Morgellons Watch

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.

The following CBS11 report suggests that a “dramatic new breakthrough” in the field of Morgellons was revealed at the recent Morgellons conference:

http://cbs11tv.com/health/Morgellons.Disease.Morgellons.2.689110.html

There may be a dramatic new breakthrough for hundreds of Texans who suffer from a mysterious disease. CBS 11 News was the only station at a medical conference that uncovered new research in the fight to prove Morgellons Disease is real.
[...]
In 2007, Dr. Stricker and experts in agrobacterium studied skin samples from seven Morgellons patients and found the DNA from the bacteria in all seven samples. Now the question is, how are people getting the bacteria in their bodies.

Firstly, this is not new, it’s over a year old. These findings were reported in January, 2007 – over a year ago.

Secondly, and more importantly, there is a very easy explanation as to how the bacteria got in their bodies: catheters. It’s very simple, and hinges upon three facts:

1. The most common cause of agrobacterium infection is from intravenous catheters.
2. Dr. Stricker uses intravenous catheters to treat his Morgellons and late-stage Lyme patients.
3. Dr. Stricker supplied the samples used to test for agrobacterium

It seems then that these agrobacterium infections may not be a part of Morgellons, but are more likely a result of Dr. Strickers’ treatment methods.

(EDIT: See Dr Smith’s response, in the comments section).

UPDATE:

Dr Smith says:

In these patients, agrobacterium was NOT cultured from the patients’ body. The DNA was detected by PCR testing in Dr. Vitaly Citovsky’s lab at StonyBrook. The samples submitted were skin biopsy specimens done on out-patients in the course of routine offiice visits. The patients were not acutely ill at the time and none had an in-dwelling catheter at the time. It is my understanding that 7 of 7 patients with Morgellons tested positive for agrobacterium and 0 of control patients were positive.

Let’s assume that is accurate, and see what other reasons there could be for this group of patients to have Agrobacterium in their skin samples.

First let’s ask what the difference is between the “Morgellons” patients and the control patients. From the Morgellons case definition:

3. Skin lesions, both (a) spontaneously appearing and (b) self-generated, often with pain or intense itching. The former (a) may initially appear as “hive-like”, or as “pimple-like” with or without a white center. The latter (b) appear as linear or “picking” excoriations.

“Self-generated” here means that the patient generates their own lesions by scratching and picking. The medical term for this is Neurotic Excoriations. There is a remarkable similarity between the lesions of patients with Neurotic Excoriations, and many (but not all) patients who claim to have Morgellons.

The control subjects were healthy individuals (lab workers), who did NOT have Neurotic Excoriations.

Hence another possible explanation for this study is that people with Neurotic Excoriations are greatly more susceptible to Agrobacterium infection (especially in the skin), than the general population. This seems very reasonable, as for the lesions to be “self-generated”, it would take constant repeditive scratching for many months. Fingernails get dirt under them. Dirt harbors agrobacterium. The scratching transfers agrobacterium to the skin.

Correlation does not imply causation. The presence of agrobacterium in a group of seven, while being absent in a control group, is statistically significant enough to warrant investigation. The presence of agrobacterium is likely indicative of some factor that the seven patients shared. I’ve given two possible shared factors here: 1) They were all patients of Dr. Stricker, and 2) They scratch their skin far more than is healthy. It is not hard to come up with other commonalities, such as the unusual use of certain medications prescribed by Stricker, or even the equipment and envirionment used to collect the samples.

This post is a response to claims of a “dramatic new breakthrough”, and I simply hope to point out that this is no such thing, but simply a statistically interesting observation that currently indicates absolutly nothing, but perhaps warrants further study.

Indeed it may well turn out that Agrobacterium IS a common infection in patients with Neurotic Excoriations, and this may be a previously undiscovered common complication, which doctors can then treat. Meaning it could actually be a useful breakthrough, but not directly to do with the assertion that Morgellons is a distinct disease.