QWhat is Morgellons disease?

Morgellons disease is a confusing and controversial term that may have many meanings in clinical practice. Bolognia Dermatology 5^th Ed states that Morgellons disease is a synonym for delusional infestation (DI) but then states in the introduction paragraph that “Morgellons disease” has been “used by patients to describe what they falsely perceive as fibers extruding from their skin”. This is distinct from reporting a parasitic infestation which is the usual complaint seen in patients presenting with a delusional disorder to the dermatologist. Further confusion and controversy with the term was explored in the 2020 documentary film entitled, “Skin Deep: The Battle Over Morgellons”.

The term Morgellons disease was first coined in 1674 by Sir Thomas Browne, an English physician. He used this term to refer to a peculiar skin disease concerning crooked hairs associated with distemper and convulsions in pediatric patients. This is obviously very different from the modern interpretation of the term as described in Bolognia Dermatology 5^th Edition.

Despite the fact that Morgellons disease is a confusing and controversial to some, this term is still very useful in clinical practice. When speaking with patients who present with DI, I prefer to use this neutral term of “Morgellons disease”. This is because DI patients are very averse to any inkling of mental health and psychiatry. It is best practice to avoid using the word delusional such as in “delusions or parasitosis” or “delusional infestation” when speaking with the patient or when documenting in their chart (especially since patients can easily access their medical records).

I tell patients that I do not know what causes Morgellons disease but this is the name that I choose to refer to their condition. I then tell the patient that since I don’t know the cause of their condition, Morgellons disease is as good as name as any other name. I then explicitly tell the patient that I have seen many other patients with their condition and that I have a medication which can relieve them of their symptoms and get their life back on track. This is when I introduce pimozide to the patient. I always try to minimize focusing on the etiology of their condition but spend time focusing on the prospect of treating their symptoms. By using the term, “Morgellons disease” I can avoid using the terms such as “psychosis” or “delusions” that will upset any DI patient and significantly impact rapport.

References:

1. Brownstone ND, Koo J. Special Consideration for Patients With Morgellons Disease, Even Among Psychodermatology Patients? JAMA Dermatol. 2020;156(10):1142. doi:10.1001/jamadermatol.2020.2679
2. Middelveen MJ, Fesler MC, Stricker RB. History of Morgellons disease: from delusion to definition. Clin Cosmet Investig Dermatol. 2018;11:71-90. doi:10.2147/CCID.S152343