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Journal of Clinical and
Basic Psychosomatics Morgellons: Delusion or disease

skin; this has often been referred to as the “matchbox multidisciplinary approach, and prevents delayed referrals,
sign”. In addition, patients often report neuropsychiatric thereby managing Morgellons disease easily for primary
2,3
symptoms, ranging from muscle pain to burning and healthcare practitioners and making it less challenging for
stinging foreign body sensations. 2-4 tertiary referrals. Patients with Morgellons have reported
9
“Morgellons” was first coined in 1674 by Sir Thomas “doctor-hopping” – occurring when the patient may reject
Browne while describing a skin disease in French the diagnosis of delusion or a psychiatric cause – which
children. This description of Morgellons referred to a may be attributed to the stigma associated with the label
group of heterogeneous skin conditions that manifested “Morgellons.” Thus, the patient may consult multiple
with animate and inanimate objects. There was a brief physicians across various specialties and institutions. 7,15
mention of Morgellons by Emslie; however, this was Morgellons diagnosis and management continue to
immediately rejected. In 1983, Lyell published a survey in be controversial. Our literature search revealed a lack
The Lancet, reporting that dermatologists were treating of treatment guidelines for Morgellons. Herein, while
patients who presented specimens in matchboxes, and the considering all angles of the conflicting debate, we aimed
term “matchbox sign” was coined. Recently, Morgellons to provide a comprehensive overview of Morgellons,
5
was reclaimed by the biologist Mary Leitao in 2002. She including its epidemiology, etiological theories, clinical
observed that her son had frequent episodes of itchiness presentation, diagnosis, and therapy.
4
accompanied by visible fiber protrusions from the skin,
This was further explored by the Centers for Disease The complexity of Morgellons presentation has
Control (CDC). They published their study results in 2012 hindered the development of diagnostic criteria and
16
and linked the condition to DI. 5 effective therapies. Furthermore, the intertwined physical
and psychological manifestations pose a challenge. Thus,
Some authors have identified Morgellons as a somatic the literature review can synthesize the existing knowledge
delusional disorder, characterized by a strong belief and highlight areas that require further research,
that one’s skin is infested with foreign pathogens. The potentially improving the understanding and treatment
6
Diagnostic and Statistical Manual of Mental Disorders of this enigmatic condition. Herein, we will examine
defines the somatic delusional disorder as a patient’s whether Morgellons is a delusion, disease, or result of
persistent belief regarding their physical health or bodily neuropsychiatric factors or drug use.
sensations. These bodily sensations can be induced by
7
inanimate objects, such as filaments or living organisms 2. Methodology
such as parasites. Unusual tactile sensations and a strong
belief in an infestation by materials,SSSS such as hair, fibers, A comprehensive literature review was conducted through
crystals, and other substances are the reported features of PubMed, MEDLINE, and EMBASE using the keywords
Morgellons. 6,8-12 These filaments resemble textile fibers and “Morgellons,” “Morgellons disease,” and “Morgellons
are available in several colors, including white, red, blue, syndrome.” Medical subject headings were employed as
green, and black. 13 search terms when available and additional keywords were
used where appropriate. The search was limited to articles
Morgellons can be classified as primary and secondary. published in English.
Distinguishing between these two types in a clinical
setting will help determine clinical outcomes and tailor One reviewer conducted the initial search and identified
treatment approaches. In primary Morgellons, the potentially relevant studies meeting the inclusion criteria.
delusional symptoms appear in the absence of any other Subsequently, two independent reviewers evaluated the
underlying medical conditions. Thus, psychiatric support articles based on the established inclusion and exclusion
and appropriate medication are emphasized for managing criteria; the articles were assessed for their use of an
the delusional component. Notably, the complexity of appropriate source population, methods of measuring
treatment increases when Morgellons is categorized exposure and outcomes, strategies to address design-
as a secondary disorder. The symptoms are observed specific issues such as bias and loss to follow-up, application
alongside psychiatric disorders, brain injuries, substance of analytical methods, and approaches for the primary
intoxication, and nutritional deficiencies. Recognizing statistical analysis of effects.
8,9
this distinction is vital for clinicians to appropriately refer, The studies were selected based on their level of
manage, and treat patients. 7 evidence, according to the 2011 guidelines of the Oxford
11
Literature supports the importance of accurate disease Centre for Evidence-Based Medicine. We prioritized
classification. Disease classification improves the the highest levels of evidence and systematically reviewed
14
identification and treatment of Morgellons, encourages a systematic reviews, meta-analyses, randomized controlled

Volume 3 Issue 2 (2025) 23 doi: 10.36922/jcbp.4735