What is Morgellons disease?

Quick Answer
A skin disorder characterized by a pattern of dermatologic symptoms described as insectlike sensations, with skin lesions varying from very minor to disfiguring, and associated with disabling fatigue, joint pain, and various neuropsychiatric symptoms. In the first decade of the twenty-first century, the cause, transmission, and treatment remained under investigation.
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Causes and Symptoms

Morgellons disease is a pattern of dermatologic symptoms first described several centuries ago. Patients typically complain of insectlike sensations, such as persisting itching, stinging, biting, pricking, burning, and crawling. They often have skin lesions that can vary from very minor to disfiguring. Some patients, however, have no visible changes in the skin. In some cases, fiberlike material can be obtained from the skin lesions; patients describe this material as “fibers,” “fiber balls,” and “fuzz balls.” In other cases, “granules” can be removed from the skin, described by the patients as “seeds,” “eggs,” and “sands.” The majority of patients report disabling fatigue, reduced capacity to exercise, joint pain, and sleep disturbances. Additional symptoms may include hair loss, neurological symptoms, weight gain, recurrent fever, orthostatic intolerance, tachycardia, decline in vision, memory loss, and endocrine abnormalities (such as diabetes type 2, Hashimoto’s thyroiditis, hyperparathyroidism, or adrenal hypofunction).

The disease may occur at any age and has a large geographic distribution. It occurs in both males and females. Cases of elderly women living alone seem more frequently reported. Physical stress was reported to be a common precursor. Rural residence and exposure to unhygienic conditions (contact with soil or waste products) are often described. Results from routine laboratory tests are often variable and inconsistent.

The vast majority of these patients have been diagnosed with psychosomatic illness. Prior psychiatric diagnosis (such as bipolar disorder, paranoia, schizophrenia, depression, and drug abuse) has been recorded in more than 50 percent of patients . Patients are obsessively focused on the skin symptoms in terms of complaints and measures to eradicate the disease and to prevent contagion. They usually seek help from between ten and forty physicians and complain of being not understood or taken seriously. Usually, patients are intensely anxious and not open to the idea that they may have a psychological or neurological pathology. They often experience extreme frustration.

Morgellons disease has also been reported in association with conditions that are characterized by itching, such as renal disease, malignant lymphoma, or hepatic disease.

The etiology of Morgellons disease remains under investigation. So far, no examinations, biopsies, and tests have been able to provide evidence supporting any possible cause. Skin biopsies from patients with Morgellons disease typically reveal nonspecific pathology or inflammatory process/reaction with no observable pathogen. In a 2012 study from the US Centers for Disease Control and Prevention (CDC) researchers did not find any evidence that Morgellons is caused by either an environment substance or an infectious agent.

Treatment and Therapy

The management of patients with Morgellons disease is symptomatic and supportive. It can include skin care with baths, topical ointments, and emollients. It is important for the treating physician (in most cases, a dermatologist) to refer the patient to a psychiatrist or to prescribe appropriate psychoactive medication. Long-term treatment with pimozid (0.5 to 2 milligrams once daily) has been suggested. Risperidone and aripiprazone have also been reported to be efficient. Patients should be convinced that the medication may be needed for months or years.

Perspective and Prospects

Morgellons disease was initially described in France, in 1674, by Sir Thomas Browne. “The Morgellons” was the term used to describe dermal complaints such as hairlike extrusions and sensations of movement beneath the skin reported by children. By the early seventeenth century, this condition was thought to be caused by the parasite Dranculus (later called Dracontia), and the suggested treatment consisted of filament removal from the skin. Michel Ettmuller produced the only known drawing dating from 1682 of “The Morgellons,” the objects associated with what was then believed to be a parasitic infestation in children.

The name “Morgellons disease” was created in 2002 to describe patients presenting with this clinical set of symptoms and to provide an alternative to “delusion of parasitosis.” Although the condition was first described many centuries ago, much attention has recently been given to the disease because of the Internet, mass media, and the online support group Morgellons Research Foundation at www.morgellons.com. There is still a discussion whether Morgellons disease is very similar, if not identical, to “delusion of parasitosis.” Thus, whether Morgellons disease is a delusional disorder or even a disease has been a mystery for more than three hundred years. So far, research about Morgellons is sparse and limited. General practitioners, mental health professionals, and the general public need to be aware of the signs and symptoms of this mysterious condition. Some authors suggest the term “syndrome” instead of “disease.”

Bibliography

"CDC Study of an Unexplained Dermopathy." Centers for Disease Control and Prevention, January 25, 2012.

Harvey, William T., et al. “Morgellons Disease: Illuminating an Undefined Illness—A Case Series.” Journal of Medical Case Reports no. 3 (2009): 8243.

Fair, Brian. "Morgellons: Contested Illness, Diagnostic Compromise and Medicalisation." Sociology of Health & Illness 32, no. 4 (May 2010): 597–612.

Koblenezer, Caroline S. “The Challenge of Morgellons Disease.” Journal of the American Academy of Dermatology 55 (2006): 920–22.

"Morgellons Disease: Managing a Mysterious Skin Condition." Mayo Clinic, April 11, 2012.

Savely, Virginia R., Mary M. Leitao, and Raphael B. Stricker. “The Mystery of Morgellons Disease: Infection or Delusion?” American Journal of Clinical Dermatology 7, no. 1 (2006): 1–5.

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