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Morgellons disease: A rapport-enhancing term for delusions of parasitosis

2006; Elsevier BV; Volume: 55; Issue: 5 Linguagem: Inglês

10.1016/j.jaad.2006.04.042

1097-6787

Jenny E. Murase, Jashin J. Wu, John Koo,

Empathy and Medical Education

To the Editor: A 45-year-old female presented to our clinic in March of 2005 armed with several small plastic bags filled with “fibers,” her magnifying glass in hand. She had been to seven physicians the past four months, three of whom were dermatologists. “Doctor, have you heard of Morgellons disease?” I explained that I had, and to my surprise, she burst into tears. She spent the first few minutes of our conversation sobbing, relieved to have found a physician who had heard of Morgellons disease. Morgellons disease is not located in modern medical texts or online journals. But a Goggle search will produce approximately 15,400 hits. Our patient had made this self-diagnosis by performing an internet search on “bugs in the skin.” Patients regularly request information on Morgellons disease from academic centers. The Morgellons Research Foundation Web site can be found at www.morgellons.org. This site describes the foundation's mission: “dedicated to finding the cause of an emerging infectious disease, which mimics scabies and lice.” On this Web page, you will find pictures of the “mysterious fibers,” a patient registration page, a distinguished medical advisory board including six doctorates, a description of the current research efforts of scientists in Oklahoma, and a request for donations to fund this research. The website claims over 3300 registrants. They also have proposed an association with Lyme disease and encourage patients to have Lyme titers drawn. The site further explains the history behind the term Morgellons, coined in 1674 by Sir Thomas Browne in his monograph entitled “De vermiculis capillaribus infantium.”1Kellett C.E. Sir Thomas Browne and the disease called the Morgellons.Ann Med His. 1935; 7: 467-479Google Scholar To the layperson, the information on this Web site is deceptive, particularly to someone who suffers from delusions of parasitosis.2Koo J. Lebwohl A. Psycho dermatology: the mind and skin connection.Am Fam Physician. 2001; 64: 1873-1878PubMed Google Scholar, 3Koo J. Lee C.S. Delusions of parasitosis. A dermatologist's guide to diagnosis and treatment.Am J Clin Dermatol. 2001; 2: 285-290Crossref PubMed Scopus (99) Google Scholar However, because the term “Morgellons disease” does not have the word “delusions” embedded in the term, it is a useful way to communicate with patients regarding their disease. As a case in point, I have established a close relationship with the patient described above by referring to her delusions of parasitosis as Morgellons disease. After taking cultures and a biopsy, I reassured her that there were no bacterial, fungal, or parasitic infections. I emphasized that I did not doubt the authenticity of the sensations she was experiencing, and I empathized with how disconcerting it must be to feel bugs crawling and stinging her skin. I explained that sometimes medications that psychiatrists use to calm nerve signals help patients with Morgellons disease. She is currently on the anti-psychotic risperidone, followed by both dermatology and psychiatry.4Elmer K.B. George R.M. Peterson K. Therapeutic update: use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis.J Am Acad Dermatol. 2000; 43: 683-686Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar As is the case with the majority of patients with delusions of parasitosis, she will likely need anti-psychotic medications long-term to keep her disease under control. We caution that the use of the term “Morgellons disease” should not validate an association with an infectious disease process. Further, in order to practice ethical patient care and to serve our patients honestly and as best we can, we stress the importance of clarifying to all delusions of parasitosis patients that their condition is not a result of an infectious agent. However, we found the term to be of paramount importance in establishing patient confidence and in developing patient–physician rapport throughout this patient's care. Morgellons disease leaves us to gently question Shakespeare's age-old adage: does that which we call a rose truly smell as sweet by any other name?