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2.
Ital J Dermatol Venerol ; 157(5): 389-401, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36062949

RESUMO

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 two 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.


Assuntos
Transtornos Autoinduzidos , Doença de Morgellons , Síndrome de Munchausen , Dermatopatias , Transtornos Autoinduzidos/diagnóstico , Humanos , Masculino , Síndrome de Munchausen/diagnóstico , Pele , Dermatopatias/diagnóstico
3.
J Dermatolog Treat ; 33(8): 3199-3201, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35950783

RESUMO

BACKGROUND: Delusional infestation (DI) is one of the most challenging situations dermatologists and other dermatology providers may face in their practice. Dermatologists must know how to properly communicate with these patients. The process of acquiring delusional states can be a gradual development and not all delusional patients in dermatology are the same. OBJECTIVE: The objective of this manuscript is to introduce the 'Koo-Brownstone Staging System' for Delusional Infestation (Morgellons disease) with the goal of improving communication and management for these patients. METHODS: This staging system has been derived based on more than three decades of experience of the senior author supported by additional years of experience of the first author. RESULTS: The following stages are presented and explained: formication only (stage 1), overvalued ideation of parasitosis (stage 2), pre-delusional (stage 3), delusional (stage 4) and terminally delusional (stage 5). LIMITATIONS: This staging system has been derived based on expert clinical experience rather than a direct reporting from this patient population themselves. CONCLUSIONS: This staging system will enhance awareness on the part of the health providers to enable them to categorize a given patient, which becomes critical in optimizing communications and management.


Assuntos
Delusões , Doença de Morgellons , Humanos , Delusões/diagnóstico , Delusões/terapia , Doença de Morgellons/diagnóstico , Comunicação
4.
Clin Dermatol ; 40(6): 686-690, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35905899

RESUMO

Morgellons disease is a rare condition characterized by patient-reported multicolored fibers and other nonorganic particles or organic particles embedded in and protruding from diffuse skin ulcerations. Although the scientific community is prone to believe that Morgellons disease is a psychiatric disorder, an infectious pathogenesis associated with Borrelia burgdorferi in the setting of Lyme disease has also been proposed. The histopathology is usually considered as nonspecific. To illustrate this condition, we present the case of an adult woman with significant ulcerative skin lesions and cicatricial changes on the face, trunk, and arms. After multiple biopsies and successful microscopic visualization of the fibers, she received a diagnosis of Morgellons disease in the setting of delusional infestation. No evidence of Borrelia infection was found. Treatment with antipsychotics was initiated, but the patient was lost to follow-up, as is often the case with patients with Morgellons disease.


Assuntos
Antipsicóticos , Doença de Lyme , Doença de Morgellons , Dermatopatias , Adulto , Feminino , Humanos , Doença de Morgellons/complicações , Doença de Morgellons/diagnóstico , Doença de Morgellons/psicologia , Doença de Lyme/complicações , Doença de Lyme/diagnóstico , Doença de Lyme/tratamento farmacológico , Dermatopatias/tratamento farmacológico , Antipsicóticos/uso terapêutico , Pele/patologia
6.
Dermatol Online J ; 27(8)2021 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-34755952

RESUMO

Morgellons disease is characterized by patient reports of fibers embedded in and protruding from the skin. Etiologies from infection to delusion have been endorsed, and treatment guidelines are not well-defined. The objective of this manuscript is to evaluate the existing evidence regarding the etiology and treatment of Morgellons disease in an effort to better inform clinical management. A PubMed search including key words "Morgellons," "delusional parasitosis and fibers," "delusions of parasitosis and fibers," or "delusional infestation and fibers" was completed. Original publications directly assessing etiology or treatment methods of Morgellons disease published between January, 2010 and the time of manuscript preparation were reviewed and evaluated. Sixteen articles regarding etiology were reviewed. All studies were correlative in nature with various limitations. Support for a psychiatric etiology was more widespread than support for an infectious etiology. Eleven articles regarding treatment efficacy were reviewed. Antipsychotic regimens have the most evidence of efficacy. Existing data regarding Morgellons disease suggests a psychiatric etiology and supports treatment with a low-dose antipsychotic agent once non-psychiatric causes have been excluded.


Assuntos
Antipsicóticos/uso terapêutico , Doença de Morgellons/psicologia , Infecções por Borrelia/complicações , Borrelia burgdorferi , Delusões , Quimioterapia Combinada , Humanos , Doença de Morgellons/diagnóstico , Doença de Morgellons/tratamento farmacológico , Doença de Morgellons/etiologia
7.
Hand (N Y) ; 16(6): NP5-NP9, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33435739

RESUMO

Somatic manifestations of mental illness sometimes occur in patients presenting to hand specialists. These conversion disorders can also occur in groups, a phenomenon known as "mass psychogenic illness." The increasing penetrance of the Internet and social media in modern society has greatly facilitated the interaction of patients with others with similar disorders. One example relevant to hand surgery is "Morgellons disease," a disorder popularized in 2002 and characterized by a firm belief in foreign material extruding from the skin, leading to nonhealing, self-inflicted ulcerations and excoriations. A series of 4 patients collected through an informal survey of hand surgeons regarding experience with Morgellons disease is reviewed and discussed. All patients in the series presented with a chief complaint of foreign material extruding from the hand. In 1 case, the complaint was made by a young patient's mother. In none of the patients were foreign bodies identified, although 2 patients demonstrated significant ulcerations and scars from self-excoriation. Three patients had a somatic condition affecting the hand or upper extremity, 1 directly related to self-excoriation and 2 unrelated. Treatments, workups, and ultimate outcomes varied among patients. Patients presenting with Morgellons disease often undergo multiple unnecessary tests and are at risk of inappropriate procedures. It is therefore important that providers have a compassionate understanding of the involved psychology. Herein, we offer an approach to the recognition of and treatment strategies for these patients.


Assuntos
Doença de Morgellons , Mãos/cirurgia , Humanos , Internet , Pele
8.
Dermatol Online J ; 27(10)2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-35130384

RESUMO

Psychodermatological problems are prevalent in dermatology practices. Among those, delusional infestation (DI) is the subject of one of the most challenging patient encounters practicing dermatologists may experience. This difficulty arises, at least partly, from the unavailability of psychiatric knowledge and skillset necessary to properly manage these patients, reflecting that most dermatology residency programs are unable to provide training in psychodermatology. This relates to the lack of faculty available with such expertise. This article reviews various suggestions made in the medical literature to try to improve this current unfortunate situation. However, the more common suggestion regarding organizing a multidisciplinary psychodermatologic clinic may be difficult to achieve as reflected by the scarcity of such clinics in the U.S. The authors offer alternative suggestions beyond the idea of organizing a multidisciplinary clinic.


Assuntos
Delírio de Parasitose/terapia , Dermatologia , Comunicação Interdisciplinar , Doença de Morgellons/terapia , Psiquiatria , Competência Clínica , Delírio de Parasitose/psicologia , Dermatologia/organização & administração , Humanos , Doença de Morgellons/psicologia , Psiquiatria/organização & administração
9.
Dermatol Online J ; 26(11)2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-33342168

RESUMO

Little is known about the pathophysiology of delusional infestation (DI), a psychodermatologic condition in which patients have a fixed, false belief of being infested with parasites or inanimate material in their skin, despite lack of objective evidence. Because some delusional states, such as schizophrenia and psychotic state in bipolar disorder have been found to be associated with brain structural and functional abnormalities, a literature review was conducted to summarize available data on structural and functional abnormalities that are found to be associated with DI. A review of the literature found cases of brain imaging studies in patients with primary DI, as well as patients with secondary DI. Accumulating evidence from the studies reviewed suggests that dysfunction of the fronto-striato-thalamo-parietal network may explain how delusions manifest in DI and suggest that DI has an organic etiology. Abnormalities in the striato-thalamo-parietal network may cause false sensations of infestation through dysfunction in visuo-tactile regulation, whereas abnormalities in the frontal region may impair judgement. Delusional infestation patients also exhibit increased activation of brain structures implicated in itch processing. Furthermore, patients at high risk for cerebrovascular disease who present with secondary DI may benefit from brain imaging studies to rule out brain ischemic insult.


Assuntos
Encéfalo/anormalidades , Encéfalo/fisiopatologia , Doença de Morgellons/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Doença de Morgellons/patologia , Doença de Morgellons/psicologia , Tomografia por Emissão de Pósitrons
13.
Ned Tijdschr Geneeskd ; 1632019 11 07.
Artigo em Holandês | MEDLINE | ID: mdl-31750635

RESUMO

BACKGROUND: Morgellons disease is a controversial condition characterised by a great variety of skin-related symptoms such as wounds, itch and pain and whereby the patient strongly believes these are caused by threads or fibres penetrating the skin. The subject is often discussed in social media, which leads to increasing numbers of patients who think they have the condition. CASE DESCRIPTION: A 56-year-old woman had been suffering for three years of compulsive behaviour involving her hair and scratching her skin. She was convinced there were threads running under her skin. She had self-diagnosed 'Morgellons disease'. Psychodermatological treatment led to reduced symptoms. CONCLUSION: The majority of medical practitioners believe that Morgellons disease is a type of delusional infestation. Even though there are some medical and non-medical practitioners who take the position that there is an infectious cause, such a cause has never been found.


Assuntos
Fármacos Dermatológicos/uso terapêutico , Doença de Morgellons , Técnicas Psicológicas , Comportamento Compulsivo/fisiopatologia , Comportamento Compulsivo/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Doença de Morgellons/fisiopatologia , Doença de Morgellons/psicologia , Doença de Morgellons/terapia , Dermatopatias/etiologia , Dermatopatias/psicologia , Dermatopatias/terapia , Resultado do Tratamento
16.
Clin Dermatol ; 36(6): 714-718, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30446193

RESUMO

Delusional infestation is the conviction that one is infested with pathogens-either animate or inanimate-despite medical or microbiologic evidence to the contrary. Infestation with inanimate pathogens, specifically fibers or filaments, has been controversially termed Morgellons disease by the patients themselves, who believe that this is not a psychiatric disease but rather a new organic condition or a skin manifestation of an infection, such as Lyme disease. A large-scale study by the Centers of Disease Control and Prevention on patients presenting with Morgellons clinical manifestations did not find evidence of fibers in the skin nor an association with any infection, including Lyme disease. Once the diagnosis of delusional infestation is made, the cornerstone of treatment is antipsychotics, although this is often quite challenging, as patients are reluctant to take these medications.


Assuntos
Delírio de Parasitose/epidemiologia , Delírio de Parasitose/psicologia , Doença de Morgellons/epidemiologia , Doença de Morgellons/psicologia , Pesquisa Biomédica , Centers for Disease Control and Prevention, U.S. , Delírio de Parasitose/patologia , Humanos , Internet , Doença de Morgellons/patologia , Terminologia como Assunto , Estados Unidos/epidemiologia
17.
Clin Dermatol ; 36(6): 765-773, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30446201

RESUMO

Antipsychotic drugs can be beneficial in dermatology because of their both central nervous system and peripheral effects. All antipsychotic drugs have a central postsynaptic dopamine D2 receptor blocking effect, which underlies their antipsychotic action. The antipsychotic drugs have varying degrees of histamine H1-receptor, cholinergic muscarinic receptor, and α1-adrenergic receptor blocking effects, which can affect cutaneous perception and the autonomic reactivity of the skin and can be potentially beneficial in the management of certain histamine or sympathetically mediated dermatologic manifestations (eg, urticaria, pruritus, hyperhidrosis). In addition to their antipsychotic effect, antipsychotic drugs also have a general anxiolytic effect related in part to their α1-adrenergic receptor blocking action, which can be of benefit in many dermatologic conditions, including pruritus. The antipsychotic drugs are most commonly used in dermatology for the management of a delusional disorder, somatic type, manifesting as delusional infestation, and as monotherapy or as augmentation therapy of selective serotonin reuptake inhibitor (SSRI) antidepressants, and for management of trichotillomania and skin-picking or excoriation disorder. There is earlier literature (1) on the possible beneficial effect of the phenothiazine antipsychotics in a wide range of pruritic dermatoses, and (2) the efficacy of pimozide as adjunctive therapy for metastatic melanoma, which both warrant further investigation.


Assuntos
Antipsicóticos/uso terapêutico , Dermatopatias/tratamento farmacológico , Antipsicóticos/efeitos adversos , Transtornos Dismórficos Corporais/tratamento farmacológico , Delírio de Parasitose/tratamento farmacológico , Humanos , Doença de Morgellons/tratamento farmacológico , Guias de Prática Clínica como Assunto , Prurido/tratamento farmacológico , Tricotilomania/tratamento farmacológico
19.
Compend Contin Educ Dent ; 39(4): 244-1246, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29600872

RESUMO

Delusional infestations are psychodermatologic disorders in which those affected have a false belief they are infested by parasites and/or "growing" inanimate objects from cutaneous surfaces. Individuals with delusional parasitosis (DP) believe parasites, bacteria, worms, mites, or other living organisms are the source of cutaneous symptoms, while those with Morgellons disease (MD) attribute their symptoms to growth of small fibers or inorganic material. In both DP and MD, self-inflicted, non-healing cutaneous lesions caused by scratching at the affected areas to alleviate symptoms are commonly observed. This report describes a case of oral mucosal lesions in a patient demonstrating overlapping symptoms of DP and MD. It is important for oral healthcare providers to recognize oral signs and symptoms that may be associated with psychodermatologic disorders.


Assuntos
Doença de Morgellons/diagnóstico , Doenças da Boca/psicologia , Doenças da Boca/terapia , Mucosa Bucal/patologia , Antipsicóticos/uso terapêutico , Delírio de Parasitose/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Lábio/patologia , Pessoa de Meia-Idade , Doença de Morgellons/terapia
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