation, personal communication, 2017). ...
... The characteristic filaments are microscopic, visually resembling textile fibers, and are white, black, or a more vibrant color, such as red or blue. [1][2][3][4][5][6][7] In addition to fiber production, some patients may experience formication, described as stinging, biting, creeping and crawling sensations. The symptoms of MD are not limited to the skin. ...
... MD patients experience a variety of systemic manifestations, such as fatigue, joint pain, cardiac complications, cognitive difficulties, and neuropathy, all symptoms that are commonly reported by Lyme disease (LD) patients. [1][2][3][4][5][6][7] and "it is perhaps too simple that the parasitophobias should be considered as mental illness and nothing more". 20 Interestingly, like Vié, Ekbom found that spirochetal infection was present in his patient cohort, and three of Ekbom's seven patients had documented cases of syphilis. ...
Marianne J Middelveen,1 Melissa C Fesler,2 Raphael B Stricker2 1Atkins Veterinary Services, Calgary, AB, Canada; 2Union Square Medical Associates, San Francisco, CA, USA Abstract: Morgellons disease (MD) is a skin condition characterized by the presence of multicolored filaments that lie under, are embedded in, or project from skin. Although the condition may have a longer history, disease matching the above description was first reported in the US in 2002. Since that time, the condition that we know as MD has become a polemic topic. Because individuals afflicted with the disease may have crawling or stinging sensations and sometimes believe they have an insect or parasite infestation, most medical practitioners consider MD a purely delusional disorder. Clinical studies supporting the hypothesis that MD is exclusively delusional in origin have considerable methodological flaws and often neglect the fact that mental disorders can result from underlying somatic illness. In contrast, rigorous experimental investigations show that this skin affliction results from a physiological response to the presence of an infectious agent. Recent studies from that point of view show an association between MD and spirochetal infection in humans, cattle, and dogs. These investigations have determined that the cutaneous filaments are not implanted textile fibers, but are composed of the cellular proteins keratin and collagen and result from overproduction of these filaments in response to spirochetal infection. Further studies of the genetics, pathogenesis, and treatment of MD are warranted. Keywords: Morgellons disease, dermopathy, Lyme disease, Borrelia burgdorferi, spirochetes
... Morgellons disease (MD) is an emerging dermatological disorder and multisystem illness. The disease is characterized by unexplained dermopathy associated with formation of unusual filaments found both subcutaneously and emerging from spontaneously appearing, slow-healing skin lesions [1]. Filaments associated with MD appear beneath unbroken skin [1,2], thus demonstrating that they are not self-implanted. ...
... The disease is characterized by unexplained dermopathy associated with formation of unusual filaments found both subcutaneously and emerging from spontaneously appearing, slow-healing skin lesions [1]. Filaments associated with MD appear beneath unbroken skin [1,2], thus demonstrating that they are not self-implanted. Filaments have been observed protruding from and attached to a matrix of epithelial cells [3]. ...
... Lyme disease-like symptoms in MD such as neurological disorders and joint pain are evidence of systemic involvement [1,2,7]. Objective clinical evidence of disease has been demonstrated by its association with peripheral neuropathy, delayed capillary refill, decreased body temperature, tachycardia, elevated pro-inflammatory markers, cytokine release, selective immune deficiency and elevated insulin levels, suggesting that an infectious process is involved [8,9]. ...
Morgellons disease is an emerging multisystem illness characterized by unexplained dermopathy and unusual skin- associated filament production. Despite evidence demonstrating that an infectious process is involved and that lesions are not self-inflicted, many medical practitioners continue to claim that this illness is delusional. We present relevant clinical observations combined with chemical and light microscopic studies of material collected from three patients with Morgellons disease. Our study demonstrates that Morgellons disease is not delusional and that skin lesions with unusual fibers are not self-inflicted or psychogenic. We provide chemical, light microscopic and immunohistological evidence that filaments associated with this condition originate from human epithelial cells, supporting the hypothesis that the fibers are composed of keratin and are products of keratinocytes.
... Morgellons disease (MD) is a human dermopathy characterized by spontaneously-appearing, slowly-healing skin lesions containing filaments that are often extraordinarily colorful (blue, white, black, green, purple, pink and red) and lie under, are embedded in, or project from skin [9][10][11][12][13][14][15][16][17]. Many medical professionals consider MD to be a delusional disease and attribute the presence of colorful filaments to excoriation coupled with accidental or deliberate implantation of textile fibers [18,19]. ...
... Many medical professionals consider MD to be a delusional disease and attribute the presence of colorful filaments to excoriation coupled with accidental or deliberate implantation of textile fibers [18,19]. In contrast, dermatopathology studies suggest that the filaments may lie under or project from unbroken skin, making it highly unlikely that they are self-implanted [9][10][11][12][13][14][15][16][17]. Furthermore, the unusual filaments are composed of keratin and collagen, and blue coloration in filaments is the result of melanin pigmentation, as shown by specific histological staining [14,15]. ...
... Furthermore, the unusual filaments are composed of keratin and collagen, and blue coloration in filaments is the result of melanin pigmentation, as shown by specific histological staining [14,15]. The unusual filaments can be visualized in skin under 50X-100X magnification and some filaments fluoresce under ultraviolet (UV) light, thus aiding the identification of MD cases [9][10][11][12][13]. ...
Canine Filamentous Dermatitis Associated with Borrelia Infection
Background: Although canine clinical manifestations of Lyme disease vary widely, cutaneous manifestations are not well documented in dogs. In contrast, a variety of cutaneous manifestations are reported in human Lyme disease caused by the spirochete Borrelia burgdorferi. A recently recognized dermopathy associated with tickborne illness known as Morgellons disease is characterized by brightly-colored filamentous inclusions and projections detected in ulcerative lesions and under unbroken skin. Recent studies have demonstrated that the dermal filaments are collagen and keratin biofibers produced by epithelial cells in response to spirochetal infection. We now describe a similar filamentous dermatitis in canine Lyme disease. Methods and Results: Nine dogs were found to have cutaneous ulcerative lesions containing embedded or projecting dermal filaments. Spirochetes characterized as Borrelia spp. were detected in skin tissue by culture, histology, immunohistochemistry, polymerase chain reaction (PCR) and gene sequencing performed at five independent laboratories. Borrelia DNA was detected either directly from skin specimens or from cultures inoculated with skin specimens taken from the nine canine study subjects. Amplicon sequences from two canine samples matched gene sequences for Borrelia burgdorferi sensu stricto. PCR amplification failed to detect spirochetes in dermatological specimens from four healthy asymptomatic dogs. Conclusions: Our study provides evidence that a filamentous dermatitis analogous to Morgellons disease may be a manifestation of Lyme disease in domestic dogs.
... Filaments can be white, black, or brightly colored. [2][3][4][5][6] Furthermore, MD patients exhibit a variety of manifestations that resemble symptoms of Lyme disease (LD), such as fatigue, joint pain, and neuropathy. [2][3][4][5][6] A study found that 98% of MD subjects had positive LD serology and/or a tickborne disease diagnosis, 5 confirming the clinical association between MD and spirochetal infection. ...
... [2][3][4][5][6] Furthermore, MD patients exhibit a variety of manifestations that resemble symptoms of Lyme disease (LD), such as fatigue, joint pain, and neuropathy. [2][3][4][5][6] A study found that 98% of MD subjects had positive LD serology and/or a tickborne disease diagnosis, 5 confirming the clinical association between MD and spirochetal infection. Conversely, 6% of LD patients in an Australian study were found to have MD. ...
... Secondary etiologic factors such as genetic background, hormonal influences, immune status, and the presence of other coinvolved infections appear to play a role in the development of this phenomenon. [2][3][4][5][6] Other pathogens have been detected in Morgellons tissue samples. Strains of Helicobacter pylori and closely related bacteria were detected along with Borrelia spp. in tissue samples from MD lesions. ...
Marianne J Middelveen, Raphael B Stricker International Lyme and Associated Diseases Society, Bethesda, MD, USA Abstract: Morgellons disease (MD) is a dermopathy characterized by multicolored filaments that lie under, are embedded in, or project from skin. Although MD was initially considered to be a delusional disorder, recent studies have demonstrated that the dermopathy is associated with tickborne infection, that the filaments are composed of keratin and collagen, and that they result from proliferation of keratinocytes and fibroblasts in epithelial tissue. Culture, histopathological and molecular evidence of spirochetal infection associated with MD has been presented in several published studies using a variety of techniques. Spirochetes genetically identified as Borrelia burgdorferi sensu stricto predominate as the infective agent in most of the Morgellons skin specimens studied so far. Other species of Borrelia including Borrelia garinii, Borrelia miyamotoi, and Borrelia hermsii have also been detected in skin specimens taken from MD patients. The optimal treatment for MD remains to be determined. Keywords: Morgellons disease, dermatitis, Lyme disease, Borrelia burgdorferi, spirochetes
... Morgellons disease (MD) is a complex dermopathy characterized by the spontaneous appearance of slowly-healing skin lesions that contain multicolored filaments either lying under, embedded in, or projecting from skin ( Figure 1A-C) [1][2][3][4][5][6][7][8][9]. Patients may also exhibit constitutional, musculoskeletal and neurocognitive symptoms that are associated with Lyme disease (LD) and tickborne coinfections. ...
... A major strength of our study is that MD patients were identified based on the presence of multicolored fibers within skin lesions or detectable under unbroken skin. Some of our patients did suffer from neuropsychiatric symptoms, and we do not deny that primary delusional infestation can occur in rare cases [1][2][3][4]. By selecting only MD patients meeting our dermopathy criterion, however, we have presumably excluded primary delusional infestation patients from our study. ...
... Although some MD patients suffering from neuropsychiatric symptoms with Borreliaassociated intradermal filaments may claim to have worms, parasites or the like, the skin crawling and stinging sensations that these patients feel coupled with visible skin lesions, anxiety and anthropomorphic thinking may result in complaints that are misinterpreted by clinicians as a primary delusional disorder. Other MD patients in our study had no neuropsychiatric symptoms and yet had the same Borrelia-associated dermopathy, so it appears that in our well-defined MD patient cohort these symptoms, when they occurred, were the result rather than the cause of the infectious dermopathy, as previously described [1][2][3][4]23]. ...
Morgellons disease (MD) is a complex skin disorder characterized by ulcerating lesions that have protruding or embedded filaments. Many clinicians refer to this condition as delusional parasitosis or delusional infestation and consider the filaments to be introduced textile fibers. In contrast, recent studies indicate that MD is a true somatic illness associated with tickborne infection, that the filaments are keratin and collagen in composition and that they result from proliferation and activation of keratinocytes and fibroblasts in the skin. Previously, spirochetes have been detected in the dermatological specimens from four MD patients, thus providing evidence of an infectious process.
Based on culture, histology, immunohistochemistry, electron microscopy and molecular testing, we present corroborating evidence of spirochetal infection in a larger group of 25 MD patients. Irrespective of Lyme serological reactivity, all patients in our study group demonstrated histological evidence of epithelial spirochetal infection. Strength of evidence based on other testing varied among patients. Spirochetes identified as Borrelia strains by polymerase chain reaction (PCR) and/or in-situ DNA hybridization were detected in 24/25 of our study patients. Skin cultures containing Borrelia spirochetes were obtained from four patients, thus demonstrating that the organisms present in dermatological specimens were viable. Spirochetes identified by PCR as Borrelia burgdorferi were cultured from blood in seven patients and from vaginal secretions in three patients, demonstrating systemic infection. Based on these observations, a clinical classification system for MD is proposed.
Our study using multiple detection methods confirms that MD is a true somatic illness associated with Borrelia spirochetes that cause Lyme disease. Further studies are needed to determine the optimal treatment for this spirochete-associated dermopathy.
http://www.biomedcentral.com/1471-5945/15/1
... Morgellons disease (MD) is an evolving skin disease associated with filaments found beneath unbroken skin or projecting from spontaneously-appearing, slowly-healing skin lesions 1 . In addition to dermopathy, patients may also exhibit debilitating musculoskeletal and neurological manifestations resembling the symptoms of Lyme disease 1,2 . ...
... Morgellons disease (MD) is an evolving skin disease associated with filaments found beneath unbroken skin or projecting from spontaneously-appearing, slowly-healing skin lesions 1 . In addition to dermopathy, patients may also exhibit debilitating musculoskeletal and neurological manifestations resembling the symptoms of Lyme disease 1,2 . Similarities were found between MD and bovine digital dermatitis (BDD), a disease common in dairy herds and characterized by keratin filament formation in skin lesions that frequently occur above the hind feet of cows 3,4 . ...
... Like cattle with BDD, patients with MD also produce antibodies reactive to Borrelia burgdorferi antigens 18 . Multisystemic symptoms resembling Lyme disease also imply a possible spirochetal etiology for MD [1][2][3]18,19 . The frequent clinical diagnosis of Lyme disease and coinfecting tick-borne pathogens in MD patients suggests a multifactorial etiology and possible vectoring by ticks [1][2][3]18,19 . ...
Morgellons disease (MD) is an emerging multisystem illness characterized by skin lesions with unusual filaments embedded in or projecting from epithelial tissue. Filament formation results from abnormal keratin and collagen expression by epithelial-based keratinocytes and fibroblasts. Recent research comparing MD to bovine digital dermatitis, an animal infectious disease with similar skin features, provided clues that spirochetal infection could play an important role in the human disease as it does in the animal illness. Based on histological staining, immunofluorescent staining, electron microscopic imaging and polymerase chain reaction, we report the detection of
Borrelia spirochetes in dermatological tissue of four randomly-selected MD patients. The association of MD with spirochetal infection provides evidence that this infection may be a significant factor in the illness and refutes claims that MD lesions are self-inflicted and that people suffering from this disorder are delusional. Molecular characterization of the
Borrelia spirochetes found in MD patients is warranted.
... A wide range of somatic, psychiatric and neurological symptoms are associated with Morgellons [11] but since the main manifestations are cutaneous lesions, pruritus and formication, patients frequently seek treatment from dermatologists. Treating these patients is challenging because of the disagreement on the etiology and pathology of their illness, which means that the patients are likely to reject proposals of seeking psychiatric treatment. ...
... The remaining 45 texts were from the period 2006-2013, and for the most part belonged to dermatology and psychosomatic literature. Other disciplines represented were nursing, entomology, otorhinolaryngology, oral surgery, psychiatry, clinical hypnosis, and clinical microbiology [1,[3][4][5][6][7][8][9][10][11][12][13]. Among the 45 articles, there was no contribution by bioethicists. ...
... From their perspective, Morgellons is still poorly understood and research is needed in order to find an effective treatment. Because of the assumption that Morgellons is infectious and possibly related to Lyme disease, some mention antibiotics as a treatment option [5,11,27]. One case study found hypnosis to be effective, while leaving the question of etiology open [24]. ...
Morgellons is a medically contested diagnosis with foremost dermatological symptoms. Patients experience fibers emerging from the skin, together with a range of other somatic, psychiatric, and neurological complaints. Within the medical community, it is generally held to be a variation of delusional parasitosis/delusional infestation, which is usually treated with antipsychotics. Little attention has been paid in the literature to the ethical aspects of treating patients with Morgellons disease. The communicative strategies suggested in the literature display significant ethical issues, primarily the use of therapeutic privilege, i.e. withholding information from the patient. Since this limits patient autonomy, that approach is ethically problematic. Instead, the physician has an ethical obligation to respect the patient's autonomy, provide full information, and seek consent before initiating a psychiatric referral.
... Persons who identify themselves as having the condition typically report poorly or non-healing skin lesions, excretion/emergence of fibers or solid material from the skin, and pruritus or other disturbing cutaneous sensations such as formication, stinging and biting, or a pins-and-needles sensation. These symptoms are usually described as being chronic and recurrent [1]. ...
... For six of these specimens, IHC or PCR testing of the formalin-fixed tissues confirmed the bacteria as Streptococcus pyogenes (3), Staphylococcus aureus (2), or a Streptococcus sp. (1). ...
... Previous reports of this condition have described the material emerging from the skin being like fibers, hairs or filaments [1,19], but we found a more heterogeneous description of materials emerging from the skin, with many case-patients describing materials other than fibers including specks, dots, granules, or worms. We found no difference in the sociodemographic, clinical, or histopathologic characteristics of case-patients who did and did not report fibers. ...
Morgellons is a poorly characterized constellation of symptoms, with the primary manifestations involving the skin. We conducted an investigation of this unexplained dermopathy to characterize the clinical and epidemiologic features and explore potential etiologies.
A descriptive study was conducted among persons at least 13 years of age and enrolled in Kaiser Permanente Northern California (KPNC) during 2006-2008. A case was defined as the self-reported emergence of fibers or materials from the skin accompanied by skin lesions and/or disturbing skin sensations. We collected detailed epidemiologic data, performed clinical evaluations and geospatial analyses and analyzed materials collected from participants' skin.
We identified 115 case-patients. The prevalence was 3.65 (95% CI = 2.98, 4.40) cases per 100,000 enrollees. There was no clustering of cases within the 13-county KPNC catchment area (p = .113). Case-patients had a median age of 52 years (range: 17-93) and were primarily female (77%) and Caucasian (77%). Multi-system complaints were common; 70% reported chronic fatigue and 54% rated their overall health as fair or poor with mean Physical Component Scores and Mental Component Scores of 36.63 (SD = 12.9) and 35.45 (SD = 12.89), respectively. Cognitive deficits were detected in 59% of case-patients and 63% had evidence of clinically significant somatic complaints; 50% had drugs detected in hair samples and 78% reported exposure to solvents. Solar elastosis was the most common histopathologic abnormality (51% of biopsies); skin lesions were most consistent with arthropod bites or chronic excoriations. No parasites or mycobacteria were detected. Most materials collected from participants' skin were composed of cellulose, likely of cotton origin.
This unexplained dermopathy was rare among this population of Northern California residents, but associated with significantly reduced health-related quality of life. No common underlying medical condition or infectious source was identified, similar to more commonly recognized conditions such as delusional infestation.
... Patients report that physicians make a quick diagnosis of delusional parasitosis with little to no physical examination done. They often attribute the ulcers and excoriation marks on the skin to attempts at self-mutilation, and fail to provide patients with the care they require [17]. ...
... Some authors have reported success in treating MD patients with antibiotics. Antibiotics used in treating Lyme disease such as doxycycline and amoxicillin have been used and have shown to be effective in many cases [17,21]. It should be noted that spirochetes have the ability to persist even in hostile environment and can adopt different sizes and shapes. ...
Morgellons Disease (MD) is a multisystem disorder with a primary symptom characterized by emerging of small fibres from the skin. For years, many doctors thought MD is a psychiatric disorder and treated the patients with antipsychotic drugs, behavioural therapy and counselling. However, recent studies suggest that MD is a completely different entity from psychiatric disorders. Morgellons pathophysiology remains a mystery even up to now. It was previously considered to be a delusional disorder due to its similarity to delusions of parasitosis or delusional infestation described many years ago. This constellation of symptoms has not been well studied in different populations, however, a study in North California found a prevalence of 3.65 per 100,000 for MD, with Caucasian and female predominance.
... Morgellons disease (MD) is a dermatological condition in which lesions that contain unusual filamentous inclusions and/or projections spontaneously arise. [1][2][3][4][5] The filaments are distinctive in part due to their varied white, red, blue, green or black coloration, and because visually they resemble microscopic textile fibers. [6][7][8][9] In addition, the dermopathy may be accompanied by formication (sensation of something crawling on skin). ...
... 6,7,10 In addition to filamentous dermopathy, patients frequently experience Lyme-like symptoms such as musculoskeletal, neurological and cardiovascular manifestations suggestive of spirochetal etiology. [1][2][3][4][5]8 Cohort studies indicate that most patients with MD test positively for Borrelia infection and/or have a clinical Lyme disease (LD) diagnosis. 4,[11][12][13] Two separate cohort studies have demonstrated that MD afflicts approximately 6% of LD patients. ...
Introduction:
Morgellons disease (MD) is a contested dermopathy that is associated with Borrelia spirochetal infection. A simple classification system was previously established to help validate the disease based on clinical features (classes I-IV).
Methods:
Drawing on historical and pathological parallels with syphilis, we formulated a more detailed staging system based on clinical features as well as severity of skin lesions and corresponding histopathological infection patterns, as determined by anti-Borrelia immunohistochemical staining.
Results:
Clinical classes I-IV of MD are further categorized as mild, moderate and severe, or stages A, B and C, respectively, based on histopathological findings. Stage A lesions demonstrated little or no immune infiltrates and little or no disorganization of cells; macrophages were not present, and hemorrhage was negligible. Extracellular isolated spirochetes and intracellular staining of keratinocytes in the lower epidermis was occasionally seen. Stage C lesions demonstrated positive staining of keratinocytes in the stratum basale and stratum spinosum and positive intracellular staining of macrophages for Borrelia. Aggregate Borrelia colonies were frequently encountered, hemorrhage was frequent, and intracellularly stained fibroblasts were occasionally seen. Stage B lesions demonstrated a pattern intermediate between Stages A and C.
Conclusion:
The enhanced staging system provides objective criteria to assess the severity of dermopathy in MD. Further studies are needed to determine the optimal treatment for MD based on this staging system related to Borrelia infection.
... Morgellons disease (MD) is a controversial illness characterized by spontaneously developing skin lesions that contain multicolored (mostly white, red, blue and black) filamentous inclusions and/or projections [1][2][3][4][5]. The dermopathy may be accompanied by symptoms of formication, and accordingly some health care practitioners claim that the condition is a variation of delusional parasitosis (DP) and that the filaments are implanted textile fibers [6,7]. ...
... A spirochetal etiology for MD was considered because the dermopathy is accompanied by Lyme-like symptoms including musculoskeletal, neurological and cardiovascular manifestations [1][2][3][4][5]10]. Two independent cohort studies reported that almost all subjects with MD were diagnosed with LD and that there was a high incidence of infection with other tickborne pathogens [4,11]. ...
Background:
Morgellons disease (MD) is a dermopathy that is associated with tick-borne illness. It is characterized by spontaneously developing skin lesions containing embedded or projecting filaments, and patients may also experience symptoms resembling those of Lyme disease (LD) including musculoskeletal, neurological and cardiovascular manifestations. Various species of Borrelia and co-infecting pathogens have been detected in body fluids and tissue specimens from MD patients. We sought to investigate the coexistence of Borrelia burgdorferi (Bb) and Helicobacter pylori (Hp) in skin specimens from MD subjects, and to characterize their association with mixed amyloid biofilm development.
Methods:
Testing for Bb and Hp was performed on dermatological specimens from 14 MD patients using tissue culture, immunohistochemical (IHC) staining, polymerase chain reaction (PCR) testing, fluorescent in situ hybridization (FISH) and confocal microscopy. Markers for amyloid and biofilm formation were investigated using histochemical and IHC staining.
Results:
Bb and Hp were detected in dermatological tissue taken from MD lesions. Bb and Hp tended to co-localize in foci within the epithelial tissue. Skin sections exhibiting foci of co-infecting Bb and Hp contained amyloid markers including β-amyloid protein, thioflavin and phosphorylated tau. The biofilm marker alginate was also found in the sections.
Conclusions:
Mixed Bb and Hp biofilms containing β-amyloid and phosphorylated tau may play a role in the evolution of MD.
... As the subjects suffering with disorder have a fixed, false belief that they are infested with parasites or other organisms, it is reported that they suffer from skin lesions, there are excretions of fibers or some solid material from the skin and, usually there are skin sensations of formication (crawling, stinging and/or biting) associated with or without itching and skin lesions like pruritic patches and at times, "pins and needles" sensations that may be long lasting and recurrent. (5,6) Sometimes there are elaborate explanations by patients regarding the details of complex life cycles of these "parasites," giving descriptions of their growth and breeding cycles. Patients with this disorder are often preoccupied with structures like fibers, hair or skin tags or similar such inanimate objects, claiming that these "move" and so have life. ...
... The subjects are also known to bring these particles or objects to the clinician as evidence of their claim of the parasite living in their body. (6,7) They also exhibit the "matchbox sign" (also called "specimen sign") wherein the subject brings specimens kept in a small container such as a matchbox for examination as evidence for their claim. The particles usually consist of fragments of skin, hair, dried blood or scabs or occasionally living organisms such as ants or flies. ...
Introduction: Delusion of parasitosis is a common presentation with multiple aetiologies. It usually presents in a dermatological set up; however a psychiatric consultation is often required for optimal management. Materials and Methods: A series of 22 cases which presented in the psychiatric outpatient section or were referred from the dermatology department were analyzed and followed up. Results: The majority of the subjects were females in the middle to elderly age group and the commonest diagnosis was psychosis and the majority responded to olanzapine and fluoxetine. Discussion: The presentation of delusion of parasitosis (DOP) is a disorder with multiple aetiologies and needs optimal management which should ideally be tailor made, hence a good liaison set up is needed.
... Even today, some doctors consider it as a delusional disorder despite the ample amount of evidence suggesting otherwise. For example, multiple studies have shown the association between MD and Borrelia burgdorferi infection [5][6]. B. burgdorferi is the same spirochetal agent causing Lyme Disease (LD). ...
Piscine Mycobacteriosis (PM) or sometimes called fish tuberculosis, is a deadly zoonotic disease found in both fresh and marine fish throughout the world. More than 20 strains of Mycobacterium spp. are known to cause PM, but their pathogenesis is currently unclear. This is a chronic progressive disease with a variety of clinical symptoms including skin ulcerations, loss of color, scoliosis, and weight loss. Advanced technical molecular methods have now allowed us to different Mycobacterium to the individual species level. Out of the 20 known strains, M. marinum is the commonest and the most pathogenic organism and it is found in marine and freshwater fish. Morgellons Disease (MD) is a multi-system disorder where patients commonly present with multiple, non-healing, cutaneous wounds. Patients report seeing multi-colored filaments/fibers under the skin and often provide samples to the clinician. However, most clinicians thought this is a delusional disorder and treated the patients with antidepressant drugs. However, recent studies have linked MD with systemic manifestations of Lyme Disease (LD). Other studies have found correlation between MD and tick-borne co-infections. Despite these studies, the definite causative agent of MD has not yet been confirmed. Since the clinical symptoms of PM and MD are somewhat similar, it could be hypothesized that PM and MD could be related to each other. Therefore, the objective of this literature review is to find any link between PM and MD based on the current literature available. However, it should be noted that there is no study done specifically looking into Review Article Dolapihilla et al.; AJRDES, 4(4): 1-8, 2021; Article no.AJRDES.74043 2 this hypothesis. The primary search engine used to find information for this review is PubMed and ScienceDirect. More than 30 research articles and case reports were reviewed and only 19 were shortlisted and used as references. None of the studies were limited to study design, number of participants or the study year. However, only articles written in English language were considered for this review.
... V kůži se mohou objevit vlákna látky, nejčastěji bavlny. Častými doprovodnými příznaky jsou obecně intenzivní zaměření na vlastní zdravotní stav, únava, stížnosti na difuzní muskuloskeletální bolesti, subjektivně vnímané oslabení kognitivních funkcí a labilita emocí (18). Pacienti zpravidla navštěvují entomology, specialisty na hubení škůdců a dermatology (2). ...
... It is also popularly known as Ekbom syndrome after the Swedish neurologist Karl Axel Ekbom who published seminal accounts of the disease in 1937 and 1938 [2,5]. DP has a wide spectrum of delusional subtypes and multiple specifiers and related terms [2][3][4][5][6]. It can still be considered an under-explored territory as not many epidemiological studies have been conducted. ...
Objective:
Delusional parasitosis (DP) is a difficult-to-treat condition. It is prevalent in all cultures, societies, and countries. Previous case reports of DP have been published; however, the patient presented in this report is unique because of the co-occurrence of both primary and secondary types of DP. We aim to explore the two subtypes of DP.
Conclusions:
We discuss DP from a nosological perspective and also highlight the various theories at play in the pathogenesis of primary and secondary DP. The different subtypes of DP should be taken into consideration as they also have a bearing on the management.
... Another clinical variant of the condition is represented by the so-called Morgellons disease, a bizarre belief that strange materials emerging from the skin, accompanied by perceived or real skin lesions and it corresponds to a somatic type of monosymptomatic delusional disorder (American Psychiatric Association, 2013;Firger, 2015;Hylwa & Ronkainen, 2018). The name derives from a 1674 description of children experiencing 'harsh hairs on their backs' which the author called Morgellons (Hinkle, 2010;Savely et al., 2006). ...
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. The prototypical patient is a middle-aged woman (or a younger subject in those cases in which substance and/or alcohol abuse is implicated), often single, divorced or widowed (loneliness component and social withdrawal), who has already consulted several specialists due to skin lesions associated with a firm and delusional belief to be infested. The identification and diagnosis are challenging due to poor patient’s insight, poor knowledge and collaboration between specialists and differential diagnoses to be considered before asking for a psychiatric referral. Management and treatment strategies mainly derive from isolated case reports or observational studies with a small sample size. Further randomized clinical trials should be performed to evaluate the efficacy of newer antipsychotic drugs, including long-acting injectable formulations.
... The most widely recognized term is bug, which is used in the sense used by ES patients. A comparative condition called Morgellons Syndrome is said to include putative invasion of the skin by fibers [10] . Since Morgellons does not include insects, it isn't synonymous with DP yet likely is a variation inside the equivalent delusional complex [11][12][13][14] . ...
Ekbom Syndrome synonymous with Delusional Parasitosis, is a turmoil in the mind of patient wherein people erroneously trust that they are pervaded with parasites, insects, or bugs, while as a general rule no such invasion is available. People experiencing this kind of disorder arrogantly believe the feelings of tactile sensations and the imaginary presence of insect, although nobody else can see those. Morgellons malady is a doubtful condition expressed by a fixed conviction that fibers that are imbedded or expelling from the skin; this condition is also falls in the range of Delusional Parasitosis. Ekbom Syndrome is a capricious condition; it is unmanageable and can't be redressed by argument or proof. Ekbom Syndrome sufferers display a scope of unsurprising practices in their endeavors to take out their pervasions, including looking for distinguishing pieces of proof and treatment from physicians and entomologists. Moreover, they may additionally experience co-morbid psychological conditions. Since this is a delusional affliction, effective treatment commonly requires intervention by therapeutic experts as well as need based antipsychotics. From an investigation, it was observed that disturbed reasoning and judgment were present in all cases of DI as against only 82% (27 of 32 patients) tactile symptoms, the picture is better clear by the disturbed thought.
... [5] There was also a condition called "Morgellons phenomenon" named by Leitao after doctors were unable to find the cause of her son's illness in 2002. [6] Patients usually describe various abnormal sensations of the pathogens akin to "crawling," "biting," "leaving marks," "movement from one part of the body to other," and "building nests/breeding," etc. There still remained a controversy, whether the rigid beliefs represented only overvalued ideas or delusions. ...
... It can be accompanied by Lyme-like symptoms such as fatigue, joint inflammation, cardiac manifestations and neuropathy, which suggest a spirochetal relationship. [1][2][3][4][9][10][11][12] Results from two independent cohort studies established that LD was present in almost all patients with this disorder. A 2010 study reported that 98% of its 122 subjects either tested serologically positive for LD or were clinically diagnosed with LD. 1 Similar results were reported in a 2018 study in which 100% of a cohort of 60 MD patients tested positive for LD. 13 Two independent studies, one in Australian patients and one in North American patients, reported that MD occurs in a subset of approximately 6% of LD patients. ...
Background:
Morgellons disease (MD) is a skin condition associated with Lyme disease (LD) and tick-borne illness. Patients with this skin disorder experience ulcerative lesions that contain multicolored filamentous collagen and keratin inclusions. Infection with various species of Borrelia and other tick-borne pathogens has been detected in tissue and body fluid specimens from MD patients. We sought to explore this association further in a cohort of MD patients.
Patients and methods:
Sera from 30 patients with MD were tested for antibody reactivity to antigens from the Borrelia burgdorferi (Bb) group and the relapsing fever Borrelia (RFB) group of spirochetes. Tissue and/or body fluid specimens from these patients were also tested for the presence of Bb and RFB infection using PCR technology. In addition, tissue and body fluid specimens were tested for the presence of Bartonella henselae using PCR, and formalin-fixed skin sections from a subset of patients were tested using fluorescent in situ hybridization (FISH) with B. henselae-specific DNA probes.
Results:
Seroreactivity to Bb, RFB or both was detected in 63% of the cohort, while positive PCR testing for Bb, RFB or both was detected in 53% of the cohort. Overall, 90% of patients tested positive for exposure and/or infection with Borrelia spirochetes. B. henselae infection was detected by PCR in skin sections or body fluids from 20% of the subjects, and B. henselae FISH testing was positive in 30% of the dermatological specimens submitted for study.
Conclusion:
The study demonstrates an association between MD and positive tests for both Bb and RFB spirochetes. In conjunction with previous studies, our study provides corroborative evidence linking MD to Borrelia infection and tick-borne illness.
... It is characterized by fibers appearing in slow-or non-healing skin lesions and even beneath unbroken skin, along with abnormal (crawling, stinging, or biting) sensations of skin. Extracutaneous manifestations (fatigue, joint pain, fibromyalgia, or sleep disorders) have been reported to co-exist 1 . It has been recognized as a delusional infestation 2 . ...
Morgellons disease is a rare disease with unknown etiology. Herein, we report the first case of Morgellons disease in Korea. A 30-year-old woman presented with a 2-month history of pruritic erythematous patches and erosions on the arms, hands, and chin. She insisted that she had fiber-like materials under her skin, which she had observed through a magnifying device. We performed skin biopsy, and observed a fiber extruding from the dermal side of the specimen. Histopathological examination showed only mild lymphocytic infiltration, and failed to reveal evidence of any microorganism. The polymerase chain reaction for Borrelia burgdorferi was negative in her serum.
... The symptoms of the restless legs syndrome are at first felt when the patient is at rest: an unpleasant sensation in the legs (rarely in the arms) accompanied by uncontrollable movements which become less intense when there is voluntary activity, to return when this activity ceases. Serious sleep disturbance results 3,4 . ...
Dear Sir: Two persons met one of us to ask for medical advice. On the basis of the clinical picture, we established the diagnosis of Ekbom syndrome, fundamentally related to skin lesions. We judged it relevant to communicate these occurrences, particularly for the reason that, in spite of our vast experience in dealing with clinical and assistance practice, we had not until now come into contact with patients in such situation. There is no doubt that this subject deserves specific commentaries, as it connotes speculation, doubts, and a wide range of opinions. The first account of a complex set of symptoms later known as the restless legs syndrome (anxietas tibiarum) was given in 1685 by Sir Thomas Brown, an English physician. The same investigator wrote a monograph under the title "Letter to a Friend" describing a condition observed in children of Languedoc, characterized by the periodic extrusion of stiff "black hairs" observed on their lumbar region. These children were called "morgellons" in the local language. Even now, such fundamental aspects of both conditions, as etiology, clinical picture and therapy, are the object of doubts. The symptoms of the restless legs syndrome are at first felt when the patient is at rest: an unpleasant sensation in the legs (rarely in the arms) accompanied by uncontrollable movements which become less intense when there is voluntary activity, to return when this activity ceases. Serious sleep disturbance results 3,4 . Both syndromes: the restless legs (Wittmaak -– Ekbom) and the morgellons are now identified as two distinct entities, but there are some authors who still consider them as two aspects of the same entity because neuropsychiatric symptoms considered to be analogous can be observed in both cases. The persistence of such doubts is an indication of scarcity of information available about the causes of symptoms that, for lack of proper investigation, are inexplicable as to their origin and persist interfering with people's normal daily activities. A better fate was not in prospect for those with morgellons disease. They sense the migration of mysterious "parasites" under their skin. Sometimes skin fragments together with structures defined as "fibers" are extruded. Such cases are often diagnosed as delusory parasitosis 2 . As yet their etiology has not been defined. In the consultation room these patients describe the feeling that they have migrating parasites and, as evidence to prove their case, they bring for examination small boxes containing fragments of apparently normal skin in which can sometimes be found filaments which are not identified as pieces of cloth. The frequency of this occurrence led medical students to coin the expression "matchbox syndrome". Atrocious suffering is associated with the presence of such "parasites". Sometimes the diagnostic hypothesis of "larva migrans" is accepted and anthelminthic treatment is prescribed. On consulting a dermatologist, the patients are usually referred to a psychiatrist. The paucity of convincing information about their causes has led to the acceptance of the hypothesis that the symptoms of the morgellons disease are a manifestation of Lyme disease, even though no epidemiological or laboratory data confirm such diagnostic assumption. There is a tendency to judge the accounts of patients as illogical, resulting from neuropsychiatric problems which do not correspond to a true clinical picture 1 . In view of such hypothesis, prophylactic measures against this syndrome would be pointless. A tendency has been recently observed to oppose the notion that the Wittmaack-Ekbom syndrome is exclusively the result of a neuropsychiatric disorder; various medical research institutions are showing interest in identifying its possible causative agents, devising new laboratory research techniques and eventually finding a suitable therapeutic project. Basic data concerning the two cases observed are specified below: Case 1 -EMLZ, feminine gender, 53 years old, plastic artist, residing in Ilha Bela (São Paulo State, Brazil). She feels that there are "animalcules" everywhere in her body, which have been producing violent itching since an epoch she cannot precisely remember. She has lost weight (36 kg) since then. Treatment: several non-specified anthelminthics and topic thiabendazole. Clinical examination revealed intense destructive lesions in finger-and toenails, no measures having been taken to ascertain their origin. The patient suffers from diabetes insipidus and revealed some episodes worth mentioning, according to our opinion: bat and snake bites, impetigo secondary to insect bites, pre-myocardial infarction and Stevens-Johnson syndrome due to the use of thiabendazole, and reaction due to the use of tetanus serum. Lives in a region where African snails are abundant.
... Coloration may include blue, red, green, and purple, although filaments may also be white or black. 1,2,4 Filaments, regardless of coloration, have been shown to stem from follicular sheaths, and hyaline filaments have been shown to stem from the stratum basale. 5 Some colored filaments have follicular bulbs and scaling consistent with the morphology of hairs, although others do not. ...
Morgellons disease is an emerging skin disease characterized by formation of dermal filaments associated with multisystemic symptoms and tick-borne illness. Some clinicians hypothesize that these often colorful dermal filaments are textile fibers, either self-implanted by patients or accidentally adhering to lesions, and conclude that patients with this disease have delusions of infestation. We present histological observations and electron microscopic imaging from representative Morgellons disease samples revealing that dermal filaments in these cases are keratin and collagen in composition and result from proliferation and activation of keratinocytes and fibroblasts in the epidermis. Spirochetes were detected in the dermatological specimens from our study patients, providing evidence that Morgellons disease is associated with an infectious process.
... Delusional parasitosis, named in 1946, [1] is a chronic psychiatric disorder in which patients have a false and fi xed belief that they are infested by parasites. Savely et al [6] introduced the term Morgellons disease to describe a type of infestation characterized by fi bers attached to the skin. Koblenzer [7] and Waddell and Burke [8] have discussed the utility of the term, with Murase et al [9] fi nding the term useful for building a therapeutic alliance with patients with DP. ...
Otolaryngologists in India often encounter patients with various insects presenting as foreign bodies in the ear and nose. However they overlook the possibility of the clinical entity that has come to be known as delusional parasitosis. Three patients presented in our OPD with this condition and their case reports are discussed.
... ommunity's response to Morgellons disease. While digital dermatitis has been the subject of extensive scientific investigation, unravelling the " mystery " of Morgellons disease has been hampered by claims that it results from delusions of parasitosis, 26–28 and meaningful scientific studies have been carried out by only a handful of investigators. 20,22,24,29,30 This report compares the clinical and laboratory features of the veterinary and human diseases.Figure 1 Bovine digital dermatitis. Note painful ulcerating lesion above the interdigital cleft of the hoof with multiple grayish fibers (top) and closer view of fibers (bottom). Photographs courtesy of GeA Farm Technologies, reprin ...
Bovine digital dermatitis is an emerging infectious disease that causes lameness, decreased milk production, and weight loss in livestock. Proliferative stages of bovine digital dermatitis demonstrate keratin filament formation in skin above the hooves in affected animals. The multifactorial etiology of digital dermatitis is not well understood, but spirochetes and other coinfecting microorganisms have been implicated in the pathogenesis of this veterinary illness. Morgellons disease is an emerging human dermopathy characterized by the presence of filamentous fibers of undetermined composition, both in lesions and subdermally. While the etiology of Morgellons disease is unknown, there is serological and clinical evidence linking this phenomenon to Lyme borreliosis and coinfecting tick-borne agents. Although the microscopy of Morgellons filaments has been described in the medical literature, the structure and pathogenesis of these fibers is poorly understood. In contrast, most microscopy of digital dermatitis has focused on associated pathogens and histology rather than the morphology of late-stage filamentous fibers. Clinical, laboratory, and microscopic characteristics of these two diseases are compared.
Morgellons Disease (MD) is a multisystem disorder with a primary symptom characterized by emerging of small fibres from the skin. For years, many doctors thought MD is a psychiatric disorder and treated the patients with antipsychotic drugs, behavioural therapy and counselling. However, recent studies suggest that MD is a completely different entity from psychiatric disorders. Morgellons pathophysiology remains a mystery even now. It was previously considered to be a delusional disorder due to its similarity to delusions of parasitosis or delusional infestation described many years ago. This constellation of symptoms has not been well studied in different populations, however, a study in North California found a prevalence of 3.65 per 100,000 for MD, with Caucasian and female predominance.
Self-inflicted skin disorders are artefact diseases inflicted by the use of multiple different means, for various different purposes. They account for about 2% of dermatology patient visits and include disorders with a denied or hidden pathological behavior (factitious disorders) and disorders with a non-denied and non-hidden pathological behavior (compulsive disorders). In turn, factitious skin disorders are subdivided into 2 groups: factitious disorders without an external incentive and factitious disorders with external incentives. In addition to the general diagnostic criteria, the present work examines the clinical forms of diseases of the first group (including dermatitis artefacta, Munchausen syndrome, Munchausen syndrome by proxy, and Morgellons syndrome). In this case, the subject suffers from psychological problems and generally aims to attract the attention of the people around him, and in particular of his general practitioner, or else is reacting to difficult or unfavorable environmental conditions by means of an involuntary somatization at the level of the skin. The second part of the work on self-inflicted skin disorders will comprise the factitious disorders with external incentives and the compulsive disorders.
Psychische oder soziokulturelle Einflussfaktoren haben in den letzten Jahrzehnten Morbidität, pathogenetisches Kausalitätsverständnis und auch Therapiekonzepte in der Dermatologie beachtlich verändert; den Beziehungen zwischen Haut und Psyche beziehungsweise Psyche und Haut wird zunehmend mehr Beachtung geschenkt. Psychische Störungen liegen in der Dermatologie bei bis zu einem Drittel aller Patienten vor. Hinzu kommen Störungen bei der Krankheitsbewältigung. Psychische Faktoren können erheblichen Einfluss auf Manifestation und Verlauf einer Hautsymptomatik haben. Weiterhin werden chronische Hauterkrankungen von den Betroffenen oft als hochgradig belastend erlebt. Demnach müssen bei vielen Patienten und Symptomen in der Dermatologie psychosomatische Aspekte im Sinne des biopsychosozialen Krankheitsmodells betrachtet werden, auch um eine erfolgreiche spezifische Therapie zu ermöglichen. Die psychosomatische Dermatologie beschäftigt sich mit Hautkrankheiten, bei denen psychische Ursachen, Folgen oder Begleitumstände einen wesentlichen und therapeutisch bedeutsamen Einfluss haben.
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. It helps to start a trustful doctor-patient relationship and motivates the patient for psychiatric treatment. We here review diagnostic criteria, classification of symptoms, pathophysiology and treatment options of DI. Antipsychotic medication is the treatment of choice when any other underlying cause or disorder is excluded. Further research is needed to assess the pathophysiology, and other treatment options for patients with DI.
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. These patients are more frequently seen in dermatology clinics, as they may be unwilling to acknowledge a psychiatric basis for their psychical symptoms. If we want the treatment to be effective and timely, it is important for the dermatologist to understand the underlying psychopathology of these conditions. Treatment should be gradual. An initially supportive, nonconfrontational, empathic approach to the patient is indicated. Immediate confrontation regarding the suspicion that the patient's lesions are self-induced can be counterproductive in that the patient will often refuse treatment. Frequent visits and symptomatic topical treatments are useful in the beginning. The goal is to establish a trusting and supportive enough relationship with the patient so that he or she will accept a psychiatric referral to explore the complex personality and behavioral issues that often underlie these conditions.
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. Psychiatric referral for presumed delusional infestation (DI) was recommended. Despite this, he remained insistent in his belief of infestation, and was inevitably lost to follow-up. DI, previously known as delusional parasitosis, is a rare delusional disorder where affected individuals have a fixed, false belief that they have a parasitic infestation. Diagnosis can be challenging. Practitioners need to evaluate between primary and secondary DI carefully, as management differs depending on the etiology. Despite this, patients diagnosed with primary DI tend to be resistant to psychiatric referral. This report aims to optimize management by giving the reader a guideline for appropriate investigations and advice on patient approach. It is important to recognize hallmark features of DI to minimize self-inflicted trauma and associated psychosocial consequences. Effective treatment for DI is available, and devastating consequences, including blindness, can be avoided.
Morgellons disease is characterized by complaints of uncomfortable skin sensations and fibers emanating from nonhealing skin lesions. Morgellons disease is well-known in the dermatology and psychiatry literature, where it is typically considered a subtype of delusional parasitosis, but it has not yet been described in the ophthalmology literature. A patient with self-reported Morgellons disease is presented, who was referred for evaluation of left lower eyelid ectropion. She reported that her skin was infested with fibers that were "trying to get down into the eyelid." On examination, she had ectropion of the left lower eyelid, broken cilia, and an ulcerated left upper eyelid lesion concerning for carcinoma. Biopsy of the lesion was consistent with excoriation. Treatment of her ectropion was deferred out of concern for wound dehiscence, given the patient's aggressive excoriation behavior. This case is presented to make the ophthalmologist aware of this disorder and to highlight the appropriate clinical management.
The original rationale and impetus for artificial genetic modification was the
“central dogma” of molecular biology that assumed DNA carries all the instructions for
making an organism, which are transmitted via RNA to protein to biological function in
linear causal chains. This is contrary to the reality of the “fluid genome” that has emerged
since the mid-1970s. In order to survive, the organism needs to engage in natural genetic
modification in real time, an exquisitely precise molecular dance of life with RNA and
DNA responding to and participating in “downstream” biological functions. Artificial
genetic modification, in contrast, is crude, imprecise, and interferes with the natural
process. It drives natural systems towards maximum biosemiotic entropy as the
perturbations are propagated and amplified through the complex cascades of interactions
between subsystems that are essential for health and longevity.
Delusional Infestation (DI) is a relatively rare condition with a fixed belief of being infested with living organisms, despite a lack of medical evidence of such infestation. Although it seems to be a psychiatric disease, patients commonly are admitted to dermatology clinics because of skin findings. Psychiatrists can underestimate its prevalance, whereas dermatologists can miss the diagnosis. It should be managed as a psychodermatological disease. Our aim in the study was to evaluate six patients with different clinical presentations of DI and to emphasize some clinical features.
All patients were internalized in the psychodermatology clinic for this study. Medical history and clinical data from dermatologic and psychiatric examinations were noted; Mini International Neuropsychiatric Interview (MINI-Plus) and laboratory investigations including blood and urine analyses, microscopic analysis of so-called pathogens, and skin biopsy if needed, were performed. The diagnosis was made based on detailed history, dermatologic and psychiatric examinations, and laboratory investigations. Results: All patients had symptoms of itching, burning, or crawling sensations dermatologically and thus were admitted to dermatology clinic. They were all considered secondary DI to another medical condition or to psychiatric illness. Vitamin B12 deficiency, diabetes, and hypothyroidism were the underlying medical conditions. Related psychiatric illnesses were trichotillomania and schizoaffective disorder, schizophrenia, shared pychotic disorder, and brief psychotic disorder. Two patients had delusions of inanimate materials; four patients had partial and complete remissions; and two patients have dropped out.
Each patient had different clinical characteristics creating diagnostic challenges. All complaints were related to the infestation of the skin. The presence of different psychiatric comorbidities is remarkable. It seems that both psychiatrists and dermatologists can face diagnostic and therapeutic challenges of this complex disease in clinical settings, particularly if there are unusual clinical features of DI. Therefore, both psychiatrists and dermatologists should be well aware of DI.
This chapter is a potpourri of stories that touch on various aspects of medicine. Faced with the task of ordering them somehow,
I have arranged them under five categories: serendipity, telling about some fortuitous advances in medicine; curiosities, describing a selection of fascinating clinical phenomena; trivia, telling some short stories about diseases, remedies, and persons; authorship, recording some little-known facts about medical reference books; and speculation, offering some theories about how disease just might possibly have influenced the world as we know it today.
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. In this review, we discuss the epidemiology, presentation, differential diagnosis and treatment strategy for patients with DOP.
Morgellons disease is a mysterious skin disorder that was first described over 300 years ago. The disease is characterized by fiber-like strands extruding from the skin in association with dermatologic and neuropsychiatric signs and symptoms. Although Morgellons disease has been confused with delusional parasitosis, the occurrence of the disease in children, the lack of pre-existing psychopathology in most patients and the presence of subcutaneous fibers on skin biopsy indicate that the disease has a somatic origin. The association with Lyme disease and the apparent response to antibiotic therapy supports the concept that Morgellons disease may be triggered by an infectious process. Recent studies suggest that infection with Agrobacterium may play a role in the disease. Further clinical and molecular research is needed to unlock the mystery of Morgellons disease.
Morgellons disease, a controversial, newly emerging skin disease, is not usually included in the differential diagnosis of patients presenting to the emergency department with dermatologic complaints. Delay in diagnosis may result in months or years of suffering for patients who are routinely misdiagnosed with incorrect psychiatric or dermatologic conditions. A patient's case is presented in this article. The patient history, differential diagnosis, and distinctive features of Morgellons disease are discussed so that advanced practice nurse and physician providers may gain a knowledge base for clinical practice.
Morgellons disease is a psycho-dermatologic condition in which patients report fibers or filaments "growing" out of their skin. This case report highlights an oral ulceration in a young woman associated with Morgellons disease, a condition that has not been previously described in the dental literature. An increasing number of individuals are self-reporting this condition and oral health care providers must be familiar with this disorder. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 112: e19-e23)
Delusions of parasitosis (DP) is a primary psychiatric disorder, a type of monosymptomatic hypochondriac psychosis in which patients believe that 'bugs' or 'parasites' have infested their skin or that they have even spread into their visceral organs. Patients with DP usually approach different medical specialists, mostly dermatologists and primary care physicians because of symptoms presenting as crawling under their skin. Therefore, the exact prevalence of DP is unknown. It is believed that it is a rare disorder but different studies indicate that the prevalence is greater than presented. The etiology of this disorder is still unclear. Patients with DP come to a physician with a stereotypic history. Usually the patient has previously addressed many other different specialists and symptoms are usually present for several months to years. The main cutaneous symptom is crawling, biting and pruritus due to 'burrowing of parasites, insects or bugs' under the skin. Patients with DP are rare but can be very challenging for making the correct diagnosis and for the treatment as well. It is essential to distinguish primary from secondary disorder since the approach to these patients is different. Dermatologists who have good knowledge in diagnosis, both dermatologic and psychodermatologic, and who dare prescribe antipsychotics after consulting liaison-psychiatrist, can have good results in treating patients with DP. When treating patients with DP, multidisciplinary approach by collaboration between a dermatologist and a psychiatrist is necessary to provide complete and meaningful treatment for these patients.
A 58-year-old woman suffering from delusional parasitosis tried to kill her general practitioner. Her husband shared in her beliefs but lost all delusional conviction after she was compulsorily admitted to a special hospital. The case illustrates the intractable nature and potential dangerousness of some of these cases, and their affinity to paranoia.
A region of the chromosome of Agrobacterium tumefaciens 11 kb long containing two operons required for cellulose synthesis and a part of a gene homologous to the fixR gene of Bradyrhizobium japonicum has been sequenced. One of the cellulose synthesis operons contained a gene (celA) homologous to the cellulose synthase (bscA) gene of Acetobacter xylinum. The same operon also contained a gene (celC) homologous to endoglucanase genes from A. xylinum, Cellulomonas uda, and Erwinia chrysanthemi. The middle gene of this operon (celB) and both the genes of the other operon required for cellulose synthesis (celDE) showed no significant homology to genes contained in the databases. Transposon insertions showed that at least the last gene of each of these operons (celC and celE) was required for cellulose synthesis in A. tumefaciens.
Perforating dermatoses, an often overlooked entity comprised of Kyrle's disease, perforating folliculitis, reactive perforating collagenosis, elastosis perforans serpiginosa, and acquired perforating dermatosis, are succinctly described, focusing attention on their clinical features, histopathology, treatment, and pathogenesis. The literature on these facets has been extensively reviewed. In addition, three fresh cases of Kyrle's and one of perforating folliculitis have been incorporated to illustrate these conditions.
Xylan is the principal type of hemicellulose. It is a linear polymer of beta-D-xylopyranosyl units linked by (1-4) glycosidic bonds. In nature, the polysaccharide backbone may be added to 4-O-methyl-alpha-D-glucuronopyranosyl units, acetyl groups, alpha-L-arabinofuranosyl, etc., in variable proportions. An enzymatic complex is responsible for the hydrolysis of xylan, but the main enzymes involved are endo-1,4-beta-xylanase and beta-xylosidase. These enzymes are produced by fungi, bacteria, yeast, marine algae, protozoans, snails, crustaceans, insect, seeds, etc., but the principal commercial source is filamentous fungi. Recently, there has been much industrial interest in xylan and its hydrolytic enzymatic complex, as a supplement in animal feed, for the manufacture of bread, food and drinks, textiles, bleaching of cellulose pulp, ethanol and xylitol production. This review describes some properties of xylan and its metabolism, as well as the biochemical properties of xylanases and their commercial applications.
Delusional parasitosis (Ekbom syndrome) is an uncommon psychiatric disorder that presents with a delusion of being infested with parasites. Treatment of this condition is difficult as patients with this paranoid disorder reject psychiatric diagnosis and treatment and often consult a dermatologist. Sharing the delusional beliefs of the paranoid patient by other people living in close emotional bonding with him/her could occur. We report here the clinically interesting phenomenon of delusion of parasitosis occurring simultaneously in all the members of a family. There was a pathological bonding between the members of the family who all presented to the dermatologist and rejected treatment. Dermatologists need to be aware of this uncommon clinical picture.
Pimozide is an antipsychotic drug of the diphenylbutylpiperidine class. In the US, it is FDA-approved only as a backup treatment for Gilles de la Tourette syndrome, although it has been used in other countries for many years as a treatment for schizophrenia. In the past 20 years, pimozide has been found to be especially efficacious in the treatment of monosymptomatic hypochondriacal psychoses and is used by psychiatrists and dermatologists for this off-label purpose. In particular, pimozide is considered the treatment of choice for delusions of parasitosis. In addition, pimozide has been found to be efficacious in the treatment of body dysmorphic disorder, metastatic melanoma, trichotillomania, and trigeminal and postherpetic neuralgia. This review aims to familiarize physicians, especially dermatologists, on the uses of pimozide in dermatologic practice. A review of the literature was performed and the relevant information synthesized to give a complete overview of the drug and its therapeutic uses in dermatology.
Introduction
Ekbom's syndrome or delusional parasitosis is a disorder in which the patient believes that he/she is infected by a parasite. Epidemiologic, nosologic, psychopathologic and therapeutic data can barely be interpreted, as delusional parasitosis has mostly been described in either isolated cases or small cohorts. An extensive literature review is recommended to better understand common features associated with this syndrome.
Exegesis
Ekbom's syndrome is a chronic disorder that may occur at any age but is more common in the elderly, particularly in females. International classifications have included this syndrome in non-schizophrenic delusions. However, it has also been reported in schizophrenia, affective disorders, and organic or induced psychosis. Treatment is based on antipsychotic agents, psychotherapy, and cooperation between dermatologists and psychiatrists.
Conclusion
Pimozide is currently the most effective treatment. It requires careful monitoring, as it has several adverse effects. For patients with concomitant depressive symptoms, the use of ant/depressants is recommended.
Carbohydrate researchers may think it is reasonable to believe that the synthesis and structure of a crystalline b-1,4 glucan would be quite straightforward; however, this is not the case. The pitfalls and detours of research have been counterbalanced by exciting new discoveries in cellulose structure, biosynthesis, and molecular biology. Cellulose exists in crystalline and noncrystalline states, with the metastable cellulose I allomorph being the most abundant native crystalline form. Two stages of cellulose I crystallization will be described as well as a new form of ordered, noncrystalline cellulose known as quasi-tactic cellulose. The biosynthesis of cellulose is exceedingly complex, involving many genes and enzymes. Ordered membrane complexes (TCs) control the polymerization and crystallization to form cellulose microfibrils. Biochemical investigations have proven to be very difficult; however, recent breakthroughs on in vitro cellulose I assembly lend confidence that this part of cellulose research will soon yield great advances. The greatest success has come from molecular genetics research where the genes for cellulose biosynthesis from Acetobacter have been identified, cloned, mutated, and expressed in other systems. The multidomain architecture of b-glycosyl transferases has led to a better understanding of glucan chain polymerization leading to the twofold screw axis in cellulose as well as finding similar domains hypothesized to function in higher plant cellulose biosynthesis. The recent flurry of activity in this field promises to give even more clues to the developmental regulation of cellulose biosynthesis among plants, including the major textile and forest crops.
Delusional parasitosis (Ekbom syndrome) is an uncommon psychiatric disorder that presents with a delusion of being infested with parasites. Treatment of this condition is difficult as patients with this paranoid disorder reject psychiatric diagnosis and treatment and often consult a dermatologist. Sharing the delusional beliefs of the paranoid patient by other people living in close emotional bonding with him/her could occur. We report here the clinically interesting phenomenon of delusion of parasitosis occurring simultaneously in all the members of a family. There was a pathological bonding between the members of the family who all presented to the dermatologist and rejected treatment. Dermatologists need to be aware of this uncommon clinical picture.
• Patients with renal disease or diabetes mellitus often have an acquired perforating disease of the skin develop that is characterized by hyperkeratotic papules with transepidermal elimination of degenerated material, including collagen or elastic fibers. There is disagreement regarding the most appropriate name for this disease. The pathologic process has been identified by various authors as reactive perforating collagenosis, elastosis perforans serpiginosa, perforating folliculitis, or Kyrle's disease. We have seen four patients with renal disease and/or diabetes whose skin biopsy specimens demonstrated combined transepidermal elimination of both collagen and elastic fibers. This finding is not characteristically seen in any of the previously defined perforating diseases. Since the histologic findings vary greatly in different lesions from different patients with renal disease, we recommend referring to this process as "acquired perforating dermatosis." It is best not to create a new category of perforating disease or to say that a given patient has one of the other four diseases based on random sampling of only a few lesions.
(Arch Dermatol. 1989;125:1074-1078)
Just as psychodermatologic disorders can mimic real dermatologic conditions, real dermatologic or other bona fide physical problems such as neurologic disorders can also mimic psychodermatologic disorders. This article illustrates several cases of pseudopsychodermatologic disorders. When faced with a difficult patient or baffling case, sometimes there is a tendency to "jump to conclusions" with regard to the psychogenic origins of the case. It is important to be cognizant of the possibility that one may be missing a real organic disorder if one does not keep an open mind with regard to diagnosis of the patient's skin condition.
In this article, the epidemiology and differential diagnosis of monosymptomatic hypochondriacal psychosis are discussed in detail. The use of pimozide is also discussed and illustrated with case reports. Delusional patients are some of the most challenging cases based in dermatologic practice. This challenge is so much easier to meet if one knows how to approach these patients and feels comfortable in the use of pimozide.
A wild-type Acetobacter pasteurianus was subjected to chemical mutagenesis for the induction and isolation of a cellulose overproducing strain. A mutagenized strain capable of synthesizing double amounts of cellulose compared to the wild type was obtained. Cellulose, both from the wild-type and the mutagenized strain, was extracted and purified for chemical characterization and investigation of its physico-chemical properties. The comparison of the two microbial polysaccharides shows that the putative mutation of A. pasteurianus strain had no effect on some cellulose features such as chemical structure, polymorphic form, crystallinity.
Ekbom's syndrome or delusional parasitosis is a disorder in which the patient believes that he/she is infected by a parasite. Epidemiologic, nosologic, psychopathologic and therapeutic data can barely be interpreted, as delusional parasitosis has mostly been described in either isolated cases or small cohorts. An extensive literature review is recommended to better understand common features associated with this syndrome.
Ekbom's syndrome is a chronic disorder that may occur at any age but is more common in the elderly, particularly in females. International classifications have included this syndrome in non-schizophrenic delusions. However, it has also been reported in schizophrenia, affective disorders, and organic or induced psychosis. Treatment is based on antipsychotic agents, psychotherapy, and cooperation between dermatologists and psychiatrists.
Pimozide is currently the most effective treatment. It requires careful monitoring, as it has several adverse effects. For patients with concomitant depressive symptoms, the use of antidepressants is recommended.
We report elastosis perforans serpiginosa (EPS) arising in three patients with Ehlers-Danlos syndrome, osteogenesis imperfecta and Down's syndrome. These cases illustrate some of the rare but well-recognized disease associations with EPS. The other causes of EPS are reviewed.
Delusions of parasitosis is a rare psychiatric disorder in which the patient has a fixed, false belief that he or she is infested by parasites. Even though it is a psychiatric disorder, these patients usually present to a dermatologist because they are convinced that they have a dermatological problem. Patients with delusions of parasitosis generally reject psychiatric referral. The diagnosis of delusions of parasitosis can often be made on the basis of the history alone, but it is important to make sure that the patient does not have a organic skin disorder, and the delusion is not secondary to another mental or physical illness. The current treatment of choice is the antipsychotic medication pimozide. The principal difficulty in management is convincing patients to take the drug. This results from the obvious discrepancy between the patients' belief system and the clinician's understanding of the situation. The most common adverse effects of pimozide are extrapyramidal symptoms such as stiffness and, less frequently, a special inner sense of restlessness called akathisia. Effective treatment of such extrapyramidal reactions includes benztropine 1 to 2 mg up to 4 times daily as needed, or diphenhydramine 25 mg 3 times daily as needed. Pimozide can have cardiotoxic effects at high dosages. Traditionally, it has been recommended to check pretreatment and post-treatment electrocardiograms even for patients who have no history or cardiac conduction abnormalities or arrhythmia. However, a more recent publication questions the need for this if the patient takes < 10 mg/day, is not elderly, and has no history of cardiac arrhythmia. Effective dosages of pimozide for delusions of parasitosis have ranged from 1 to 10 mg/day. The lowest effective dosage of pimozide should be used for the shortest possible duration to minimize the risk of tardive dyskinesia developing in these patients. Significant improvements in quality of life have been achieved with successful treatment with pimozide. Atypical antipsychotics such as risperidone with a much safer adverse effect profile may prove to be effective for the treatment of delusions of parasitosis in the future.
Lymphatic filariasis has afflicted people in the tropical areas of the world for thousands of years but even up to comparatively recent times it has been poorly understood and its importance under recognised. In the last 2 decades or so there has been a flurry of activity in filariasis research, which has provided new insights into the global problem of filariasis, the pathogenesis of filarial disease, diagnosis and control. (C) 2002 Published by Elsevier Science Ltd. on behalf of Australian Society for Parasitology Inc.
A cellulose-protein complex is reported as a normal although minor constituent of mammalian connective tissue; higher concentrations have been observed in certain pathological human skin conditions. Experiments on the degradation of collagen by treatment with alkaline buffers have afforded histochemical evidence for the production of highly anisotropic fibres. Chemical and physical studies show that these fibres consist of a protein-polysaccharide complex, the polysaccharide fraction of which is indistinguishable from native cellulose, arranged in helical form round a protein template. The question of fibrogenesis is discussed in the light of synthetic studies whereby anisotropic fibres having similar properties to those of native mammalian cellulose fibres can be obtained by the interaction of gelatin, chondroitin sulphate and calcium ions.
Sugar chains are abundantly expressed on the outer surfaces of the vast majority of viral, bacterial, protozoan and fungal pathogens, as well as on the membranes of mammalian cells. This class of carbohydrate molecule is without peer in structural diversity and is characteristically suitable for storing and displaying biological signals for molecular and cellular recognition. Exploring the biological information contained in sugar chains is an important topic of current postgenomic research. To facilitate these investigations, we have focused on the establishment of a carbohydrate-based microarray technology. Recently, we reported that a large panel of carbohydrate-containing macromolecules, including polysaccharides, natural glycoconjugates, and the mono- and oligosaccharides coupled to carrier molecules, can be stably immobilized on a microglass slide to produce a large-scale carbohydrate microarray. In this review, we attempt to summarize our recent progress in using this technology to uncover the carbohydrate-based biological signals that are recognized by the human and animal immune systems. We also discuss the potential of various platforms of carbohydrate microarrays that were recently established and analyze the challenges to future development of carbohydrate microarray technologies and their applications.
Currently, only three drugs are used to control and treat the mosquito-borne parasitic disease lymphatic filariasis: diethylcarbamazine, ivermectin (Mectizan) and albendazole (Zentel). All interrupt transmission by eliminating microfilaria, the parasite stage that is responsible for transmission between hosts, but do not reliably kill the adult worms that are responsible for much of the pathology seen in the disease. There is an urgent need to develop drugs that will reliably kill adult worms and several compounds are under-going in vitro and animal testing. An alternative strategy - that of targeting symbiont bacteria within the parasite - has also shown promising results.
Pimozide is an antipsychotic drug of the diphenylbutylpiperidine class. In the US, it is FDA-approved only as a backup treatment for Gilles de la Tourette syndrome, although it has been used in other countries for many years as a treatment for schizophrenia. In the past 20 years, pimozide has been found to be especially efficacious in the treatment of monosymptomatic hypochondriacal psychoses and is used by psychiatrists and dermatologists for this off-label purpose. In particular, pimozide is considered the treatment of choice for delusions of parasitosis. In addition, pimozide has been found to be efficacious in the treatment of body dysmorphic disorder, metastatic melanoma, trichotillomania, and trigeminal and postherpetic neuralgia. This review aims to familiarize physicians, especially dermatologists, on the uses of pimozide in dermatologic practice. A review of the literature was performed and the relevant information synthesized to give a complete overview of the drug and its therapeutic uses in dermatology.
Elastosis perforans serpiginosa (EPS) is a reactive perforating dermatosis characterized by the elimination of abnormal elastic fibers from the upper dermis through the epidermis. In a few cases, it occurs as a side effect of treatment by D-penicillamine (DPA). The first case of EPS induced by DPA was described in 1972 in a patient treated for Wilson's disease. Subsequently, cutaneous changes resembling pseudoxanthoma elasticum (PXE) were observed in patients treated with DPA and were reported as pseudo-PXE.
We report herein the clinical, pathological and ultrastructural study of 2 new cases of DPA-induced EPS and pseudo-PXE. These patients had been treated for Wilson's disease since 14 and 16 years, respectively. Characteristic abnormal elastic fibers were found on histopathological examination of both EPS and pseudo-PXE skin and confirmed by an ultrastructural study. There was no ABCC6 mutation.
Penicillamine is able to induce widespread, cutaneous and systemic, elastic fiber damage. Our patients present typical features of DPA-induced elastosis, presenting as EPS and pseudo-PXE. ABCC6 mutation is associated with PXE and, as expected, it was absent in our cases of pseudo-PXE. This elastopathy has been related to morphologic changes in elastic fibers secondary to prolonged therapy in most cases. DPA may interfere with elastin cross-linking through inhibition of the enzyme lysyl oxidase, or by formation of complexes with the cross-linked precursors, impairing a normal maturation of elastic fibers. However, no fatal complication of DPA-induced elastopathy has been reported so far. An improvement of the cutaneous lesions is expected after the drug discontinuation.
Sir Thomas Browne and the disease called the Morgellons
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E-mail: rstricker@usmamed.com 2006 Adis Data Information BV. All rights reserved
E-mail: rstricker@usmamed.com
2006 Adis Data Information BV. All rights reserved.
Am J Clin Dermatol 2006; 7 (1)
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