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Journal of Clinical and
Basic Psychosomatics Morgellons: Delusion or disease

psychological factors. The lack of treatment options Accurate diagnosis of Morgellons can be achieved
for Morgellons can exacerbate psychological distress, through a thorough history elicitation, clinical
reinforcing the self-limiting belief of patients that lack examination, and investigation. These investigations
autonomy when it comes to managing their condition; 27,39,41 include full blood screening, a 4-mm skin punch biopsy,
this hinders recovery and highlights the need for a patient- and in some cases, imaging studies such as brain and spinal
centered approach focusing on the patient’s perspective magnetic resonance imaging. 54,55 A multidisciplinary
and well-being. approach is key to interpreting and managing these
An interplay may exist between genetic susceptibility findings. An approach in which dermatologists can work
and immune dysregulation in patients with Morgellons. closely with psychiatrists, histopathologists, and perhaps
An exaggerated immune response to infectious agents neurologists to analyze the clinical information would be
such as Borrelia or an environmental trigger might trigger beneficial. In addition, this approach could distinguish
unusual fiber formation and skin symptoms characterized Morgellons from conditions that may mimic Morgellons
by Morgellons disease, particularly in genetically pre- or other complex psychocutaneous disorders such as DI,
disposed individuals. 27,39,41 malingering, psychogenic excoriation, or dermatological
conditions (scabies).
7. Diagnosis and differential diagnosis One way to achieve an accurate diagnosis is by
Current studies mostly emphasize that Morgellons is implementing an algorithm that can guide clinicians
a type of DI. However, it has not been included in the toward a diagnosis. Proposed models, such as the two-
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10 edition of the International Classification of Diseases. stage clinical pathway, aim to support the diagnosis of DI
th
Furthermore, DIs are currently diagnosed based on the when a thorough and detailed diagnostic investigation/
Diagnostic and Statistical Manual of Mental Disorders examination (step 1) is needed for treating a specific cause
22
criteria for somatic delusional disorders. 49,50 (step 2). However, these models are yet to be evaluated for
sensitivity, specificity, and cost-effectiveness. Experienced
In patients with Morgellons, although testing for
infectious organisms can be challenging, some known clinicians must be involved in decision-making and model
creation to ensure their expertise and experience have
pathogens can be excluded, potentially supporting the maximum benefits.
diagnosis of a DI. However, the possibility of an unknown
or newly emerging infectious agent cannot be completely 8. Treatment approaches
ruled out.
The management of Morgellons continues to be a
Screening patients with Morgellons for major controversial topic due to multiple etiological theories
psychiatric disorders (e.g., disorders with body and space- and viewpoints on its classification. Current literature
related delusions, hallucinations, catatonia, and self- describes mixed reports of antimicrobials, antidepressants,
inflicted skin lesions), organic and substance-induced and antipsychotics for managing Morgellons.
DI (e.g., neurological disorders and illicit substances),
delusional parasitosis, hypochondriasis, and schizophrenia 8.1. Pharmacological interventions
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(Schneider’s first rank symptoms) is crucial. This can Evidence supports the potential effectiveness of
be achieved through a thorough history-taking, focused antipsychotic medications in patients with Morgellons,
clinical examination (skin and mental health examinations), especially if the disease is considerably a DI. A retrospective
and appropriate investigations. Certain symptoms – such analysis of 24 patients with Morgellons assessed the
as formication, a sensation of insects crawling on or under effectiveness of trifluoperazine. Of 24 patients, 15 exhibited
the skin that is not characteristic of Morgellons – are likely an improvement of at least 50% and 7 exhibited a return
to occur in individuals with a history of cocaine use. to baseline, where at least 90% lesion clearance and no
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Similarly, other psychodermatological conditions can be patient-reported distress from perceived skin infiltrates.
misdiagnosed. For instance, dermatitis artefacta, a type
of factitious disorder, can be misdiagnosed as Morgellons An average of 2.4 and 6.6 months was required to attain
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due to similarities between the two conditions, including 50% and 90% of the disease control, respectively.
skin lesions, psychological factors, and strong patient Because of their cardiotoxic and extrapyramidal side
beliefs about the origin of their symptoms. To ensure effects, second-generation antipsychotics are gradually
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an accurate diagnosis, considering the possibility of self- replaced by first-generation antipsychotics. Low-dose
inflicted injuries and adopting a holistic approach that risperidone and other second-generation antipsychotics,
acknowledges the nuances between these conditions is such as quetiapine and olanzapine, have also been
crucial. recommended by some studies. 9,58

Volume 3 Issue 2 (2025) 28 doi: 10.36922/jcbp.4735