Page 30 - JCBP-3-2

Journal of Clinical and
Basic Psychosomatics Morgellons: Delusion or disease

trials, cohort studies, case-control studies, and case series. of Morgellons. Until then, subsequent studies will
16
In addition, we included observational studies and expert considerably have flaws in their methodology, as evidenced
opinions that lacked high levels of evidence. by the inclusion criteria of the CDC study. Although
the CDC study included patients with Morgellons-like
Studies that directly addressed the pathogenesis,
clinical features, diagnosis, and treatment of Morgellons symptoms, primarily the emergence of fiber-like materials
from the skin reported by 70.4% of the patients, it did not
and provided insights into the neurobiological and exclude individuals with skin lesions and other physical
psychological aspects of Morgellons were included. manifestations. A combination of compromised inclusion
However, studies that did not meet the minimum quality criteria and the case definition overlapping with that of
standards or were unrelated to the primary focus of the delusional parasitosis reduced the validity of validity of the
review were excluded. study.
3. Epidemiology and current literature Large-scale, population-based, cohort studies with

There is a substantial gap in the epidemiology of registry-based surveillance are required to comprehend
17
Morgellons. To date, the largest study on the Morgellons the incidence and prevalence of Morgellons, identify
its risk factors, and improve diagnosis by collaborating
epidemiology is a retrospective cohort study conducted by between dermatologists and psychiatrists. Furthermore,
the CDC in 2006 – 2008. They analyzed 115 patients in large-scale, prospective, observational studies are required
Kaiser Permanente Northern California (KPNC), reporting
that the prevalence of Morgellons was 3.65/100,000, and to collect detailed clinical data from patients presenting
the median age of the patients was 55 years. In addition, with Morgellons. To achieve this, a universal definition for
Morgellons must be recognized. Establishing a Morgellons
the disease was predominant in Caucasian people (77%) disease registry could facilitate the creation of a centralized
and women (77%). Comparatively, a smaller study in database for systematically collecting patient data,
1
London yielded similar results and found that Morgellons identifying trends, and determining future studies. This can
predominantly affected women and was diagnosed around be achieved by implementing standardized data collection
the age of 54 years, with symptoms lasting 3.8 years. 2 methods, obtaining informed consent, and ensuring data
There were no statistically significant differences in privacy and security. Consequently, researchers can work
age, sex, marital status, employment, or duration of the toward understanding Morgellons disease and developing
condition between patients who did (n = 51) and ho did effective management strategies.
not (n = 19) report the emergence of fibers in the KPNC
study. Both groups were predominantly Caucasian (fibers 4. Clinical presentation of Morgellons
group, 76.5%; non-fibers group, 79%). A homogenous disease
sample indicates less variability in the dataset, making it 4.1. Symptoms and patient descriptions
challenging to generalize the findings to other populations.
There were slightly more African–American participants The clinical presentation of Morgellons is predominately
in the non-fibers group (15.8%) than in the fiber group centered around cutaneous findings reported by patients
(7.8%). As the small sample size was insufficient power and associated cutaneous and systemic symptoms.
to detect a true difference, determining if there was Morgellons disease is a rare condition with characteristic
a significant difference in both groups was difficult. objective findings of filaments, fibers, or spheres underneath
Furthermore, because the study was conducted in or extruding from the skin that generate uncomfortable
12
California, there was a lack of national and international sensations. Other commonly reported parallel symptoms
representation. Thus, the full spectrum of manifestations include formication, burning or stinging, and intense
itching. Some patients report skin ulcers that suddenly
in patients with Morgellons may not have been included, appear and heal slowly, which develop hyperpigmented
considering it reduces the validity of the study.
scars. 18
Psychiatric assessments were used in the KPNC study to
identify potential mental health and confounding factors. Individuals who report fibers or filaments within the
This overemphasis on psychiatric aspects may introduce a skin may present with such evidence for examination
(Figure 1),
which is characteristically called “matchbox
15,18
potential confirmation bias, which prioritizes DIs in this sign” or “specimen sign.” The evidence may include
and any subsequent studies referencing it while neglecting samples of dust, skin, and fibers. Often, the materials are
other causes for Morgellons.
sent to different laboratories for examination, revealing
The CDC study and another case series have highlighted no signs of a parasitic manifestation. On a complete skin
19
the urgent need for a universally accepted definition examination, signs associated with the repeated picking,
Volume 3 Issue 2 (2025) 24 doi: 10.36922/jcbp.4735