Michael

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0029908

Abstract:

Background

Morgellons is a poorly characterized constellation of symptoms, with the primary manifestations involving the skin. We conducted an investigation of this unexplained dermopathy to characterize the clinical and epidemiologic features and explore potential etiologies.

Methods

A descriptive study was conducted among persons at least 13 years of age and enrolled in Kaiser Permanente Northern California (KPNC) during 2006–2008. A case was defined as the self-reported emergence of fibers or materials from the skin accompanied by skin lesions and/or disturbing skin sensations. We collected detailed epidemiologic data, performed clinical evaluations and geospatial analyses and analyzed materials collected from participants’ skin.

Results

We identified 115 case-patients. The prevalence was 3.65 (95% CI = 2.98, 4.40) cases per 100,000 enrollees. There was no clustering of cases within the 13-county KPNC catchment area (p = .113). Case-patients had a median age of 52 years (range: 17–93) and were primarily female (77%) and Caucasian (77%). Multi-system complaints were common; 70% reported chronic fatigue and 54% rated their overall health as fair or poor with mean Physical Component Scores and Mental Component Scores of 36.63 (SD = 12.9) and 35.45 (SD = 12.89), respectively. Cognitive deficits were detected in 59% of case-patients and 63% had evidence of clinically significant somatic complaints; 50% had drugs detected in hair samples and 78% reported exposure to solvents. Solar elastosis was the most common histopathologic abnormality (51% of biopsies); skin lesions were most consistent with arthropod bites or chronic excoriations. No parasites or mycobacteria were detected. Most materials collected from participants’ skin were composed of cellulose, likely of cotton origin.

Conclusions

This unexplained dermopathy was rare among this population of Northern California residents, but associated with significantly reduced health-related quality of life. No common underlying medical condition or infectious source was identified, similar to more commonly recognized conditions such as delusional infestation.
 

That’s basically consistent with what I’ve said all along since I started this site in April 2006. The fibers are environmental (and mostly cotton), Morgellons is not a distinct disease, and the patients suffer from a variety of conditions – both physical and/or psychological.

I recognize that the people who think they have “Morgellons” are really suffering. But the answer is not in inventing a new disease. I recognize also this report will be a disappointment for them – but hopefully some will take it as an opportunity. It’s not a strange new disease. The fibers are not alive. You might just have some known conditions that can be treated. Talk to your doctor. Keep an open mind. Good luck.

From:

http://psy.psychiatryonline.org/cgi/content/full/50/1/90

The recent success of the Morgellons-disease meme is, in part, explained by the fact that the Morgellons label resonates with symptomatic individuals. In one person’s words: “I felt so relieved. I found all these people talking about the same thing I was.”4 Accordingly, Morgellons disease has been considered a rapport-enhancing term in clinical medicine.5 The dermatology literature indicates that Morgellons disease is likely the equivalent of “delusional parasitosis,” a psychiatric illness in which patients erroneously believe that their skin is infested with parasites.5,6This competing conventional meme has been unpopular among individuals identifying themselves as having Morgellons disease.

For Morgellons disease, most information available to patients exists on the Internet; thus, the World Wide Web is a second important contributor to the proliferation of the Morgellons moniker. With widespread reports dating back only about 3 years, Morgellons has seen explosive growth for a concept dormant for more than 300 years. A large CDC-supported descriptive study is underway: a first formal clinical epidemiologic investigation of the Morgellons phenomenon, involving skin biopsies and fiber analysis (http://www.cdc.gov/unexplaineddermopathy/investigation.html).4 Results will characterize Morgellons as either a novel illness or an internet meme synonymous with one or more previously described disorders.

I think they gravely misunderstand the use of the term “rapport-enhancing”.  Here they seem to suggest a rapport between patients, yet in the literature they reference (Murase, Wu, and Koo), the term “rapport-enhancing” refers to rapport between doctor and patient.

Interesting new article from Brazil on two patients who self identified with “Morgellons”.:

http://www.scielo.br/pdf/rimtsp/v49n6/12.pdf

The first patient brought with her very small fragments of nails
and dry skin, believed by her to be parasites (Fig. 1). The second patient
also brought skin fragments identified by her as parasites (Fig. 2).
Both were submitted to histopathological examination showing
fragments of epidermis.
In times past, when we were still lacking in some important
information about the Ekbom syndrome, we came into contact with
two situations similar to those described here. One of these persons
went as far as to make a sketch of the human body showing the path of
the peculiar “things”. At that time all this sounded as nonsensical
arguments.
Possibly, people suffering from Ekbom syndrome try to solve their
problems by consulting different medical specialists. However, it is
not the subject of only one area of medical practice; it would make
sense to consider it to be a multidisciplinary subject requiring the
adoption of specific therapeutic measures. We became involved with
this subject as medical practitioners dedicated to the treatment of
infectious and parasitic diseases. Supposedly, their condition is
produced by “parasites”. In cases of serious skin lesions, one could
think of consulting a dermatologist, although other medical practitioners
could be aware of the problem. Concerning Ekbom syndrome, we think
that courses and other events on this subject should be recommended,
as it is necessary to expand the available information about this disease.

The following extract is from an article that deals with several delusional disorders.  The article differentiates Morgellons from delusions of parasitosis.   Note that this article does not mean the symptoms of Morgellons are purely delusional, but rather that, as with DOP, there is often a delusional component to what may or may not be a physical condition.   I’ve added it here as it is a useful reference to the most current medical opinion on Morgellons.  I’d encourage people to read the full article, available via this link.

http://dermatology-s10.cdlib.org/146/review/delusions/robles.html

Delusional disorders in dermatology: a brief review
David T Robles MD PhD1, Sharon Romm MD2, Heidi Combs MD2, Jonathan Olson BS1, Phil Kirby MD1
Dermatology Online Journal (2008 June 15) 14 (6): 2

Morgellons disease

In the seventeenth century Sir Thomas Browne used the term Morgellons disease to describe an unusual symptom complex resembling those seen in patients today [21]. Patients with this condition maintain the unshakeable belief that fibers or some other material is imbedded or emerging from their skin. They pick and dig at their skin to extract the offending “material.” They may reject the notion that they have parasites but may still exhibit the “matchbox” sign, bringing in fragments of clothing fibers, lint, hair fibers and dried skin fragments for examination.

We consider Morgellons to be within the spectrum of delusions of parasitosis, except that the patients are focused not on parasites but on “unusual material” that they believe is in their skin. We have seen a number of such patients in our clinic and all manipulate their lesions enough to self-induce irregular ulcerations. They frequently dig at their lesions with their own nails as well as house-hold items such as nail clippers or tweezers, the so-called “tweezer sign” (Robles, in press). It is important to ask patients if they use instruments in addition to fingernails because in our experience, the use of mechanical devices portends a more malignant psychological profile.

Morgellons disease has received recent attention, primarily through the internet and through the website of Morgellons Research Foundation (http://www.morgellons.org). The Morgellons Research Foundation claims that this condition is an emerging infectious disease [21], however, no available evidence exists to confirm this hypothesis. Some authors affiliated with the Morgellons Research Foundation claim that Lyme Borreliosis [22] has an association but this has not been substantiated.

Epidemiology

There are no data available describing the prevalence of this syndrome. It may be seen in association with a number of psychiatric conditions including unipolar and bipolar depression, schizophrenia and abuse of drugs [21].

Treatment

There are no randomized control studies to establish the recommended treatment of this disorder. Some experts discuss the importance of establishing patient rapport by referring to the delusions as Morgellons disease [23]. After ruling out an organic cause, emphasis should be placed on how disconcerting the symptoms must be for the patient.

Medication trials have been intermittently effective. Pimozide has been used in doses of 0.5-2.0 mg daily. Koblenzer believes that Pimozide, with the added anti-pruritic effect, is a preferred treatment [24]. The use of atypical antipsychotics such as risperdal, olanzapine and aripiprazole may also be of benefit [21, 23]. In our experience, the use of extra-thin hydrocolloid dressings over the ulcerations is generally very effective because it provides a mechanical barrier to manipulation and facilitates wound healing. The wounds frequently become secondarily infected, making the use of topical or systemic antibiotics an important adjunctive measure.

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

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

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

24. Koblenzer CS: Pimozide at least as safe and perhaps more effective than olanzapine for treatment of Morgellons disease. Arch Dermatol 2006; 142(10): 1364.

Morgellons coverage in the local media has never been very good, with the natural tendency of TV news to compress things into sound bites, and to force emotional responses from their viewers instead of informing them.

This coverage reached a new low on 3/6/2008 with the broadcast of the KFMB piece titled : “Is Mysterious Skin Condition A Disease Or Delusion?”:

http://www.kfmbtv8.com/features/healthcast/story.php?id=120307#

The majority of the segment is taken up with an interview with a woman who claims she has Morgellons.

Her symptoms began in July with what she thought was an insect bite. It soon evolved into skin lesions.

“One evening I was kind of scratching at one of them, what appeared to be a little white moth flew out of some of these lesions,” she said.

Her terror continues. She says citrus acid brings worm-like threads out of her body. Seeing is believing.

Here’s where things get ridiculous. The woman takes some freshly cut lemon, and rubs it vigorously over her hand for a minute, squeezing and twisting the lemon slice until her hand is covered with lemon juice and lemon pulp.

She then rubs her hands together, rolling the pulp around on her fingertips.

Then she points at some lemon pulp and says “This is worms, can you see it coming out right there?

Later, with hand dried off, she digs at a piece of dried skin at the edge of a wound – the unsaid implication being that this is the same thing.

The footage then cuts to her plucking off another piece of lemon pulp from a different region of unbroken lemon soaked skin.


The piece continues:

[She] has seen countless doctors, but her symptoms are getting worse.

“To be diagnosed by doctor after doctor as being delusional, it’s beyond frustrating,” she said.

I’m sure it is very frustrating, and I feel very sorry for her. However, little white moths are not flying out of her lesions. The “worms” are lemon pulp. I don’t know anything about her other symptoms, or her skin condition, which may well be related to a real medical condition, but in this regard, she holds a mistaken belief.

If countless doctors are telling someone the same thing, over and over, then is there not a chance that the doctors are right?

Despite the title of the piece, there is no questioning on the part of KFMB. They totally accept this woman’s story. Presenting her as a rational person who simply has worms coming out of her skin and is being ignored by countless doctors. They totally ignore the very obvious fact that there are no worms, and that all they are seeing is lemon pulp.

© 2012 Morgellons Watch Suffusion theme by Sayontan Sinha