Morgellons is thought to be a variant of dermatozoa madness in which patients subjectively perceive thread and hyphal formation under the skin. Recent studies have ruled out bacterial origin and led to the classification of the disease as delusional. Patients are treated symptomatically with antipsychotics and may also be accompanied by psychotherapy.
What is morgellons?
Dermatozoa delirium is characterized by delusional beliefs of tiny creatures under the skin. Patients think they can feel movement under their skin. They suffer from anxiety and severe itching. The parasitic infestation of their skin is an established fact for the sufferers. The patients do not allow themselves to be corrected by doctors, even though there is no clinical evidence of the infestation. Karl-Axel Ekbom first described the delusion in 1938. Morgellons or Morgellons disease is a variant of dermatozoa madness. The term was first mentioned by English physician Sir Thomas Browne in the 17th century. In 2002, the term became widespread, especially in the English-speaking world, because the mother of an affected child supported its spread by founding the so-called Morgellons Research Foundation. The delusional disorder is characterized by the delusion that hyphae or fibers form under the skin of patients. To date, the cause of the disease is largely unclear. However, different speculations on the pathogenesis now exist.
Causes
The etiopathogenesis of Morgellons is speculative. Some hypotheses assume infectious agents, such as the bacteria Agrobacterium tumefaciens or Stenotrophomonas maltophilia, the fungal species Cryptococcus neoformans, and the parasite Strongyloides stercoralis. However, since no pathogens were found in the skin samples of those affected, this explanatory approach has probably been refuted. In one study, fibers were actually found on the skin and in the scabs or crusts of the scratch wounds in about ten percent of the participants. Most of the fibers found consisted of cellulose, typically found in cotton. In addition, polyamide in the sense of nylon was found. A nail polish compound was also isolated. The study investigators summarize that the fibers found probably came from the patients’ clothing. The patients’ uninjured skin was also examined for fibers. No fibers were found in the uninjured areas, so the condition is almost certainly a delusion. What triggers the delusion remains unclear. It is possible that a disturbance in body sensation plays a causative role and makes patients feel normal bodily processes particularly intensely or misattribute them.
Symptoms, complaints, and signs
Patients with Morgellons persistently believe that variegated fibers and hyphae are forming under their skin or in subcutaneous tissue. They experience itching and are often frightened. To get rid of the fibers, they scratch their own skin, or even cut themselves. For this reason, sufferers show a variety of skin lesions. They often talk about inexplicable movement phenomena under their skin. Some also suffer from musculoskeletal complaints or complain of symptoms of the gastrointestinal tract. Because the patients are emotionally frightened, they suffer more or less severe performance limitations. Cognitive disturbances often occur. All patients are unable to recognize their delusions as such. In the U.S., the prevalence of the disorder is reported to be four cases per 100,000 population, rounded. The clinical picture primarily affects women.
Diagnosis and course of the disease
The diagnosis of Morgellons is usually made as part of a larger diagnostic workup. During the diagnostic process, the physician must carefully investigate the patient’s concerns and, as part of the investigation, must rule out the presence of actual parasites or other microorganisms. A psychiatric evaluation is also usually performed.
Complications
This disease causes not only psychological but also severe physical limitations and discomfort. Those affected suffer from a very unpleasant feeling and can also scratch their skin due to the delusions. It is not uncommon for inflammation or redness to occur, and scars can also result from scratching.For this reason, patients suffer from various lesions on the skin, which significantly reduce self-esteem and may also lead to psychological complaints or inferiority complexes. Likewise, there are complaints in the stomach and intestines and not infrequently movement disorders. The patient’s quality of life is significantly reduced by this disease. In many cases, those affected do not admit the disease to themselves, which means that early treatment is not possible in many cases. Without treatment, irreversible damage to the skin can occur, severely limiting the patient’s aesthetic appearance. Treatment of this disease is usually carried out without complications with the help of medications and through psychological care. This can limit most of the symptoms. Also the life expectancy is usually not reduced. However, the success of the treatment also depends heavily on the will of the patient.
When should one go to the doctor?
People who experience sensations immediately under the epidermis that are unusual should consult a physician. Characteristic of Morgellons is perception of colored threads or movement under the skin. A visit to the doctor is necessary to initiate an intensive examination and allow a diagnosis to be made. Itching, open sores, and general malaise should be presented to a physician. If sterile wound care cannot be provided, the affected person is at risk of blood poisoning and potentially endangering his or her life. A therapist is needed for anxiety, behavioral problems, or feelings of disbelief. Part of the clinical picture of Morgellons is the patient’s lack of insight into the disease. Therefore, relatives or people from the close social environment of the affected person who have the confidence of the affected person and should initiate a visit to the doctor. If delusions occur, there is impairment in coping with daily life, general malaise or emotional stress, medical help is needed. If the affected person seems confused, shows a noticeable demeanor, or if there are complaints of mobility, a visit to the doctor is necessary. Impaired digestion, pain in the stomach or intestines, and a feeling of illness should be presented to a physician. Dizziness, sleep disturbances, changes in weight, diarrhea or constipation are other signs of a health disorder that needs to be clarified.
Treatment and therapy
Because the cause of Morgellons is unclear, no causal treatment options exist to date. Thus, the delusional disorder can only be treated symptomatically. Widely used are conservative approaches with antipsychotics. Improvements in delusions have been achieved primarily with pimozide, risperidone and aripiprazole. Because these substances have resulted in improvement of symptoms, the classification of the disorder as delusional is almost certainly correct. Psychotherapeutic care is indicated. For causal treatment of Morgellons, the psychological cause for the onset of the delusions would first need to be identified so that it can be resolved by talk therapy. If the hypothesis of a disturbed body sensation in the sense of an over-sensitization to one’s own bodily processes is correct, a reassignment of the perceived stimuli under the skin could lead to a causal cure of the symptomatology. This reassignment would open up a different perspective of observation for the patients and could lead to the fact that the perceived stimuli are no longer perceived as frightening. Once this is no longer the case, patients no longer focus so strongly on detecting the stimuli themselves, and the delusions gradually recede. This type of therapy would be a much gentler option than symptomatic administration of antipsychotics. Even without detecting the psychological cause, subjective improvement could be brought about by positive reappraisal of the delusions.
Prospect and prognosis
Morgellons syndrome can be treated with medication. However, because symptoms can vary widely, the prognosis tends to be negative. In any case, patients must consult a specialist and receive close treatment. Prescribed antipsychotics can cause undesirable side effects and interactions.Typical symptoms are muscle and movement disorders, pregnancy damage and psychological complaints such as depression or listlessness. The side effects and Morgellons disease itself reduce the patient’s sense of well-being. Serious mental illness can result, which often persists beyond any recovery. Morgellons usually also reduces life expectancy. The symptoms of the gastrointestinal tract, skin and musculoskeletal system cause various complications in the long term, such as cancers, circulatory disorders or optical changes. Morgellons mainly affects women who develop the symptoms over a long period of time. Timely treatment of this rare condition improves the prognosis. However, serious side effects can never be completely ruled out. Therefore, the prognosis is relatively poor overall. Patients usually have to undergo treatment throughout their lives, suffering physical and psychological problems that often result in further health problems.
Prevention
The primary cause for the development of Morgellons is so far in the dark. For this reason, the delusional disorder has been difficult to prevent up to the present time. Efforts to stabilize one’s psyche can be understood in the broadest sense as nonspecific preventive measures.
Aftercare
In most cases, only very few and limited aftercare measures are available to the person affected by Morgellons, so that the affected person should see a doctor very early on in order to prevent the occurrence of further complications and complaints. There can be no self-healing, so the affected person is always dependent on medical examination and treatment for this disease. In many cases, sufferers are dependent on the help and support of their own family and friends. In many cases, these must also inform the patient of the complaints and symptoms of Morgellons and also initiate treatment. In severe cases, treatment in a closed clinic may also be necessary. Those affected themselves are usually dependent on taking various medications in the case of Morgellons. Regular intake and the prescribed dosage must always be observed in order to alleviate and limit the symptoms. Regular check-ups with a psychologist are also very important in Morgellons. As a rule, this disease does not reduce the life expectancy of the affected person.
What you can do yourself
Since it is not yet known how Morgellons develops, there is no way to treat the trigger. In any case, the sufferer requires psychotherapeutic treatment. This can be supported, for example, by attending a self-help group. Specialized clinics for mental delusional disorders can provide the sufferer with further information about the disorder and thus help him or her to accept the symptoms in the long term. Even in the context of therapy, the delusions can often only be reduced slowly or not at all. The most important self-help measure is to accept the illness and develop appropriate coping strategies. Despite the illness, an active and healthy lifestyle should be maintained with sufficient exercise, an adapted diet and the avoidance of stress. Otherwise, further psychological problems may develop as a result of misperception and withdrawal from social life, which in turn are associated with serious complications. The affected person needs support from friends and relatives in order to cope with everyday tasks. In the best case, the affected person is cared for or monitored around the clock so that a rapid response can be made in an emergency. Accompanying medical examinations should be arranged to determine any physical triggers.
