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.

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