Morgellons 1475943 226159079 2008-07-17T02:23:46Z Levine2112 263965 Reverted 1 edit by [[Special:Contributions/71.41.120.70|71.41.120.70]] identified as [[WP:VAND|vandalism]] to last revision by [[User:Levine2112|Levine2112]]. using [[WP:TWINKLE|TW]] {{POV|date=May 2008}} {{Mergefrom|Morgellons Research Foundation|date=June 2008}} '''Morgellons''' (also called '''Morgellons disease''' or '''Morgellons syndrome''') is a name given in 2002 by Mary Leitao<ref name="Gazette"/> to a proposed infectious condition characterized by a range of [[cutaneous]] (skin) symptoms including crawling, biting, and stinging sensations; finding fibers on or under the skin; and persistent skin lesions (e.g., rashes or sores). Current [[scientific consensus]] holds that Morgellons is not a new disorder and is instead a new and misleading name for known illnesses. Most doctors,<ref name="Schulte"/> including dermatologists<ref name="nature">{{cite news |url=http://www.nature.com/nm/journal/v12/n9/full/nm0906-982a.html |title=Mysterious 'Morgellons disease' prompts US investigation |first=Emma |last=Marris |publisher=Nature Medicine |date=2006-08-30 }}</ref> and psychiatrists,<ref name="AJP">{{cite journal |last=Dunn |first=J. |coauthors=Murphy, M.B., Fox, K.M. |title=Diffuse Pruritic Lesions in a 37-Year-Old Man After Sleeping in an Abandoned Building |journal=Am J Psychiatry |year=2007 |volume=164 |pages=1166–1172 |pmid=17671278 |url=http://ajp.psychiatryonline.org/cgi/content/full/164/8/1166 |doi=10.1176/appi.ajp.2007.07030381 }}</ref> regard Morgellons as a manifestation of known medical conditions, including [[delusional parasitosis]],<ref name="RenoMullen">{{cite news | title=Medical community skeptical. Doctor attributes Morgellons' 'cures' to the placebo effect | first=Frank | last=Mullen | publisher=Reno Gazette Journal | date=2004-05-08 | accessdate=2008-05-28}} "Most doctors interviewed dismiss alleged evidence that medical science has overlooked what patients are calling "Morgellons' disease" and insist that the patients are delusional."</ref><ref name="DailyMailUK">{{cite news | url=http://www.dailymail.co.uk/health/article-482408/Is-disease-episode-X-Files.html | title=Is this a disease or an episode of the X files? | first=Daniel | last=Elkan | publisher=Daily Mail (UK) | date=2007-09-18 | accessdate=2008-05-30}} "most experts believe the condition is a psychological disorder called delusional parasitosis."</ref><ref name="TimesOnlineUK">{{cite news | url=http://www.timesonline.co.uk/tol/comment/article721795.ece | title=All in the head? | first=Elaine | last=Monaghan | publisher=Times Online (UK) | date=2006-05-19 | accessdate=2008-06-05}} "most doctors believe Morgellons is not in the skin, but in the head."</ref> although some health professionals acknowledge that an infectious cause could one day be found.<ref name="mayo">{{cite web | url=http://www.mayoclinic.com/health/morgellons-disease/SN00043 | title=Morgellons disease: Managing a mysterious skin condition | publisher=[[Mayo Clinic]] | date=2007-05-02 | accessdate=2007-08-04}}</ref> Illnesses such as delusional parasitosis can be serious and debilitating, but tested and effective treatments exist. Despite the lack of evidence that Morgellons is a novel or distinct condition and the absence of any agreed set of diagnostic symptoms,<ref>[http://www.npr.org/templates/story/story.php?storyId=18367924 National Public Radio, "''Morgellons Disease'' Is Creepy. But Is It Real?" 24 January 2008.] Accessed 01 June 2008.</ref> the Morgellons Research Foundation and self-diagnosed Morgellons patients have successfully lobbied members of Congress and the U.S. government's [[Centers for Disease Control and Prevention]] (CDC) to investigate the proposed condition.<ref name="Schulte">{{Citation | last = Schulte | first = Brigid | title = Figments of the Imagination? | newspaper = Washington Post Magazine | pages = W10 | year = | date = January 20, 2008 | accessdate = 2008-06-09 | url = http://www.washingtonpost.com/wp-dyn/content/story/2008/01/18/ST2008011801924.html?sid=ST2008011801924}}</ref> The CDC states that while it is not known at present whether the condition represents a new disease entity, or whether persons who identify themselves as having Morgellons have a common cause for their symptoms, share common risk factors, or are contagious, it has begun an [[epidemiological]] investigation of the "Unexplained Dermopathy (aka 'Morgellons')."<ref name="Investigation">{{cite web |url=http://www.cdc.gov/unexplaineddermopathy/investigation.html |title=Unexplained Dermopathy (aka "Morgellons"), CDC Investigation |publisher=Centers For Disease Control |date=2007-11-01 }}</ref> == History == In 2001,<ref name="Gazette"/><ref name="doi_10.1586">{{cite journal | last = Savely | first = Virginia R | coauthors = Stricker, Raphael B | title = Morgellons disease: the mystery unfolds | journal = Expert Review of Dermatology | volume = 2 | issue = 5 | pages = 585–591 | date = October 2007 | url = http://www.expert-reviews.com/doi/abs/10.1586/17469872.2.5.585 | doi = 10.1586/17469872.2.5.585 | accessdate = 2008-06-07}}</ref> according to Mary Leitao, her then two-year-old son developed sores under his lip and began to complain of "bugs."<ref name="Primetime"/> Leitao, who graduated with a BS in Biology, and worked for five years at Boston hospitals as an electron microscopist and a immunohistochemist before becoming a stay-at-home mother, says she examined the sores and discovered red, blue, black, and white fibers.<ref name="Gazette"/><ref name="resume">{{cite web | last = Savely | first = Ginger | coauthors = Leitao, Mary | title = Delusions of Parasitosis versus Morgellons Disease: Are They One and the Same? | publisher = International Lyme and Associated Diseases Society | date = | url = http://www.ilads.org/morgellons.html | format = | doi = | accessdate = 2008-06-11 }}</ref><ref name="psychologytoday"/> She states that she took her son to see at least eight different doctors who were unable to find any disease, allergy, or anything unusual about her son's described symptoms. Dr. Fred Heldrich, a [[Johns Hopkins Hospital|Johns Hopkins]] pediatrician with a reputation "for solving mystery cases," examined Leitao's son.<ref name="Gazette">{{cite news | url=http://www.post-gazette.com/pg/06204/707970-85.stm | title=Mom fights for answers on what's wrong with her son | first=Chico | last=Harlan | publisher=Pittsburgh Post-Gazette | date=2006-07-23 | accessdate=2007-08-04}}</ref> Heldrich found nothing abnormal about the boy's skin, wrote to the referring physician that "Leitao would benefit from a psychiatric evaluation and support," and registered his worry about Leitao's "use" of her son.<ref name="Gazette"/> ''Psychology Today'' reports that Leitao last consulted an unnamed Johns Hopkins infectious disease specialist who after reviewing her son's records refused to see him, suggesting Leitao herself might suffer from "[[Munchausen syndrome by proxy|Munchausen's by proxy]], a psychiatric syndrome in which a parent pretends a child is sick or makes him sick to get attention from the medical system."<ref name="psychologytoday"/> This opinion of a potential psychological disorder, according to Leitao, was shared by several medical professionals she sought out:<ref>{{cite news | url=http://www.texasmonthly.com/preview/2006-10-01/ministerofhealth | title=Under my skin | first=Jim | last=Atkinson | publisher=Texas Monthly | date=2006-10-01 }}</ref> {{Quotation|"(Leitao) said she long ago grew accustomed to being doubted by doctors whenever she sought help for her son, who is now 7 and still suffering from recurring lesions. 'They suggested that maybe I was neurotic,' Leitao said, 'They said they were not interested in seeing him because I had Munchausen Syndrome by Proxy.'"<ref name="Witt">{{cite news | title=A mystery ailment gets under skin: The CDC doesn't know what it is, but thousands complain of painful symptoms. | first=Howard | last=Witt | publisher=The Chicago Tribune | date=2006-07-25 | accessdate=2008-06-07}}</ref>}} Leitao says that her son developed more sores, and more fibers continued to poke out of them.<ref name="psychologytoday">{{cite web | url=http://psychologytoday.com/articles/index.php?term=pto-20070227-000003&page=1 | title=The Morgellons Mystery | first=Elizabeth | last=DeVita-Raeburn | publisher=[[Psychology Today]] | date=March/April 2007 | accessdate=2007-08-04}}</ref><ref name="Primetime"/> She and her husband, Edward Leitao, an internist with South Allegheny Internal Medicine in [[Pennsylvania]], felt their son suffered from "something unknown."<ref name="Gazette"/> She chose the name ''Morgellons disease'' (with a hard ''g'') from a description of an illness in the monograph ''A Letter to a Friend'' by Sir [[Thomas Browne]], in 1690, wherein Browne describes several medical conditions in his experience, including "that endemial distemper of children in [[Languedoc]], called the morgellons, wherein they critically break out with harsh hairs on their backs."<ref name="psychologytoday"/><ref name="browne">{{cite web |url=http://penelope.uchicago.edu/letter/letter.html |title=A Letter to a Friend |author=Sir Thomas Browne |date=1690 |publisher=James Eason, University of Chicago }}</ref> There is no suggestion that the symptoms described by Browne are linked to the putative modern cases. Leitao founded the [[Morgellons Research Foundation]] (MRF) in 2002 (informally) and as an official non-profit in 2004.<ref name="psychologytoday"/><ref name="DallasObserver">{{cite news | url=http://www.dallasobserver.com/2006-07-20/news/the-plague/full | title=The Plague. Bizarre fibers. Black sweat. Bugs under the skin. Welcome to the controversial world of Morgellons disease. | first=Jesse | last=Hyde | publisher=Dallas Observer | date=2006-07-20 }}</ref> The MRF states on its website that its purpose is to raise awareness and funding for research into the proposed condition, described by the organization as a "poorly understood illness, which can be disfiguring and disabling".<ref name="mrf">{{cite web |url=http://www.morgellons.org/ |title=Morgellons Research Foundation }}</ref> Leitao stated that she initially hoped to receive information from scientists or physicians who might understand the problem, but instead, thousands of others contacted her describing their sores and fibers, as well as neurological symptoms, fatigue, muscle and joint pain, and other symptoms.<ref name="psychologytoday"/> The MRF claims to have received self-identified reports of Morgellons from all 50 US states and 15 other countries, including Canada, the UK, Australia, and the Netherlands, and states that they have been contacted by over 12,000 families.<ref name="mrf"/> In May 2006, a CBS news segment on Morgellons aired in Southern California,<ref name="KCBS News">{{cite news |title= Mysterious Disease Plagues More Southlanders |url=http://cbs2.com/video/?id=18983@kcbs.dayport.com | first=Mary Beth | last=McDade | publisher=[[CBS| CBS Broadcasting Inc.]] |format=video |date=2006-05-22 |accessdate=2007-12-04}}</ref> The same day the Los Angeles County Department of Health services issued a statement saying, "No credible medical or public health association has verified the existence or diagnosis of 'Morgellons Disease'," and "at this time there is no reason for individuals to panic over unsubstantiated reports of this disease".<ref name="ladhs">{{cite web |url=http://web.archive.org/web/20061110145454/http://search.ladhs.org/media/docs/Morgellon+Disease.pdf |title=LADHS Statement on Morgellons Disease (archive copy) |format=PDF |publisher=Los Angeles Department of Health Services |date=2006-05 }}</ref> In June and July 2006 there were segments on [[CNN]]<ref name="ZAHN">{{cite news |title=Medical Mystery |publisher=CNN |date=2006-06-23 }}</ref>, [[American Broadcasting Company|ABC]]'s ''[[Good Morning America]]''<ref name="GMA">{{cite news |url=http://abcnews.go.com/GMA/OnCall/story?id=2246987&page=1 |title=Mysterious Skin Disease Causes Itching, Loose Fibers, Morgellons Has Plenty of Skeptics |first=Cynthia |last=McFadden |publisher=Good Morning America |date=2006-07-28 }}</ref>, and [[NBC]]'s ''[[Today (NBC program)|The Today Show]]''. In August 2006, a segment of the ABC show ''Medical Mysteries''<ref name="Primetime"/> was devoted to the subject. The disease was featured on [[American Broadcasting Company|ABC]]'s ''[[Nightline]]'' on January 16, 2008<ref>{{cite news |title=CDC to Investigate Morgellons Mystery |publisher=ABC News |date=2008-01-16 |accessdate=2008-01-20 |url=http://abcnews.go.com/Nightline/Health/story?id=4142695&page=1 }}</ref> and as the cover story of the January 20, 2008 issue of the ''Washington Post Magazine.''<ref>{{cite news |title=Figments of the Imagination? |first=Brigid |last=Schulte |publisher=The Washington Post Magazine |date=2008-01-20 |url=http://www.washingtonpost.com/wp-dyn/content/article/2008/01/16/AR2008011603134.html }}</ref> The first article to propose Morgellons as a new disease in a scientific journal was a review article co-authored by V. R. Savely, M. M. Leitao, and R. B. Stricker, members of the MRF. It was published in July, 2006 by the American Journal of Clinical Dermatology.<ref name="AJCD">{{citation |last1=Savely |first1=V.R. |last2=Leitao |first2=M.M. |last3=Stricker |first3=R.B. |title=The mystery of Morgellons disease: Infection or delusion? |journal=Am J Clin Dermatol |year=2006 |volume=7 |issue=1 |pages=1–5 |pmid=16489838 |doi=10.2165/00128071-200607010-00001 }}</ref> An article in the ''[[San Francisco Chronicle]]'' reported, "There have been no clinical studies" (of Morgellons disease).<ref name="Allday">{{cite news |url=http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2006/06/02/MORGELLONS.TMP |title=Nasty disease? Or is it delusion? |first=Erin |last=Allday |publisher=San Francisco Chronicle |date=2006-06-02 }}</ref> A [[New Scientist]] article in September 2007 also covered the mystery noting that people are reporting similar symptoms in Europe and Australia.<ref name="New S">{{cite news |url=http://www.newscientist.com/channel/health/mg19526210.700-morgellons-disease-the-itch-that-wont-be-scratched.html |title=Morgellons disease: The itch that won't be scratched |first=Daniel |last=Elkan |publisher=New Scientist Magazine |issue=2621 |date=2007-09-12 }}</ref> === CDC investigation === A [[Centers for Disease Control and Prevention]] (CDC) task force first met in June 2006.<ref>{{cite news |url=http://www.mysanantonio.com/news/medical/stories/MYSA072406.morgellons.KENS.1e13fade.html |title=CDC considers Texas for Morgellons study |publisher=My San Antonio News |first=Deborah |last=Knapp |date=2006-07-25 }}</ref> In July 2006, Dan Rutz, MPH, a communications specialist for the CDC, said, "We're not ready to concede there's a new disease, but the volume of concern has stepped up because a lot of people are writing or calling their congressmen about it."<ref name="Time">{{cite news |first=Paige |last=Bowers |url=http://www.time.com/time/health/article/0,8599,1220349,00.html |title=Itching for Answers to a Mystery Condition |publisher=Time |date=2006-07-28 }}</ref> By August 2006, the task force consisted of 12 people, including two pathologists, a toxicologist, an ethicist, a mental health expert and specialists in infectious, parasitic, environmental and chronic diseases.<ref name="CDC Probes">{{cite news |url=http://www.cbsnews.com/stories/2006/08/09/ap/health/mainD8JCII281.shtml |title=CDC Probes Bizarre Morgellons Condition |publisher=CBS News |date=2006-09-09 |first=Mike |last=Stobbe }}</ref> In May 2007, [[KGW-TV]] [[Newschannel]] 8's Laural Porter asked Rutz if he had any information about the nature of the fibers. At that time Rutz said, "None. We don't know. We haven't studied them in a lab yet. There is nothing to imply there is [an infectious process], but our mind is open to everything, including that remote possibility." Since then, the CDC has launched a funded study (see below) that will include further examination of fibers taken from Morgellons lesions by the CDC. In June 2007, the CDC opened a website on "Unexplained Dermopathy (aka 'Morgellons')." <ref name="Investigation"/> By November 2007, the CDC had announced an investigation process, stating that, "The primary goals of the investigation are to better describe the clinical and epidemiologic features of this condition and to generate hypotheses about possible risk factors."<ref name="Investigation"/> [[Kaiser Permanente]] in Northern California was chosen to assist with investigation, which will begin when the scientific protocols and review board structure have been prepared and approved. Investigators will report on the geographic distribution of the illness and estimate rates of illness in affected communities. The investigation will involve skin biopsies from affected patients and characterization of foreign material such as fibers or threads obtained from patients to determine their potential source.<ref name="Investigation"/><ref>{{cite news |first=Mike |last=Stobbe |url=http://www.chicagotribune.com/news/nationworld/sns-ap-morgellons-cdc,0,5755057,print.story |title=U.S. to Study Bizarre Medical Condition |publisher=Chicago Tribune |date=2008-01-16 }}</ref> In January 2008 it was reported that CDC was enlisting the aid of the U.S. Armed Forces Institute of Pathology and the American Academy of Dermatology "to conduct 'immediate' and 'rigorous' research."<ref name="CDC_AFIP_AAD">{{cite news |url=http://www.washingtontimes.com/apps/pbcs.dll/article?AID=/20080118/NATION/36179823/1002 |title=CDC enlists military to study skin ailment |first=Jennifer |last=Harper |publisher=The Washington Times |date=2008-01-18 }}</ref> On January 2008 the [[Centers for Disease Control and Prevention]] (CDC) in conjunction with Kaiser Permanente's Northern California Division of Research launched a funded study of the unexplained skin condition known as Morgellons. A press conference was held on Jan 16, 2008 with Dr. Michele Pearson, principal investigator for the CDC, and Dr. Joe Selby, Director of Kaiser Permanente's Northern California Division of Research.<ref name="CDC-STUDY">{{cite news |url=http://www.cdc.gov/media/transcripts/2008/t080116.htm|title=CDC to Launch Study on Unexplained Illness|publisher=CDC |date=2008-01-16 }}</ref> During the press conference, Dr. Pearson stated: "What I can tell you is real is the suffering that these patients are experiencing. I cannot characterize this as a syndrome, as disease. I can tell you it's an unexplained illness." Clinical examinations for the study will be done in [[Oakland, California]]. The CDC investigation follows a mailing campaign coordinated by the Morgellons Research Foundation in which "self-described sufferers clicked on the foundation Web site and sent thousands of form letters to members of Congress."<ref name="Schulte"/> == Symptoms and diagnosis == Morgellons is currently not recognized as a unique disorder, so there is currently no list of symptoms or [[differential diagnosis]] for Morgellons that is generally accepted by the medical community. Patients usually self-diagnose based on media reports and information published by the Morgellons Research Foundation. Symptoms usually include:<ref name="AJCD"/><ref name="Advance">{{citation |last1=Savely |first1=G. |last2=Leitao |first2=M.M. |title=Skin lesions and crawling sensations: Disease or delusion? |journal=Adv Nurse Pract |date=2005-05 |volume=13 |issue=5 |pages=16–17 |pmid=15898309 }}</ref> *Disturbing sensations of insect-like crawling, stinging or biting on or under the skin (i.e. [[formication]]) *Skin rashes and lesions that do not heal *Fiber-like filaments, granules or crystals that appear on or under the skin or that can be extracted from lesions *Joint, muscle and connective tissue pain, including [[fibromyalgia]] *Debilitating fatigue *[[Cognitive]] dysfunction, including difficulty with concentration, short-term memory, and attention Dr. William T. Harvey, director of the MRF medical advisory board, states in a 2007 [[letter to the editor]] of the ''Journal of the American Academy of Dermatology'' that Morgellons patients exhibit laboratory findings including increased levels of [[Inflammation|inflammatory]] [[cytokines]], increased [[insulin]], and [[antibodies]] to three bacterial pathogens, but did not provide evidence for these claims.<ref name="Harvey">{{cite journal |last=Harvey |first=W.T. |title=Morgellons disease |journal=J Am Acad Dermatol |year=2007 |volume=56 |issue=4 |pages=705–706 |pmid=17367622 |url=http://www.eblue.org/article/PIIS0190962207001958/fulltext |doi=10.1016/j.jaad.2007.01.012 }}</ref> Many Morgellons patients have symptoms that are also consistent with [[Chronic Fatigue Syndrome]], [[Clinical depression|depression]], [[obsessive-compulsive disorder]], and [[attention deficit disorder]].<ref name="Paquette">{{cite journal |last=Paquette |first=M. |title=Morgellons: Disease or delusions? |journal=Perspectives in Psychiatric Care |year=2007 |volume=43 |issue=2 |pages=67–68 |pmid=17388848 |doi=10.1111/j.1744-6163.2007.00113.x }}</ref> Dr. Rhonda Casey, chief of pediatrics at Oklahoma State University Hospital, while working with the OSU-CHS Center for the Investigation of Morgellons Disease, noted all her Morgellons patients looked ill with neurological symptoms, which included confusion, difficulty walking and controlling their feet ([[foot drop]]), and a sagging mouth when speaking<ref name="psychologytoday"/>; the OSU Center has issued a list of symptoms similar to that of the MRF.<ref>{{Cite web |title=Morgellons Disease |publisher=Oklahoma State University, Center for Health Sciences |url=http://www.healthsciences.okstate.edu/morgellons/index.cfm }}</ref> The Morgellons Research Foundation has adopted a [[case definition]]<ref name="MRFCase">{{cite web |url=http://morgellons.org/case.htm |title=Morgellons Case Definition |publisher=Morgellons Research Foundation |date=2006 |accessdate=2008-01-08 }}</ref> of Morgellons symptoms that has been referenced in other articles.<ref name="Paquette"/><ref name="mayo"/> The 2007 ''Atlas of Human Parasitology'' covers the proposed condition in its section on "Pseudoparasites and Artifacts": <blockquote>Many dermatologists refute the suggestion that this is an actual disease but instead indicate that many of these patients have psychological problems or other common skin disorders. Given the large numbers of individuals who feel that they have this affliction, it will be most helpful over the coming years to have a valid scientific assessment of Morgellons diesease and its possible etiology (or etiologies). One of the chief criticisms by many patients has been that they feel the medical community and other scientists consulted have not been open to the idea that there is possibly an as yet undescribed infectious or physiologic causation for the disease. However it is certainly true that in fact many expert parasitologists, medical entomologists and other microbiologists have in fact carefully examined fibers and other materials expressed or extracted from such patients and found that biological organisms are not present. Although an apparent association of the condition with the presence of Lyme disease has been reported (Savely et al, 2006, Am J Clin Dermatol, 7:1–6), further research will be needed to help resolve the validity of Morgellons disease. Until then, whether Morgellons disease is another name for delusional parasitosis or a real disease entity with a biologic or physiologic basis will remain up in the air.<ref name="Atlas">{{cite book |last=Ash |first=L.R. |coauthors=Orihel, T.C. |year=2007 |title=Atlas of Human Parasitology |edition=5 |publisher=American Society for Clinical Pathology Press |location=Chicago, Illinois |pages=386–387 |isbn=0891891676 }}</ref></blockquote> == Proposed causes and pathophysiology == === Delusional parasitosis and other neuropsychological disorders=== Many dermatologists, psychiatrists, and other medical professionals view Morgellons as a new name for an old condition, [[delusional parasitosis]],<ref name="Accordino">{{cite journal |author=Accordino RE, Engler D, Ginsburg IH, Koo J |title=Morgellons disease? |journal=Dermatol Ther |volume=21 |issue=1 |pages=8–12 |year=2008 |pmid=18318880 |doi=10.1111/j.1529-8019.2008.00164.x |url=}}</ref> also known as "delusions of parasitosis" (DP or DOP) and ''Ekbom's Syndrome'': Morgellons is "a pattern of dermatologic symptoms very similar, if not identical, to those of delusions of parasitosis",<ref name="Accordino"/> and "the vast majority"<ref name="AJCD"/> (elsewhere, 95%<ref name="Acorn">{{Citation | last = Ezra | first = Navid | title = Morgellons: Disease or delusion? | newspaper = Agoura Hills Acorn | date = 2006-07-20 | accessdate = 2008-06-02 | url = http://www.theacorn.com/news/2006/0720/Health_and_Wellness/053.html}}</ref>) of Morgellons patients are diagnosed with delusional parasitosis or another psychosomatic illness. In delusional parasitosis, patients hold a delusional belief that they are infested with parasites. They may experience [[formication]], the sensation that insects are crawling under the skin. Individuals suffering from this condition may develop elaborate rituals of inspection and cleansing to locate and remove parasites and fibers, resulting in a form of self-mutilation; they injure themselves in attempts to be rid of the "parasites" by picking at the skin, causing [[lesion]]s, and then pick at the lesions, preventing them from healing.<ref name="AJP"/> Patients with delusional parasitosis often present at the doctor's office with what MDs term the "[[matchbox sign]]"<ref name="AJCD"/><ref name=koo>{{cite journal |last=Koo |first=Lebwohl |url=http://www.aafp.org/afp/20011201/1873.html |title=Psychodermatology: The Mind and Skin Connection |journal=American Family Physician |volume=64 |issue=11 |date=2001-12-01 }}</ref> -- a [[medical sign]] characterized by the patient making collections of fibers and other foreign objects supposedly retrieved from the skin<ref name="AJP"/> -- and, because of "unshakeable delusional ideation", strongly reject diagnoses that do not involve parasites.<ref name="DermTher">{{cite journal |doi= 10.1111/j.1529-8019.2008.00163.x |title= Delusions of parasitosis |year= 2008 |author= Lee, Chai Sue |journal= Dermatologic Therapy |volume= 21 |pages= 2 }}</ref><ref name="AJCD"/> A significant minority of DP cases occur in groups of two, three, or more individuals in close proximity, even families, known by the French terms ''folie à deux'', ''folie à trois'', and ''folie à famille''.<ref name="AJCD"/> Delusional parasitosis, with symptoms that have "extraordinary similarities" to Morgellons, has been described in the medical literature for over 75 years.<ref name="JAAD">{{cite journal |last=Koblenzer |first=C.S. |title=The challenge of Morgellons disease |journal=J Am Acad Dermatol |date=2006 |volume=55 |pages=920–922 |pmid=17052516 |doi=10.1016/j.jaad.2006.04.043 }}</ref> Dr. Noah Craft, a dermatologist at the Harbor-[[UCLA]] Medical Center, [[Torrance, California|Torrance, CA]], has seen a handful of Morgellons patients and biopsied their skin lesions, but found only normal skin and inflammation, as one would find in a bump that has been picked at.<ref name="psychologytoday"/> Some cases of delusional parasitosis have organic causes other than those associated with neurological/psychological conditions of unknown etiology. For example, formication, the sensation that bugs are crawling under ones' skin, can be caused by allergies, [[diabetic neuropathy]], [[menopause]], [[skin cancer]], or [[herpes zoster]]. Both dementia and mental retardation have been reported in association with DOP.<ref name="Slaughter">[Slaughter JR et al "Psychogenic Parasitosis, A Case Series and Literature Review" Psychosomatics 1998.]</ref> Symptoms associated with delusional parasitosis, including [[urticaria]] (hives), [[paresthesia]] (unexplained tingling sensations in the skin), and [[pruritis]] (itching), are common side-effects of many prescription drugs or drug abuse.<ref name="Hinkle">{{cite journal |last=Hinkle |first=N.C. |title=Delusory Parasitosis |journal=American Entomologist |year=2000 |issue=46 |pages=17–25 |url=http://www.mental.health.wa.gov.au/one/resource/41/delusory%20parasitosis%20Dr%20N%20Hinkle.pdf }}</ref> The sensations are real, but the attribution of the sensations to unknown parasites and the collection of fibers is part of the delusion. The MRF's William Harvey has written that non-healing "Morgellons lesions" have been found on infants' bodies in locations that the infants cannot themselves reach to scratch.<ref name="Harvey"/> In his letter to the editor, he does not provide evidence to support this claim. Some cases of Morgellons have been diagnosed as "cutaneous dysaesthesia."<ref name="Pop"/> ===Role of the internet=== In a 2006 report to the ''Journal of the American Academy of Dermatology'', Waddell and Burke cite the influence of the internet on their self-diagnosed Morgellons patients: "physicians are becoming more and more challenged by the many persons who attempt self-diagnosis on-line. In many cases, these attempts are well-intentioned, yet wrong, and a patient's belief in some of these oftentimes unscientific sites online may preclude their trust in the evidence-based approaches and treatment recommendations of their physician." Dermatologist Caroline Koblenzer specifically faults the MRF website for misleading patients, "Clearly, as more and more of our patients discover this site (MRF), there will be an ever greater waste of valuable time and resources on fruitless research into fibers, fluffs, irrelevant bacteria, and innocuous worms and insects." The LA Times, in an article on Morgellons, notes that "(t)he recent upsurge in symptoms can be traced directly to the Internet, following the naming of the disease by Mary Leitao, a Pennsylvania mother."<ref name="Healy"/> Robert Bartholomew, a sociologist who has studied the Morgellons phenomenon, states that the "World Wide Web has become the incubator for mass delusion and it (Morgellons) seems to be a socially transmitted disease over the Internet." According to this hypothesis, patients with delusions of parasitosis and other psychological disorders become convinced they have "Morgellons" after reading internet accounts of others with similar symptoms.<ref name="Annapolis">[Edward McSweegan, "Internet helps spread delusion that Morgellons a disease," The Capital, Annapolis, Maryland, 01 July 2007]</ref><ref name="Canton">{{cite news |url=http://www.cantonrep.com/index.php?ID=309549 |title=My computer made me sick |first=Hillary |last=Rhodes |publisher=Canton Rep |date=2006-09-24 }}</ref> A 2005 Popular Mechanics article stated that Morgellons symptoms are well-known and characterized in the context of other disorders, and that "widespread reports of the strange fibers date back" only a few years to when the MRF first described them on the internet.<ref name="Pop"/> The Dallas Observer writes that Morgellons may be spread via the Internet and mass media, and "(i)f this is the case, then Morgellons is one in a long line of weird diseases that have swept through populations, only to disappear without a trace once public concern subsides."<ref name="DallasObserver"/> The article draws parallels to several mass media-spread mass delusions. === Known skin conditions === It has been hypothesized that some cases of (self-diagnosed) Morgellons disease are actually other recognized skin disorders, including allergic dermatitis, [[contact dermatitis]], and the parasite [[scabies]].<ref name="nature"/><ref name="JAAD"/> === Theories about the fibers === Randy Wymore, a former research director of the MRF and presently Director of the Oklahoma State University Center for Health Sciences' Center for the Investigation of Morgellons Disease, claims that Morgellons patients have masses of dark fibers visible at 60x magnification under the unbroken skin, while unaffected individuals do not.<ref name=nature/> Wymore sent samples of fibers supplied by Morgellons patients to the Police Crime Lab in [[Tulsa, Oklahoma]] for analysis. A forensic scientist at the Tulsa Police Crime Lab in Oklahoma searched the FBI's national database, but the Morgellons sample did not match any known fiber in the database.<ref name="Primetime" /> Lab director Mark Boese said the fibers were "consistent with something that the body may be producing," adding, "These fibers cannot be manmade and do not come from a plant. This could be a byproduct of a biological organism."<ref name="Primetime">{{cite news |title='Morgellons' Mystery |publisher=ABC News Primetime |date=2006-08-09 |accessdate=2007-08-14 |url=http://abcnews.go.com/Primetime/Story?id=2283503&page=1}}</ref> Dr. Rhonda Casey, chief of pediatrics at Oklahoma State University Hospital and part of the MRF research team at OSU, claimed that she has examined many patients' skin via a [[dermatoscope]] and performed biopsies on both lesions and apparently healthy skin, and that "she saw fibers embedded in both places. The white ones, she says, are hard to see. A dermatologist who either didn't look at all, or didn't use a dermatoscope, might not see them under the skin."<ref name="psychologytoday"/> Dermatologists say any fibers are from clothing embedded in self-imposed sores, and the fibers patients bring in bags are textile in nature.<ref name="psychologytoday"/> <ref>{{Cite news |title=All in the head? |author=Elaine Monaghan |publisher=The Times |date=2006-05-19 |accessdate=2007-08-14 |url=http://www.timesonline.co.uk/tol/comment/article721795.ece }}</ref> === Bacterial hypothesis === Three members of the Morgellons Research Foundation, including Raphael Stricker, Director and former President of the International Lyme and Associated Diseases Society (ILADS), and Ginger Savely, also an ILADS member,<ref>{{cite web |url=http://www.ilads.org |title=International Lyme and Associated Diseases Society (ILADS) }}</ref> authored an article about Morgellons published by the ''American Journal of Clinical Dermatology'' in early 2006. The authors wrote that "Morgellons disease may be linked to an undefined infectious process," and reported that many patients with Morgellons disease have positive [[Western blot]]s for ''Borrelia burgdorferi'', the causative agent of [[Lyme disease]], and treatment with anti-bacterials appropriate for Lyme disease leads to remission of Morgellons symptoms in most patients.<ref name="AJCD"/> Dr. Harvey, another member of ILADS, has also stated there is [[serology|serological]] evidence of bacterial pathogens in Morgellons patients, but did not provide any such evidence.<ref name="Harvey"/> Stricker, along with Citovsky, MRF board member from the [[State University of New York at Stony Brook]] and a researcher on plant pathogens, reported in January, 2007, that Morgellons skin fibers appear to contain [[cellulose]], and [[PCR]] screening of samples from two Morgellons patients produced evidence of DNA from ''[[Agrobacterium]]'', a plant-infecting organism known to induce cellulose fibers at infected sites within plant tissues. They stated that if confirmed, ''Agrobacterium'' could be the first instance of plant infecting bacteria involvement in human disease.<ref>{{citation |last1=Stricker |first1=R.B. |last2=Savely |first2=V.R. |last3=Zaltsman |first3=A. |last4=Citovsky |first4=V. |title=Contribution of ''Agrobacterium'' to morgellons disease |journal=J Invest Med |year=2007 |volume=5 |issue=1 |pages=S123 #287 Suppl. S. (Abstract) }}</ref> However, ''Agrobacterium'' is already known to be responsible for [[opportunistic infection]]s in humans with weakened [[immune system]]s, but has not been shown to be a primary pathogen in otherwise healthy individuals.<ref>{{citation |last1=Hulse |first1=M. |last2=Johnson |first2=S. |last3=Ferrieri |first3=P. |title=Agrobacterium infections in humans: Experience at one hospital and review |journal=Clin Infect Dis |year=1993-01 |volume=16 |issue=1 |pages=112–7 |pmid=8448285 }}</ref> === Environmental toxins === Richard Fagerlund, an entomologist who has a column titled "Ask the Bugman" in the San Francisco Chronicle, stated that he takes Morgellons disease seriously, and he receives letters from people with Morgellons symptoms daily. Twenty years ago, he got three to four letters like this a year. He believes the condition is reaching epidemic proportions and speculates only a small percentage of cases are delusional parasitosis, while the rest may be caused by something else, such as pollutants, especially [[pesticide]]s.<ref name="SFchron">{{cite news |title=Persistent scabies-like condition may not be all in people's heads |first=Richard |last=Fagerlund |publisher=San Francisco Chronicle |date=2006-12-30 |page=F-6 ||url=http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2006/12/30/HOG2VN91IS1.DTL }}</ref> ===Conspiracy theories=== Some self-identified Morgellons sufferers and various conspiracy theorists provide their own origin hypotheses: "Perhaps it is caused by chemical spills or bio-terror or even alien abductions. On a radio program called Coast to Coast--popular among people who believe in UFOs and ghosts--a New Mexico doctor reports that a former CIA agent told him the disease was caused by the French. A botched government experiment, he says, contaminated the water. All Evian drinkers are at risk."<ref name="DallasObserver"/> == Treatment == === Treatment for delusional parasitosis === Many dermatologists treat Morgellons as delusional parasitosis. After a thorough medical examination to rule out known organic causes for the symptoms, delusional parasitosis patients are typically prescribed one of several [[typical antipsychotic]] drugs.<Ref name="Koo">{{citation |last1=Koo |first1=J. |last2=Lee |first2=C.S. |title=Delusions of Parasitosis: A Dermatologist's Guide to Diagnosis and Treatment |journal=Am J Clin Dermatol |year=2001 |volume=2 |issue=5 |pages=285–290 |pmid=11721647 |doi=10.2165/00128071-200102050-00003 }}</ref><ref name="Meehan">{{citation |last1=Meehan |first=W.J. |last2=Badreshia |first2=S. |last3=Mackley |first3=C.L. |title=Successful treatment of delusions of parasitosis with olanzapine |date=2006-03 |journal=Arch Dermatol |volume=142 |issue=3 |pages=352–355 |pmid=16549712 |url=http://archderm.ama-assn.org/cgi/content/full/142/3/352 |doi=10.1001/archderm.142.3.352 }}</ref> In the past, [[pimozide]] was the drug of choice; in addition to antipsychotic activity, it also has [[antipruritic]] activity, meaning it inhibits the sensation of itching.<ref name="Koblenzer">{{cite journal |last=Koblenzer |first=C.S. |title=Pimozide at least as safe and perhaps more effective than olanzapine for treatment of Morgellons disease |year=2006 |journal=Arch Dermatol |volume=142 |issue=10 |pages=1364 |pmid=17043201 |doi=10.1001/archderm.142.10.1364-b }}</ref> However, pimozide requires frequent electrocardiographic monitoring.<ref name="Meehan"/> Currently, [[atypical antipsychotic]]s such as [[olanzapine]] or [[risperidone]] are used as first line treatment.<ref name="Meehan"/> Antipsychotics are effective at treating delusional parasitosis at doses as low as one-fifth to one-tenth the dose typically prescribed for schizophrenia.<ref name="Meehan"/> It is common for patients who believe they have Morgellons to reject a physician's diagnosis of delusional parasitosis. It has been suggested that the term Morgellons should be adopted by dermatologists to enhance their [[rapport]] with their patients, allowing them to overcome this resistance.<ref name="Murase">{{citation |last1=Murase |first=J.E. |last2=Wu |first2=J.J. |last3=Koo |first3=J. |title=Morgellons disease: A rapport-enhancing term for delusions of parasitosis |journal=J Am Acad Dermatol |year=2006 |volume=55 |issue=5 |pages=913–914 |pmid=17052509 |url=http://www.eblue.org/article/PIIS0190962206012175/fulltext |doi=10.1016/j.jaad.2006.04.042 }}</ref> A Popular Mechanics article described a dermatologist who would not allow the use of his name, citing "concern for his safety." He said he has "diagnosed 50 or so Morgellons patients" with a disorder that can result in the sensation of insects, and "typically puts a cast over the lesions to prevent further irritation and after four weeks removes it." According to the doctor, the patients' lesions heal under the cast.<ref name="Pop"/> === Treatment for infectious disease === People who say they have Morgellons frequently reject the diagnosis of delusional parasitosis,<ref name="Pop">{{cite news |url=http://www.popularmechanics.com/science/health_medicine/1662162.html |title=Morgellons Disease Baffles Patients And Doctors |first=Benjamin |last=Chertoff |publisher=Popular Mechanics |date=2005-06 }}</ref> "report that their symptoms are not taken seriously,"<ref name="AJCD"/> and refuse psychotropic medicine. Hypothesizing that Morgellons is the result of an infectious process, some medical practitioners associated with the MRF recommend the use of [[antibiotic]]s, [[antifungal]]s, [[antiparasitic]] medications, herbal supplements, and light therapy.<ref name="Healy">{{cite news |url=http://pqasb.pqarchiver.com/latimes/access/1161014501.html?dids=1161014501:1161014501&FMT=ABS&FMTS=ABS:FT&type=current&date=Nov+13%2C+2006&author=Melissa+Healy&pub=Los+Angeles+Times&edition=&startpage=F.1&desc=Disease%3A+Real+or+state+of+mind%3F%3B+Morgellons+sufferers+describe+wild+symptoms+of+a+disorder+that+many+doctors+doubt+exists |title=Disease: Real or state of mind? Morgellons sufferers describe wild symptoms of a disorder that many doctors doubt exists. |first=Melissa |last=Healy |publisher=Los Angeles Times |date=2006-11-13 }}</ref><ref name="Allday"/><ref name="Ktvu.com">{{cite news |url=http://www.ktvu.com/news/9264350/detail.html |title=Doctors Make Progress With Mysterious Disease |publisher=KTVU-TV |date=2006-06-23 }}</ref><ref name="Pop"/><ref name="Gazette"/><ref name="New S"/><ref name="Dunavan">{{cite news |url=http://discovermagazine.com/2006/dec/vital-signs-sore-mystery |title=Vital Signs: Bugs Are Crawling In My Skin |first=Claire |last=Panosian Dunavan |publisher=Discover |date=2006-11-20 }}</ref> Randy Wymore, a former MRF director, has claimed on his website that some Morgellons patients who test positive for Lyme disease obtain symptom relief using aggressive, long-term antibiotic treatment similar to what is used by some doctors to treat [[Lyme disease controversy|"chronic" Lyme disease]], a proposed condition that many in the medical community dispute.<ref name="nejm-feder">{{cite journal |author=Feder HM, Johnson BJ, O'Connell S, ''et al'' |title=A critical appraisal of "chronic Lyme disease" |journal=N. Engl. J. Med. |volume=357 |issue=14 |pages=1422–30 |year=2007 |month=October |pmid=17914043 |doi=10.1056/NEJMra072023 }}</ref> Virginia Savely, a nurse with the MRF and member of the International Lyme and Associated Diseases Society (ILADS), claims to have similar unpublished results.<ref name="AJCD"/> The antibiotic treatment is not curative, because when it is discontinued, the symptoms return.<ref name="Paquette"/> Dermatologists say that these positive effects of antibiotic use for some patients are likely the result of a placebo effect or anti-inflammatory actions of the drugs. They advise against prescribing antibiotics, which may reinforce the patients' delusions instead of addressing what these doctors consider the core problem: delusional parasitosis.<ref name="Accordino"/> In addition, long-term antibiotic use can have serious side effects{{fact|date = July 2008}}. === Self-treatment === Persons with Morgellons symptoms may turn to alternative remedies described on web sites and discussion groups. Some treatments are dangerous, however, and have included the use of bleach, veterinary medicines intended for de-worming horses, and industrial insecticides.<ref name="CDC Probes"/> ==References== {{reflist|2}} [[Category:Dermatology]] [[Category:Ailments of unknown etiology]] [[de:Morgellons]] [[fr:Morgellons]] [[it:Morgellons]] [[pl:Choroba Morgellonów]] [[zh:莫吉隆斯症]]