Page 33 - JCBP-3-2

Journal of Clinical and
Basic Psychosomatics Morgellons: Delusion or disease

further governing the reasoning, which could be followed Reportedly, the pathogenesis of Morgellons largely
by an abnormality in the striato-thalamo-parietal region arises from tick-borne infections. Histopathological
1,18
responsible for proprioception and somatosensation. examination of the skin lesions has revealed spirochetes,
Considerably, a patient with Morgellons may genetically identified as B. burgdorferi sensu stricto, as the
experience abnormal somatosensations exacerbated predominant infective agent. Two separate cohort studies
by misinterpretations in the frontal cortex, resulting have demonstrated that Morgellons affects approximately
10,47
in the false belief of being infested and a delusion of 6% of patients with Lyme disease. Although Fesler et al.
skin infestation. This can be evaluated by structurally did not identify elevated rates of psychiatric disorders
analyzing gray matter volume, reductions in cortical among patients with Morgellons, the study limitations, such
surface area, gyrification, or pathological lesions, in as its small sample size and specialized patient population,
addition to functionally assessing decreases in blood flow limit the generalizability of its findings. In addition, the
to these regions. Kessler et al. proposed that the findings lack of a control group and potential confirmation bias
of neuroimaging for the underlying pathologies could be raise concerns about the validity of the study findings.
corroborated with the manifestations of DI symptoms, Because the study sample included only 60 patients with
which may help understand Morgellons. 43 Morgellons from 1,000 screen patients with Lyme disease,
the statistical power and generalizability of the study were
Studies have also correlated the manifestation of further reduced.
Morgellons to the hyperactivation of certain brain
regions. Increased activity in the right posterior insula The clinical manifestations observed in one case series
44
and secondary somatosensory cortex in response to tactile closely resembled those reported in patients with Lyme
18
and visual stimuli has been linked to the pruritic urge disease. Although the reported symptoms such as fatigue,
experienced by patients with Morgellons. 17 joint pain, and neuropathy were non-specific, a subsequent
study found that 98% of patients with Morgellons were
5.3. Environmental and toxic exposure hypotheses positive for Lyme disease; this finding was observed in
17
A case series have demonstrated that the inhibition four other case series in which polymerase chain reaction
26
of the dopamine transporter may contribute to the was used, followed by Sanger sequencing. Although a
pathogenesis of Morgellons, resulting in its classification positive serology test may suggest a potential link between
as a DI. There have been reports of patients developing Morgellons and Lyme disease, it is not definitive proof of an
41
Morgellons symptoms because of methamphetamine association because the body can retain immunity against
use. Another study has identified that antiparkinson the bacterium, even after the infection has cleared. 48
42
drugs, antidepressants, antiepileptics, antibiotics, and In some studies, culture, histological, immuno
prescription stimulants are commonly associated with histochemical, electron microscopic, and molecular
Dis. However, there is insufficient evidence to support a testing have demonstrated that Morgellons could be
22
similar etiology in patients with Morgellons. associated with a systemic spirochetal infection.
27
Pearson’s study revealed that drug use was detected Furthermore, the filaments detected in patients exhibited
in 50% of the participants. However, some of these a collagen component and melanin pigment, indicating
1
medications may have been prescribed to manage the that spirochetes may have activated keratinocytes and
symptoms of Morgellons. Thus, clinicians should consider fibroblasts to express keratin and collagen. 40
factors such as substance use in their clinical assessment A case report demonstrated promising results with
because a link between Morgellons and substance abuse doxycycline administration for Morgellons, with patients
has been identified. Further controlled or observational experiencing remission within 2 weeks. However, further
2,45
trials are required for assessing the causation between drug studies are required to determine the efficacy and safety
use and Morgellons.
of antibiotic therapy for Morgellons disease due to limited
32
6. Morgellons: A genuine disease evidence. Although the infectious theory suggests a clinical
association between Morgellons disease and spirochetal
6.1. Infectious agents hypothesis infection, the phenomenon may be multifactorial, such as
The pathogenesis of Morgellons has been linked to skin genetics, hormones, and immune status.
healing. Furthermore, histological examination of the 6.2. Multifactorial approach to management
lesions has revealed microscopic filaments embedded
in the skin. These filaments usually contain keratin and Studies support a multifactorial approach to Morgellons
collagen, which is a part of the skin’s healing response to disease, indicating that the symptoms may result from
an infection. 46 a combination of infectious agents (e.g., Borrelia) and

Volume 3 Issue 2 (2025) 27 doi: 10.36922/jcbp.4735