On the Morgellons research foundation, there is a flashing link that says “Click here for a letter to your doctor!”, which takes you to this page:

http://www.morgellons.org/letter.pdf

This is a two page letter, with the Oklahoma State University CHS letterhead, dated May 15, 2006, from Randy S. Wymore, Ph.D. and Rhonda Casey, D.O., beginning “Dear Practicioner,”

The letter makes some interesting claims, and contains a few leaps in reasoning, and unspoken assumptions. I’ll go over the whole letter and comment on it a bit at a time.

This letter concerns a patient population that manifests a particular set of symptoms we have encountered with increasing frequency, and that OSU-CHS is actively researching. The condition has been labeled as Morgellons Disease and it is unclear if this is a single disease or a multi-faceted syndrome.

What is unclear is if there actually is a patient population manifesting a particular set of symptoms. As has been pointed out several times, including by the Los Angeles Department of health, the “particular set of symptoms” is vague and covers a large number of conditions. The only consistent distinguishing feature, the fibers, has been shown to be simple environment contamination, since fibers are everywhere and it is impossible to keep them out of lesions.

Until recently, most of these patients have been grouped as a subset of the diagnosis of Delusions of Parasites (delusional parasitosis; DOP).

Delusions of Parasites is the mistaken belief that one is infested with parasites. If people simply have lesions, and find fibers in them, they may form the mistaken belief that their fibers are connected with their disease. DOP is a poor diagnosis in this case, and I have often spoken against this.

The Morgellons research foundation seek to characterise their campaign as a fight between two choices, either Morgellons is a new disease, or it is DOP. This serves to increase sympathy for sufferer, as clearly their symptoms (particularly the lesions) are real, and they do in fact find fibers in their lesions. But the reality is more complex. Many of the sufferers clearly have some form of dermatitis artefacta, or neurotic ecoriations, and the causes of those symptoms are many and varied, and DOP plays only a small part in them.

After obtaining careful patient histories and thorough physical exam, we have determined that Morgellons patients have several important distinctions ruling out the diagnosis of DOP.

Like I said, DOP plays only a small part here. So ruling it out only rules out a small part of the possible causes of the symptoms. There are a LOT of other things that need to be ruled out before we can decide someone has a disease new to science.

This population of patients frequently exhibit the following symptoms:

• Distinct and poorly healing skin lesions with unusually thick, membranous scarring upon eventual healing.

A classic sign of Neurotic Excoriations. Dr Noah Sheinfeld, MD, JD, FAAD, says of Neurotic Excoriations: “The erosions and scars of NEs often have irregular borders and are usually similar in size and shape”, “The erosions can heal slowly because of recurrent picking”, “Scars often remain on patients with this condition”, “Patients pick at areas until they can pull material from the skin. This may be referred to as ‘pulling a thread from the skin.’

• Moderate to extreme pruritis at sites of lesions as well as un-erupted skin.

Pruritis (itching) has many causes. That lesions should itch is not at all surprising. Itching can cause lesions via what is known as the itch-scratch-itch cycle, whereby the patient obtains temporary relief via scratching, but irritates and damages the skin in the process, causing the itching to return later. Eventually the damage to the skin causes lesions to form. The Merk manual says “chronic rubbing or picking at itchy skin results in an “itch-scratch-itch ” cycle that can eventually progress to discolored thickened patches of skin (lichen simplex chronicus) and/or lumps and swellings (prurigo nodularis) that are difficult to treat” – note that “lichen simplex chronicus” sounds similar to the “unusually thick, membranous scarring” that is mentioned above.

• Microscopic examination of these lesions will most often reveal the presence of unusual fibers, which may be black, blue or red. These fibers, which many healthcare providers initially thought to be textile contaminants, are often present in the deep tissue of biopsies obtained from unbroken skin of individuals with this condition. Careful examination of these fibers further reveals that they are frequently associated with hair follicles, and are definitely not textile in origin.

I’ve covered fibers before, demonstrating that fibers are everwhere, and that I personally have fibers on my skin, and in my lesions. I’ve not performed a deep tissue biopsy yet, but I wonder how many Wymore and Casey have performed, and if they did, were the results anything like this:

art-mn0118fig09.jpg

That’s a deep skin biopsy clearly showing some fibers. They are nerve fibers.

But what of “not textile in origin”? It is unclear how this has been determined, how many fibers have been examined, and what the source of those fibers was. Wymore has simply failed to identify some fibers out of the hundreds he has looked at. He is not an expert on fiber analysis, and even the experts can not identify every fiber they look at. Not being able to identify a fiber tells you nothing.

Black, red and blue“? Along with clear and white fibers, which are hard to see on skin, those colors are by far the most common in environmental fibers, accounting for seemingly over 95% of all random fibers I have observed.

• Most of these patients suffer from a host of neurological symptoms which can vary in severity from mild to severe. These neurological symptoms include peripheral tingling, paresthesias and varying degrees of motor involvement which appear to progress.

That describes just about everyone over the age of 40. If you were to ask any patient of middle age or above: “have you ever felt any numbness, or tingling”, you’d probably get an affirmative answer. The cause could be anything from very common conditions such as Carpel Tunnel Syndrome, arthritis, diabetes, hypothyroidism or atherosclerosis, to less common, but not unusual, conditions such as a brain tumor, motor neurone disease, or autoimmune disorders like multiple sclerosis or lupus erythematosus.

• Intermittent cognitive and behavioral status changes are often observed and also seem to progress with the severity of disease. This is often referred to as “brain fog” by the patient as they experience a waxing and waning of this symptom.

“Brain fog” is common symptom of Chronic Fatigue Syndrome, a MUPS that many Morgellons believers are diagnosed with. “Intermittent cognitive and behavioral status changes” can have many causes, including normal aging.

• Laboratory findings in these patients are variable, but often reveal eosinophilia and elevated levels of Immunoglobin E.

“Eosinophilia” is a blood test result indicating an increase in the amount of eosinophils in the blood. A “wide spectrum of illness” is associated with this. The most common cause in the US is “allergic conditions, including drug reactions and atopic asthma”. Worldwide it can be an indication of parasitic infection, which explains its popularity with some Morgellons believers, who often claim their doctors are too quick to discount exotic illnesses such as parasitic worms.

Immunoglobulin E” (IgE) is a type of antibody. Some people have elevated levels of IgE, which seems to be related to a higher incidence of allergies, eczema and asthma. One can see some correlation here with conditions that have symptoms that might lead people to believe they have Morgellons.
There is another simple explanation for elevated IgE levels, Dr. Adrezej Szczeklik notes “Tissue injury characteristically results in a marked, transient rise in IgE levels in the blood“. While this is more typically associated with major trauma, it’s quite conceivable that the the same mechanisms come into play when the body is dealing with the persistent healing situation presented by the continually generated lesions, and likely sepsis, of neurotic excoriations.

• Other symptoms of varying severity and frequency have been described, and are included in the attached case definition.

As I’ve discussed before, the case definition is all-encompassing. I fit well within the case definition, yet I don’t have Morgellons.

Morgellons patients differ from classical, delusional parasitosis patients in several areas. They do not respond to antipsychotics,

If they simply had eczema with itching (a perfectly normal condition), and found some fibers on their skin, then antipychotics would not help. Again though, this is not DOP vs. Morgellons. A vast number of conditions could cause these symptoms, many of which would not respond to antipsychotics. Also, this is based on what evidence? Clinical studies, or anecdotes?

and new lesions continue to appear upon complete cessation of manual excoriation.

Again, what is the evidence? I suspect this is based on anecdotal self-reporting by the patients. Actual dermatologists suggest otherwise: “He typically puts a cast over the lesions to prevent further irritation and after four weeks removes it. ‘Guess what?’ he says. ‘The lesions are healed.’

Due to the sensation of foreign material in their tissue, that has been described as sharp, stinging and/or splinterlike, the patient may have discovered the fibers prior to seeking medical care, and may bring them to your office for examination. Please do not assume that the patient’s problem is purely psychological based on this propensity.

What is being referred to here is the “matchbox sign“. The patient itches, the patient thinks this feels like a splinter, they look at their skin, they see fibers, they assume they are related to the itching, they take them to the doctors. Doctors will not assume these patients are delusional – they will explain that the fibers are lint, they might examine them to verify this. They will only begin to consider a delusional disorder if the patient continues to insist that the fibers are somehow unusual, in the face of contrary evidence. Further diagnosis of DOP may come if the patient insists that the fibers are some kind of organism, based on no evidence.

The “Matchbox sign” alone is not an indication of a psychological disorder. Nancy Hinkle lists twenty common attributes of DOP sufferers, of which the matchbox sign is just one. However, since it IS a symptom of DOP, the physician must take this possibility into account.

Many of these patients may appear skeptical of traditional medical care due to frequent dismissal of their symptoms in the past. The combination of suffering from a chronic disease with distressful symptoms and no known cause or cure can cause some patients to appear anxious or agitated. We encourage you to take the time to carefully interview any patient who may fall into this category, perform any testing you may deem appropriate, and most importantly treat the patient with compassion and dignity.

This last part I fully agree with. These are real people with real problems, they deserve our sympathy, our compassion, and the best medical efforts to help them recover from whatever is causing their symptoms.

(If you are looking for some free Morgellons-style photos to illustrate an article, feel free to use any on this page, and then there are also many more free photos here)

I’ve been asked several times to explain the dramatic photographs of Morgellons sufferers. Well, let’s take a look at some specific examples:

This is “skin from lesion on back, 60x, with embedded fibers”

back-lesion-scab-top.jpg

Presumably these are the types of “unusual” fibers that Ginger Savely finds in peoples lesions when she looks at them with her 30x radio shack microscope. I can’t really see much unusual about this photo though.

Then we have some close-ups: “Fiber and red spot, 200x, top lit”

back-lesion-scab-top-200x.jpg

And the same, but back lit:

back-lesion-scab-bot-200x.jpg

Now that’s kind of interesting. The poster says “large fiber looks like it’s attached to blood spot, possibly feeding. Smaller fibers, babies?”. Sounds like an over-active imagination to me.

There’s a couple more, at 200x:

back-lesion-scab-top-3-fiber-200x.jpg

back-lesion-scab-top-2-200x.jpg

The poster comments “Fibers look nothing like clothing fibers” “fibers all different sizes”, “red dots – eggs?”, “fiber embedded under skin!”

Interesting photos, don’t you think. They really look like something is going on, some weird fibers embedded in lesions. Is this the evidence the the MRF is looking for?

It’s seems to be of the highest level of evidence they have presented so far.

But I can say quite confidently that this “evidence” demonstrates nothing – in fact it actually hinders the case for Morgellons!

Why such arrogance in my assertions? How can I be so sure?

The “Morgellons sufferer” is me, Margellons. The “lesion” was a healing zit on my back, the “skin from lesion” is a piece of scab/skin I peeled off it. The photos are mine, the comments are mine, the lesion is mine, the fibers come from the combed cotton and polyester black shirt I am wearing, plus whatever shirt I was wearing the past few days the scab formed, plus a few streaks of blood and skin fibers.

So, either

A) I have Morgellons, and I am in some deep, deep, denial.

B) Fibers in lesions are not evidence of Morgellons.

Fibers are everywhere, as are the Fuzzballs.

A commenter called “Hugh R Delusional”, challenged me thusly:

Can Morgellons watch replicate bundles of colored fibers? If we fiberites are crazy and the fibers we claim to see are simply textile in origin then any doubter should easily be able to pluck some lint off their clothing or belly button even and see bright blue, red, black and translucent fibers tangled in amongst the lint. [...]

If your curious as to what you should be looking for, go to the main page of morgellonsusa.com and the background picture will give you a clear indication of what to expect.

Here’s the morgellonsusa.com picture:

morgellons_usa-760x910.jpg

So I got out my trusty QX5 and scrabbled together a few lint balls from my wardrobe. Unfortunately my microscope only does 10x, 60x, or 200x, so I can’t replicate the scale of the above (which looks 20x), but here’s my best effort at 60x

fuzzball-rwb-60x.jpg

And again at 10x

fuzzball-rwb-10x.jpg

I think that quite conclusively shows that the morgellonsusa fibers are nothing more that regular clothing fibers.

This whole experiment took me less than 20 minutes.

(Update)

Later I discovered that the Morgellonsusa photo was actually squished and elongated, which gives it that odd looking scale. It’s actually a regular 60x QX3/5 photo. Here’s the original:

morgellons_usa.jpg

This is a tiny little thing, barely a spec when viewed at arms length. Easily not noticable on your skin until you look closely. For scale, here’s a bit of MY fuzzball on a penny, at the exact same scale. Note it’s on the letter ‘E’ of ‘CENT’. Also notice how the colors and the fiber diameters all match the morgellonsusa photo.

rwb-fuzzball-on-penny-60x.jpg

I also did bit more digging, for Hugh, and found this bit of lint on the floor of the laundry room:

dryer-lint-fuzzball-60x.jpg

You see, fibers are everywhere. And this bit of lint shows that they are mostly white, with some red and blue, and the occasional black. I think laundry lint is a pretty good random sampling (seeing as I don’t sort my laundry by color).

Thrips are tiny winged insects, around 1mm (1/32th of an inch) long.

This is what they look like, life sized (on a leaf, look closely):
xxvegadv112702fig1.jpg

And here is what they look like under a microscope

xxwesternflowerthrips.jpg

Here’s a photo of some thrips that a Morgellons believer found on her skin:

xxxthrips445f.jpg
(Compare the one at the bottom left with the one in the previous picture)

Thrips infest plants. A serious infestation can have hundreds, even thousands, of thrips in a plant. Sometimes thrips swarm, they fly, and can land on your skin and bite, which can be painful. They can apparently even create lesions that they can get inside, a condition described as Thysanoptera dermatitis.

So suppose you had a thrips infestation, perhaps just on a houseplant, or perhaps you live in an agricultural area, or you have an orchard. Thrips are tiny (they can easily get through a normal window screen) and very hard to see when they are in the air. If you are closely inspecting your skin, then when the thrips land on your skin, it will be difficult to see where they came from. If you have a fertile imagination, it might look like they have emerged from your unbroken skin.

Now within the Morgellons community, there are mixed opinions as to the involvements of insects in the disease. The opinions fall thusly:

1) There are no insects involved with Morgellons, and people should stop talking about them.
2) Insects are not part of Morgellons, but it suppresses your immune system enough to allow insects to nest in your skin.
3) Morgellons is an insect infestation, the insects either create the fibers, or use clothing fibers to create cocoons, and that’s what we should talk about
4) Insects are part of the Morgellons syndrome, but we should not talk about it, as it will get us labeled as suffering from Delusions of Parasitosis.

In its doctor approved “Case Definition“, the Morgellons Research Foundation says:
The sensations are at times related to the presence of easily seen insects

On Lymebusters (the online forum that the MRF recommends), the thread entitled “Morgellons, (collembola?)” sums up the every shifting attitudes of some Morgellons believers.

O
It distresses me every time that morgellons is referanced to insects –such as insects crawling out of the body—this tangent can really confuse those who are trying to understand the morgellon syndrom..I have NEVER, in any remote way, made any observance of bugs-flies-etc exiting my body or crawling underneath my skin…

P
The insect theory can be harmful to us if not presented in the correct manner. I believe there is an indirect connection, phermonally speaking [...]

Q
Those that have the insects hatching are suffering a very bad aspect of this – they need so much support and especially to be believed and not rejected.

P
We never told anyone they couldn’t talk about it and I apologize again if it sounded that way. We just didn’t want people to place the main emphasis of this disease’s symptoms on that aspect of it, since that is where our skeptics are getting their ammunition to dismiss us.

Q
But to disarm skeptics, any mention of insects should include the fungal / various causes aspect. Any skeptic that can’t figure out that insects and fungus can be connected is A) not too bright B) has an agenda/sponsor or C) works at UoG

O
I wish to clarify my stance–no doubt that insects can lay eggs and hatch out of the hide-skin-of many animals—

H
My theroey is that the Morg attracts other parrasites. I have personally whatched a fly hatch and fly out of my leg and watched a white furry bug eat its way into my heal,

O
We all have fibers–etc=====or defined as morgellons,some have this manifestation others some other presentation..we can not define it down to say morgellons is caused by this or that—this is what I see–That is what you see–but we all see fibers, right?SOO, I ask, why are the fibers created by so many different things?

Here’s how one of the administrators of Lymebusters (who has posted his own photos of Thrips) explains his own pro-insect belief, and the diversity of what people are seeing.

AH
[...]every time I would get bit by something in the spot where I got bit there would be a fuzzball most of the time they were the color of the article of clothing in the area that that I found the fuzzball in If I was wearing white socks they would be white or if I had something red or blue the fuzzball would be likewise I cant speak for my comrade cult members but I think that the critters that are responsible gather the fibers around them like a cocoon
[...]
And I am not saying that we all have the same thing but there is a common denominator that we all have –and that is Doctors are giving us all a bogus diagnosis that we are stuck with so we unite under the same banner to fight it

(Note that AH is just joking here, when referring to the “cult”, he’s referring to another recent post)

So what is the problem with Thrips?

The problem is the assumption, almost the dogma, amongst Morgellons believers, that they all have the same “thing”. That there is some new pathogen that they all are infected with that causes all of their symptoms. Any new symptom that someone professes to have gets included in the long list of symptoms that are allowed under Morgellons. Anything too outrageous or unique gets explained as a product of a suppressed immune system. Any mental issues get explained as neurological effects of “this disease”.

The problem with that is that they obviously don’t all have the same thing. They have a wide range of symptoms. The one thing they supposedly have in common, the fibers, vary as much as the symptoms. On the question of insects – some have them, and some don’t. Again, some believers explain this as the insects taking advantage of a compromised immune system. But you can explain anything as the result of a compromised immune system.

The trouble with Thrips is that believers unquestioningly accepted that tiny bugs can be hatched in their adult form directly through your skin, if you have Morgellons. If you have Morgellons almost anything can be accepted, no matter how outrageous. The key thing many Morgellons believers want is “to be believed”. By being part of a community that wants to be believed, they support each other, and hence they believe each other, easily glossing over all inconsistencies.

Unfortunately, by believing everyone and everything, some of them abdicate reason, and this gets in the way of them receiving appropriate treatment for their very real health issues.

The recent CNN story on Morgellons (text version) was interesting as it focused on Randy Wymore’s examination of fibers, and actually showed his colleges removing fibers from a patient, and looking at them under a microscope.

In absence of any epidemiological studies, the only thing that makes the claims of Morgellons at all notable are the “fibers” that sufferers claim to have emerging from their skin. Now I’ve written quite a lot about this before, basically showing that fibers are everywhere, and that many of the photos of fibers shown can easily be identified as Kleenex, or clothing fibers.

The whole Morgellons case hinges around these fibers, which was the thing that originally got me interested – I think it’s high time that I get back to examining the fiber evidence, starting with the CNN video.

First of all, we have Dr Wymore in a thrift store, collecting fiber specimens from clothing with some scotch tape. The reporter then asks him if the fibers he found from Morgellons patients resemble clothing fibers. He responds “No, not at all, totally different”.

wymore-thrift-store.jpg
Here’s what Dr Wymore told me, on May 22, 2006:
You see, we do indeed find environmental contaminants in samples from Morgellons sufferers. Definitely cotton, likely from bandages and cellulose fibers, probably from tissue. But, we are not interested in the contaminants that are everywhere. We take the time to sort through the known fibers to examine in more detail the ones that look unusual.”

So what he’s saying here is that he ignores that fibers he can identify, and keeps looking until he finds fibers he cannot identify. I asked him if he did not think that in any sufficiently large sample of household fibers (laundry lint, for example), there would not be some fibers that he would be unable to identify – but so far he has declined to answer.

Later we have some footage of the Morgellons group examining patients, plucking fibers off them, and looking at them through a microscope. Dr Rhonda Casey, DO, points at a small blue fiber and says “That is definitely not a hair, the blue thing there”.

blue-fiber-on-skin.jpg

The fiber she points at looks exactly like standard tiny lint fiber. Probably blue cotton. She carefully take it off, and makes a slide.

This is what they saw”, the reporter says, and shows this picture:
microscope-blue-and-red.jpg
There’s a blue fiber in the middle that looks like a cotton fiber. For some reasons there are a bunch of other fibers that were not next to the blue fiber before. The clear ones in the middle look like cotton or paper, the large brown ones look like human hairs (at about 80 microns they are the correct size). The very dark lines look like the edge of a large air bubble.

We then see several other images, one of which is clearly a damaged human hair – you can even see the scales.
broken-hair-3-50.jpg

So what’s going on here? Randy Wymore is finding fibers that look different (to him) from clothing fibers. Well, notwithstanding that it’s almost inevitable that you will find unidentified fibers wherever you look, what might make ordinary fibers turn into the Morgellons fibers?

Let’s take a simplistic explanation. Say someone suffers from something that has symptoms of neurotic excoriations (they pick at their own skin, consciously or unconsciously). They are going to have many open lesions on their skin (forearms and faces being common areas). Now lesions are wet and sticky, so naturally they will have several tiny fibers stuck in them. Lesions also heal, so the tiny fibers become embedding in the new skin.

A few months later, just like a splinter, the fiber works its way to the surface of the skin. It may emerge at the original lesion site, or it may have migrated a few inches over. Is it surprising that a small blue piece of cotton that has spent many months under the skin, now looks nothing like clothing fibers plucked with scotch tape at the local thrift store?

That’s just a theory – but it’s a nice simple theory that explains things without introducing a mysterious pathogen. Occam’s Razor: “entities should not be multiplied beyond necessity”. Before claiming that because he cannot identify some fibers, then a new disease exists, Professor Wymore must explain how he has fully discounted the multitude of far simple explanations.

I’ll simplify this to two questions:

1) In any large sample of household fibers, will there not always be some that are unidentified?
2) If a clothing fiber were embedded in the skin for a long period of time, and then emerged, would you be able to identify it as a clothing fiber?

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