Delusions of Parasitosis Treatment & Management

  • Author: Noah S Scheinfeld, MD, JD, FAAD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jul 18, 2011
 

Medical Care

The only clear method to clear the delusion that underlies delusions of parasitosis is the administration of psychotropic medications. However, delusions of parasitosis can remit on its own. If the sensation of itch is related to some actual disease or substance use rather than a monosymptomatic hypochondriacal psychosis, the disease can be treated, or the substance inducing the sensation can be eliminated.

It is vitally important that the practitioner does not "use the delusion" to encourage the patient to accept certain treatments. While getting the patient to take a medication, such as risperidone, may help the condition, telling them that it is a medication that "kills the parasites" reinforces and validates the delusion. Even giving the patient a course of topical permethrin "just in case" may strengthen the delusion and make it that much more difficult later on. Every delusions of parasitosis patient can recount the visit on which his or her suspicions of infestation were "confirmed."

Serotonergic antidepressants may have a role in the treatment of these patients.[28, 29]

Reichenberg et al[30] reported on a patient whose delusions of parasitosis was cured overnight by having him stop taking cetirizine and doxepin (25 mg), as well as any over-the-counter medications.

Rocha and Hara[31] reported that aripiprazole at 15 mg for 8 weeks and then 7.5 mg/d was effective for delusions of parasitosis treatment. They stated:

Aripiprazole has a unique pharmacologic profile that is different from other atypical antipsychotic drugs. It is considered a partial dopaminergic agonist acting on both postsynaptic dopamine D2 receptors and presynaptic autoreceptors. It acts as a weak stimulator (so-called “partial” agonist) at dopamine D2 receptors, with the potential for exerting either antagonistic (inhibitory) or agonistic (stimulating) effects, depending on the sensitivity of the receptors and availability of dopamine, its natural agonist in the brain. In addition, aripiprazole displays partial agonism at serotonin (1A) receptors and antagonism at serotonin (2A) receptors.

Ladizinski et al also report that aripiprazole may be a useful treatment for delusions of parasitosis.[32]

Szepietowski et al[33] sent out 172 specially designed questionnaires to dermatologists regarding delusions of parasitosis patients; 118 responded. The questions and resulting percentages are as follows:

  • Had seen at least one patient with delusions of parasitosis - 84.7%
  • Had 1-2 cases of delusions of parasitosis over the preceding 5 years - 33%
  • Had seen 3-5 such patients over the preceding 5 years - 28%
  • Had diagnosed no cases of delusions of parasitosis during the past 5 years - 23%
  • Had more than 10 patients with delusions of parasitosis over the past 5 years - 7%
  • Were currently treating a patient with delusions of parasitosis - 20%
  • Always request a psychiatric opinion about their patients with delusions of parasitosis - 40.75%
  • Often ask for a psychiatric opinion about their patients with delusions of parasitosis - 28.8%
  • Use their own pharmacological treatment, mostly sedatives and anxiety-relieving drugs - 15.3%.
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Consultations

A psychiatrist should be consulted if the dermatologist cannot or will not prescribe the necessary medications. Most patients with delusions of parasitosis are reluctant to see a psychiatrist, and the dermatologist may be more successful in giving the referral if they have gained the patient's trust after several clinic visits instead of immediately after meeting the patient.

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Contributor Information and Disclosures
Author

Noah S Scheinfeld, MD, JD, FAAD  Assistant Clinical Professor, Department of Dermatology, Columbia University College of Physicians and Surgeons; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, and New York Eye and Ear Infirmary; Private Practice

Noah S Scheinfeld, MD, JD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Optigenex Consulting fee Independent contractor

Specialty Editor Board

Franklin Flowers, MD  Chief, Division of Dermatology, Professor, Department of Medicine and Otolaryngology, Affiliate Associate Professor of Pediatrics and Pathology, University of Florida College of Medicine

Franklin Flowers, MD, is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Savely VR, Leitao MM, Stricker RB. The mystery of Morgellons disease: infection or delusion?. Am J Clin Dermatol. 2006;7(1):1-5. [Medline].

  2. Koblenzer CS. The challenge of Morgellons disease. J Am Acad Dermatol. Nov 2006;55(5):920-2. [Medline].

  3. Waddell AG, Burke WA. Morgellons disease?. J Am Acad Dermatol. Nov 2006;55(5):914-5. [Medline].

  4. Murase JE, Wu JJ, Koo J. Morgellons disease: a rapport-enhancing term for delusions of parasitosis. J Am Acad Dermatol. Nov 2006;55(5):913-4. [Medline].

  5. Marris E. Mysterious 'Morgellons disease' prompts US investigation. Nat Med. Sep 2006;12(9):982. [Medline].

  6. Harvey WT. Morgellons disease. J Am Acad Dermatol. Apr 2007;56(4):705-6. [Medline].

  7. Walling HW, Swick BL. Psychocutaneous syndromes: a call for revised nomenclature. Clin Exp Dermatol. May 2007;32(3):317-9. [Medline].

  8. Monk BE, Rao YJ. Delusions of parasitosis with fatal outcome. Clin Exp Dermatol. Jul 1994;19(4):341-2. [Medline].

  9. Aw DC, Thong JY, Chan HL. Delusional parasitosis: case series of 8 patients and review of the literature. Ann Acad Med Singapore. Jan 2004;33(1):89-94. [Medline].

  10. Bouree P, Benattar B, Perivier S. [Ekbom syndrome or delusional parasitosis]. Rev Prat. Mar 31 2007;57(6):585-9. [Medline].

  11. Goddard J. Seasonality of delusions of parasitosis. J Agromedicine. 2003;9(1):23-6. [Medline].

  12. Vila-Rodriguez F, Macewan BG. Delusional parasitosis facilitated by web-based dissemination. Am J Psychiatry. Dec 2008;165(12):1612. [Medline].

  13. Edison KE, Slaughter JR, Hall RD. Psychogenic parasitosis: a therapeutic challenge. Mo Med. Mar-Apr 2007;104(2):132-7; quiz 137-8. [Medline].

  14. Le L, Gonski PN. Delusional parasitosis mimicking cutaneous infestation in elderly patients. Med J Aust. Aug 18 2003;179(4):209-10. [Medline].

  15. Bury JE, Bostwick JM. Iatrogenic delusional parasitosis: a case of physician-patient folie a deux. Gen Hosp Psychiatry. Mar-Apr 2010;32(2):210-2. [Medline].

  16. Koo J, Lee CS. Delusions of parasitosis. A dermatologist's guide to diagnosis and treatment. Am J Clin Dermatol. 2001;2(5):285-90. [Medline].

  17. Swick BL, Walling HW. Drug-induced delusions of parasitosis during treatment of Parkinson's disease. J Am Acad Dermatol. Dec 2005;53(6):1086-7. [Medline].

  18. Lopez PR, Rachael T, Leicht S, Smalligan RD. Gabapentin-induced delusions of parasitosis. South Med J. 2010;103:711-2. [Medline].

  19. Steinert T, Studemund H. Acute delusional parasitosis under treatment with ciprofloxacin. Pharmacopsychiatry. Jul 2006;39(4):159-60. [Medline].

  20. Tran TM, Browning J, Dell ML. Psychosis with paranoid delusions after a therapeutic dose of mefloquine: a case report. Malar J. Aug 23 2006;5:74. [Medline].

  21. Krauseneck T, Soyka M. Delusional parasitosis associated with pemoline. Psychopathology. Mar-Apr 2005;38(2):103-4. [Medline].

  22. Guarneri F, Guarneri C, Mento G, Ioli A. Pseudo-delusory syndrome caused by Limothrips cerealium. Int J Dermatol. Mar 2006;45(3):197-9. [Medline].

  23. Ghaffari-Nejad A, Toofani K. Delusion of oral parasitosis in a patient with major depressive disorder. Arch Iran Med. Jan 2006;9(1):76-7. [Medline].

  24. Duggal H, Singh I. Delusional parasitosis as a presenting feature of dementia. J Neuropsychiatry Clin Neurosci. Winter 2010;22(1):123.E11-12. [Medline].

  25. Trager MJ, Hwang TN, McCulley TJ. Delusions of parasitosis of the eyelids. Ophthal Plast Reconstr Surg. Jul-Aug 2008;24(4):317-9. [Medline].

  26. Huber M, Karner M, Kirchler E, Lepping P, Freudenmann RW. Striatal lesions in delusional parasitosis revealed by magnetic resonance imaging. Prog Neuropsychopharmacol Biol Psychiatry. Dec 12 2008;32(8):1967-71. [Medline].

  27. Hylwa SA, Bury JE, Davis MD, Pittelkow M, Bostwick JM. Delusional Infestation, Including Delusions of Parasitosis: Results of Histologic Examination of Skin Biopsy and Patient-Provided Skin Specimens. Arch Dermatol. May 2011;[Medline].

  28. Scheinfeld N. Delusions of parasitiosis: a case with a review of its course and treatment. Skinmed. Nov-Dec 2003;2(6):376-8. [Medline].

  29. Wenning MT, Davy LE, Catalano G, Catalano MC. Atypical antipsychotics in the treatment of delusional parasitosis. Ann Clin Psychiatry. Sep-Dec 2003;15(3-4):233-9. [Medline].

  30. Reichenberg JS, Magid M, Drage LA. A cure for delusions of parasitosis. J Eur Acad Dermatol Venereol. Nov 2007;21(10):1423-4. [Medline].

  31. Rocha FL, Hara C. Aripiprazole in delusional parasitosis: Case report. Prog Neuropsychopharmacol Biol Psychiatry. Apr 13 2007;31(3):784-6. [Medline].

  32. Ladizinski B, Busse KL, Bhutani T, Koo JY. Aripiprazole as a viable alternative for treating delusions of parasitosis. J Drugs Dermatol. Dec 2010;9:1531-2. [Medline].

  33. Szepietowski JC, Salomon J, Hrehorow E, Pacan P, Zalewska A, Sysa-Jedrzejowska A. Delusional parasitosis in dermatological practice. J Eur Acad Dermatol Venereol. Apr 2007;21(4):462-5. [Medline].

  34. Elmer KB, George RM, Peterson K. Therapeutic update: use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis. J Am Acad Dermatol. Oct 2000;43(4):683-6. [Medline].

  35. Friedmann AC, Ekeowa-Anderson A, Taylor R, Bewley A. Delusional parasitosis presenting as folie à trois: successful treatment with risperidone. Br J Dermatol. Oct 2006;155(4):841-2. [Medline].

  36. Meehan WJ, Badreshia S, Mackley CL. Successful treatment of delusions of parasitosis with olanzapine. Arch Dermatol. Mar 2006;142(3):352-5. [Medline].

  37. Freudenmann RW, Schönfeldt-Lecuona C. Delusional parasitosis: treatment with atypical antipsychotics. Ann Acad Med Singapore. Jan 2005;34(1):141-2; author reply 142. [Medline].

  38. Atilganoglu U, Ugurad I, Arikan M, Ergun SS. Monosymptomatic hypochondriacal psychosis presenting with recurrent oral mucosal ulcers and multiple skin lesions responding to olanzapine treatment. Int J Dermatol. Oct 2006;45(10):1189-92. [Medline].

  39. van Vloten WA. Pimozide: use in dermatology. Dermatol Online J. Mar 2003;9(2):3. [Medline].

  40. Fellner MJ, Majeed MH. Tales of bugs, delusions of parasitosis, and what to do. Clin Dermatol. Jan-Feb 2009;27(1):135-8. [Medline].

  41. Bennassar A, Guilabert A, Alsina M, Pintor L, Mascaro JM Jr. Treatment of delusional parasitosis with aripiprazole. Arch Dermatol. Apr 2009;145(4):500-1. [Medline].

  42. Lim GC, Chen YF, Liu L, Huang SC, Lin KK, Hsiao CH. Camphor-related self-inflicted keratoconjunctivitis complicating delusions of parasitosis. Cornea. Dec 2006;25(10):1254-6. [Medline].

 
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