CNN/Mayo Study-Morgellons is DOP?

[kmar]

Skin infestation a delusion, study says - CNN.com

-- For years, dermatologists have been aware of -- and baffled by -- people who feel a constant creepy-crawly sensation beneath their skin, which they believe is due to bugs, worms, or eggs below the surface.

Now, in the largest study to date to examine skin samples from patients with these symptoms, doctors have firm proof that these infestations -- known as delusional parasitosis or delusional infestation -- are not real.

The researchers acknowledge, however, that the findings may not be enough convince many of these patients. Patients often feel dismissed when doctors reassure them that the infestation is all in their head, and many continue to believe they are teeming with bugs even when skin biopsies come back negative.

"It's almost impossible to get them to shake this belief, no matter how much evidence you produce to the contrary," says Mark D. P. Davis, M.D., a professor of dermatology at the Mayo Clinic, in Rochester, Minnesota.

Antipsychotic drugs are the standard treatment for delusional infestation. But, Davis says, "A lot of patients with this disorder don't want to take these drugs because they don't feel they have a delusional disorder."

Some patients who experience this skin-crawling sensation believe it is caused by textile-like fibers produced by an unknown organism.

Along with a group of sympathetic doctors and advocates, these patients have pushed for the condition to be officially recognized as Morgellons disease, and have lobbied -- successfully -- for the Centers for Disease Control and Prevention to investigate it.

However, most doctors maintain that the condition is psychological rather than physical.

In a new study, published this week in the Archives of Dermatology, Davis and his colleagues sought to confirm this view by presenting the results of skin biopsies taken from patients in whom the delusional infestation was diagnosed at the Mayo Clinic between 2001 and 2007.

The researchers performed 80 biopsies. As expected, none showed evidence of skin infestation, although 49 patients did have some skin inflammation, known as dermatitis.

This inflammation might be due to some underlying cause, such as allergies, or it could have been caused by the patient's efforts to remove the bugs or objects by digging them out or even trying to burn them, Davis says.
Health.com: What's that rash?

In addition, 80 of the study participants -- including some who also had biopsies taken -- supplied their own skin samples to the doctors.
Ten of these specimens contained insects, such as a mite or tick, but only one such bug was actually capable of causing an infestation; it was a pubic louse, but the patient's biopsy did not show any signs that his or her skin was infested with the lice.

The CDC recently completed its own study of the condition, which the agency refers to as unexplained dermopathy, but the results have not yet been published.

Davis' study "leaves little room for speculation," says Roland Freudenmann, M.D., an associate professor of psychiatry at the University of Ulm, in Germany. Freudenmann is an authority on delusional infestation but didn't take part in the current study.

"It may irritate those who cannot accept the diagnosis of delusional infestation," he says. "But the study shows that delusional infestation exists and that it is the patients who are wrong."

Health.com: Healthy weight or healthy mind? Psych drugs can pile on pounds
Freudenmann adds that he hopes the new findings, as well as the forthcoming CDC report, "bring an end to the 'Morgellons story.'" Jennifer Murase, M.D., a dermatologist and associate clinical professor at the University of California San Francisco (UCSF), says she typically sees a handful of patients with delusional infestation each year.

It's important to take the patient's complaints seriously, says Murase, who was not involved in the new research. These people often have an underlying skin condition such as eczema or psoriasis, which could be affecting their nerves in abnormal ways and contributing to the sensation of infestation, she explains.

Murase and her colleagues often conduct biopsies in these patients, mostly to reassure the patients rather than to confirm the diagnosis of delusional infestation.

The patient chooses the spot where the biopsy is to be taken, and must agree that only one biopsy will be done. The patient also has to agree that if the microscopic examination doesn't find evidence of infestation, "they will be more open-minded and think of other causes for the condition," she says.
John Koo, M.D., a dermatologist who works with Murase at UCSF, estimates that roughly one-third of these patients can be easily convinced that the problem is not a real infestation; one-third require more convincing; and another one-third can't be swayed from their conviction.

"If you kind of hang in there and stay with them, they can get better," Murase says. "They can actually do quite well."



More on conversation here:
LymeBuster Chat - Peer-Reviewed Journal Out 05-16-11

[kmar]

Arch Dermatol -- Abstract: Delusional Infestation, Including Delusions of Parasitosis: Results of Histologic Examination of Skin Biopsy and Patient-Provided Skin Specimens, May 16, 2011, Hylwa et al. 0 (2011): archdermatol.2011.114v1

Archives of Dermatology

May 16, 2011

Delusional Infestation, Including Delusions of Parasitosis
Results of Histologic Examination of Skin Biopsy and Patient-Provided Skin Specimens

Sara A. Hylwa, BS; Jessica E. Bury, MD; Mark D. P. Davis, MD; Mark Pittelkow, MD; J. Michael Bostwick, MD


Objective To review the results of skin biopsies and patient-provided specimens from patients whose assessment was consistent with delusional infestation, including delusions of parasitosis.

Design Retrospective medical record review.

Setting Mayo Clinic, Rochester, Minnesota.

Patients The study population comprised all patients who were seen at Mayo Clinic and had a diagnosis of delusional skin infestation, including delusions of parasitosis, between 2001 and 2007, and who underwent biopsies as part of their dermatologic evaluations or brought samples to their clinical consultations.

Main Outcome Measures The results of examination of these biopsy and patient-provided specimens.

Results A total of 108 patients met inclusion criteria for this study: 80 received biopsies, 80 had self-procured skin specimens, and 52 patients received biopsies and provided specimens. No biopsy specimen (0 of 80) provided evidence to support skin infestation.

The most common interpretations in the 80 biopsy specimens were dermatitis in 49 of 80 (61%); excoriation, ulceration, or erosion in 38 (48%); and nonspecific dermal inflammation in 25 (31%). Patient-provided specimens were most frequently assessed by the physician (generally a dermatologist) evaluating the patient, although 20 of the 80 samples (25%) were submitted for pathologic evaluation. Of these 80 specimens, 10 (13%) contained insects. All but 1 of the insects were noninfesting varieties; 1 (1%) was a pubic louse. The remaining findings consisted of cutaneous debris, environmental detritus, or plant material.

Conclusion In patients with suspected delusional infestation, neither skin biopsies nor examination of patient-provided specimens provided objective evidence of skin infestation.


Author Affiliations: Visiting Medical Professional for Research, Department of Dermatology (Ms Hylwa), Mayo Medical School, College of Medicine (Dr Bury), and Departments of Dermatology (Drs Davis and Pittelkow) and Psychiatry and Psychology (Dr Bostwick), Mayo Clinic, Rochester, Minnesota.

[kmar]

Itchy Skin: Imaginary Bugs Often Blamed

Itchy Skin: Imaginary Bugs Often Blamed
Dermatologists Say Patients Have a Hard Time Believing Itch Is a Psychiatric Condition

By Denise Mann
WebMD Health News Reviewed by Laura J. Martin, MD



May 16, 2011 -- People with a “delusional bug syndrome" are convinced that bugs, worms, germs, or other creepy crawlers are infesting their skin and often see skin doctor after skin doctor to find out what is causing the infestation. Often, patients bring in samples of the insect and request a skin biopsy.


But new research published online in the Archives of Dermatology finds that in the case of delusional skin infestation, neither samples nor biopsies show any evidence of skin infestation.

Researchers at Mayo Clinic in Rochester, Minn., reviewed 108 people with symptoms resembling delusions of parasitosis (infection with a parasite). Some of the patients brought samples, others had biopsies of their skin, and some had both.


“When we looked at what they brought in and when we looked under the microscope, we never found a parasite,” says study author Mark Davis, MD, a professor of dermatology at the Mayo Clinic.


Of 80 self-procured specimens, 10 were insects, but nine of them were not capable of infestation. One person brought in a sample of pubic lice, which is technically capable of infestation, but not the type that could cause head-to-toe itching. The other specimens were dead skin, plant material, or environmental debris.


Slightly more than 60% of these patients were diagnosed with dermatitis, which is characterized by inflamed, itchy skin, the study showed.

There are no exact numbers on how many people have delusional skin infestation, but it is “relatively frequent,” Davis says.

Invisible Bug Syndrome Is Psychiatric Illness

This is a psychiatric condition, but people with a “delusional bug syndrome” typically see a dermatologist.

“The patient refuses to believe it is a psychiatric disorder because they have a false, fixed belief, so even if you present them all of the evidence, they still believe they have parasites invading their skin,” Davis says. “They travel from center to center for another opinion because they really believe their skin is infected.”

It is a devastating illness, he says.

“They are very upset because they believe their skin is infested with all sorts of nasty things and we don’t see anything or find anything with a biopsy and yet they are in our office, their lives are ruined, and they want treatment,” Davis says. “Patients say ‘you are just missing it and not looking carefully enough,’ and just walk out.”

Dermatologists' Dilemma

This condition is the bane of many dermatologists’ existence, says Bruce Strober, MD, an assistant professor of dermatology at New York University Langone Medical Center in New York City. “People with delusions of parasitosis are a great challenge to us,” he says. “It's clearly a psychiatric disorder that requires psychiatric medication and counseling. Unfortunately, these patients are rarely amenable to those approaches.”


Donald S. Waldorf, a dermatologist in Nanuet, N.Y., has seen his fair share of patients with a delusional bug syndrome. As a result, he has developed his own approach to treating these patients.


“They often come in with a bag of stuff, including threads and dead skin, but nothing real and capable of infestation,” he says. “They also dig at and scratch their skin.”


Waldorf will often prescribe topical agents to prevent infections from scratching and may suggest steroids to reduce inflammation. Sometimes, he will prescribe psychiatric medications.


“They won’t go to a psychiatrist,” he says. “If tell them to go, I will have lost them, so I basically give them support and prevent infection,” he says.

------------------------------------------

What do you guys think?

[kmar]

An infestation that begins in the mind - latimes.com

An infestation that begins in the mind
Self-described sufferers of Morgellons disease say their skin is infested with mysterious parasites, and they demanded a government study. The Mayo Clinic concludes the symptoms are often delusional.

By Melissa Healy,
Los Angeles Times
May 16, 2011, 10:37 p.m.


They complain of mysterious, creepy symptoms: bugs — or some form of infestation — crawling beneath their skin, sometimes burrowing to the surface, leaving odd specks and colored filaments in their wake.


They have flocked to websites to share details of their malady, which they call Morgellons disease; they have charged the medical community with ignoring their plight and have strong-armed the government into studying it.


They go from doctor to doctor, carrying specimens in Ziploc bags and on glass slides, desperate to find a physical cause.


Now a Mayo Clinic study reviewing samples provided by 108 such patients, published Monday in the Archives of Dermatology, has concluded that the perceived infestation exists only in their minds.


Although one patient who consulted dermatologists for Morgellons was found to have pubic lice, microscopic examination showed that none of the remaining 107 patients — who were seen over a seven-year period ending in 2007 — had any evidence of infestation by bugs or parasites, despite their firm conviction that they did.


Instead, the authors concluded, the rashes, eruptions and skin ulcerations patients suffered were either mundane skin conditions that gave rise to delusions of infestation, or the result of sufferers scratching or picking at their skin to make it go away.


And the fibers and filaments so often described and offered as evidence of infestation were, upon microscopic examination, skin flakes, scabs, hair, lint, textile fiber and everyday debris.


Two fruit flies, which do not colonize the human body, were found, as well as one mite and one tick.


The review of patients' records from the Mayo Clinic is the first major study to conclude that a seeming outbreak of subcutaneous creepy-crawlies is not evidence of a new pathogen abroad in the land: rather, patients suffering such symptoms more likely have a psychological disorder long described in dermatological literature as "delusional parasitosis."


"This study is important for patients," the authors wrote. "Patients frequently believe that physicians are dismissive of their concerns and are not examining their skin closely enough, and therefore patients request that more testing be performed. This showed that biopsy results do not change a physician's clinical diagnosis of delusional infestation."


Results of another, three-year study, undertaken by the Centers for Disease Control and Prevention and Kaiser Permanente of Northern California, are slated for release in the next few months. That study was launched in January 2008 after patients and a small group of medical professionals led by an organization called the Morgellons Research Foundation advocated for a full-scale government investigation of their symptoms.


The CDC and Kaiser scientists conducted skin biopsies, physical and psychiatric evaluations of sufferers and microscopic analysis of samples. The findings are now under review by independent experts.


"We recognize it has taken time, and people and their families are suffering, but at same time, it's important to release these findings appropriately and to ensure their scientific integrity," said CDC spokeswoman Lola Russell.


The Mayo Clinic findings are certain to be bitter medicine for patients who identify themselves as sufferers of Morgellons disease. The Internet is home to a growing community of patients certain that their symptoms are evidence of a new and very real disorder. Study lead author Dr. Mark D.P. Davis, a Mayo Clinic dermatologist, said he doubted the study would convince such patients that their disease originates in their brains and not under their skin.


"They feel you're still missing something even if you've gone the extra mile," Davis said.


Several board members and a spokesperson for the Morgellons Research Foundation could not be reached for comment.


Dr. Noah Craft, a dermatologist at Harbor-UCLA Medical Center, praised the Mayo work as "the best study done to date" on the bizarre constellation of symptoms called Morgellons. He commended the Mayo researchers "for putting in the effort to understand a disease that's becoming more and more important in our culture today."


At the same time, Craft cautioned that dermatologists and primary-care physicians who see patients with similar complaints should not automatically conclude, based on the study, that they are all delusional.

"Infrequently, we do find real bugs. So everybody gets their due diligence," he said. And, he added, taking a patient's complaints seriously will often help him or her take the next step in cases where a physical cause of their agony cannot be found.


"I have a growing numbers of patients who respond really well to medicines that treat the brain," he said. "I know it's frustrating, but I often encourage them to try it if we can't get to a diagnosis."

melissa.healy@latimes.com

[kmar]

The CDC has not published their report yet. (Thankfully)

I was not even aware that the Mayo Clinic in MN was doing a clinical study. I suppose that I was not paying attention for a while.

No Clue what the CDC's take on this or what their study will reveal for us.

[kmar]

No physical explanation for delusional infestations | Reuters

No physical explanation for delusional infestations

By Genevra Pittman
NEW YORK | Mon May 16, 2011 4:23pm EDT

(Reuters Health) - People complaining that they were infected with bugs, worms, eggs, fibers, and even triangles, generally had a clean report on medical exams a new study finds.


Although many of the patients diagnosed with "delusional infestation" did have dermatitis -- an itchy skin condition -- the researchers weren't sure if that was causing the symptoms, or if it was a result of excessive scratching or medications the patients had applied to "treat" their problem.


Whether delusional infestation -- also known as Morgellons Disease -- is a psychiatric condition, or whether people who complain of the mysterious skin symptoms might have an underlying physical disease continues to be debated and investigated. According to the Centers for Disease Control and Prevention, which is looking into the condition, sufferers have also reported fatigue, joint pain, and short term memory loss.


In cases of delusional infestation, "patients often complain that the physician isn't examining their skin closely enough to see the infesting organisms," Dr. Mark Davis of the Mayo Clinic in Rochester, Minnesota, told Reuters Health in an email.


"This study indicates that even when skin biopsies are obtained, and specimens of the organisms brought by the patients are carefully examined, there is no objective evidence of skin infestation," added Davis, who worked on the new study.


Davis and his colleagues reviewed the cases of 108 patients who were diagnosed with delusional infestation at the Mayo Clinic between 2001 and 2007.



All of those patients believed they were infested with bugs, worms, or inanimate objects, and complained of strange skin sensations, according to the report published in Archives of Dermatology.


Doctors did a biopsy on 80 of those patients to look more closely at the skin, and found no evidence of an infestation. Most patients also brought in skin flakes, scabs, or hairs for testing -- none of which had anything that would explain patients' symptoms.


More than half of the biopsies did show dermatitis, a skin condition marked by inflammation and red and itchy skin. But the researchers said they weren't sure if that could be leading to patients' symptoms and beliefs that they were infested -- or if their skin was inflamed because of scratching and various attempts at treating the perceived infestation.


In at least one case, a patient's symptoms were partially explained by an underlying medical condition. The patient initially had rectal itching and tingling that turned into a crawling sensation, the authors report -- which led her to believe that she was infested with eggs and non-living things. In the end, she was diagnosed with the virus that causes herpes.


Davis said reports show that some patients with a delusional infestation may also have other medical or psychiatric conditions -- but that some researchers believe it's a type of hypochondria that is generally seen alone, without other conditions.


While there are no published estimates of how common delusional infestation is, the CDC has been researching that question, as well as what type of people tend to report symptoms. Researchers there prefer the term "unexplained dermopathy."


"It is an unexplained and debilitating illness of unknown cause," a CDC spokesperson told Reuters Health. "We recognize that...healthcare providers are perplexed and frustrated" and patients and their families are suffering, the spokesperson added.


Davis said that it's still important for doctors to take a patient's history and do a physical exam if they suspect delusional infestation but aren't positive. "If there is any possibility that the patient's complaints/concerns could be explained by anything other than delusional infestation, then all relevant tests should be done," he concluded.


SOURCE: bit.ly/aAdwaR Archives of Dermatology, online May 16, 2011.

[tcmgpt13]

I think that unless the study patients lived close to the coast of the US this dermatology report could have been skewed towards patients without large lesions. I mean, do you see mention of lesions here? One of the principal symptoms of M? Or fibers, another? No just an off hand remark about skin ulceration is mentioned in the abstract itself. Minnesota is about as far from the ocean as you can get. The first article called the skin symptoms a rash. So, I think we need to wait a bit more to see what others have found in their studies.

We all may have an underlying toxicity such as what I definitely was exposed to when I ate a bad fish. Toxicity could trigger some symptoms as it definitely did with me. My unset was very sudden. We know that what Harvey found in some M patients involved underlying macro parasites too. Notice how this report does not even discuss the underlying infections most have. It's a dermatology study and they are all intent on supporting their colleagues. People with a bias slanted towards finding DOP will usually find what they are looking for. The mention of only one systemic causes for symptoms seems to indicate little serious study was done in this area. BTW the herpes mentioned is part of my symptom picture as discussed on other threads, but I still got lesions despite taking acylovir for a long time. It only cured my herpes lesions. The others I have had to treat myself.

None of this sounds like a thorough and well thought out study. Again some patients brought their own samples. We all know our illness is systemic and does not just involve skin issues. We are aware that M also causes symptoms which are systemic such as chronic fatigue, joint pain, joint swelling and severe brain fog. Many doctors are even reluctant to accept chronic fatigue as an issue, but at least there is some support there. Hopefully since others who are not dermatologists also are studying this disease there is some hope. The cause of the lesions and the itching will be discovered in the future. Unfortunately it will not be any time soon the way things look.

Let us pray this newly introduced (to MDR) microbiologist who says he sees a new type of protozoa is doing studies which are replicable and accurate as this could be the issue for some of us. It is not impossible a protozoa is behind it, such as the protozoa which causes leishmaniasis. Leishmaniasis can be asymptomatic as far as lesions. Leishmaniasis patients who are asymptomatic do not get lesions. There is even some research which discusses the fact that something like fibers (not just from within the body) form in leismaniasis lesions causing the raised scaring. So it is entirely possible that the main issue we have is caused by some type of undiscovered protozoa. Look at how toxoplasmosis was dismissed as a mental issue alone by the medical profession for years. It turns out though that toxoplamsmosis is an issue for many who have schizophrenia, making it a physical disorder and not a purely mental one. Even so many in the profession continue to see that illness solely as a mental disorder.

The main thing is not to be combative with doctors when seeing them and never mentioning Morgellons. Discuss only symptoms with them. If there are lesions show them, but do not say M caused them. Let the doctor figure it out.

The other thing that has hurt us severely is all the discussion about weird to standard science causes of symptoms (outspace, chemtrails, GMO foods etc). As a result the medical profession looks the other way and calls most M patients DOP. This is why I sometimes have wished I had another illness where such matters had never been discussed in doctors' offices. To them such assertions are crazy. Frankly I think there's enough unknowns right here on earth which could cause M including unknown parasites.

Meanwhile there are two studies on chronic fatigue kmar and more coming out of another foundation, so perhaps some of the researchers there will discover something which is causing chronic fatigue. We may just have to find piecemeal answers to symptoms and not depend on M "studies" which so far have been very small and IMHO for the most part were poorly designed studies due to funding constraints.

[Baraka Obam]

If we keep yelling bugs we will keep getting this same result, our insistance that the infection are bugs is also the end of scientific study.

For those of you crying bug, you will get nothing done for yourself or us as a group.

I will not even say it feels like crawling under the skin, these idiots even ask, does it feel like bugs, have youu seen any bugs, NO, I have never seen a bug, there are no bugs on earth. LOL

We have so many other issues these guys are blind.

[janedoe]

MINE are bugs, period, end of story. my BIOPSY said bugs, ive been symptom free since i redid this house. we took down a tree the other day, im broke out all over my back, the same crap as before...
maybe YOU dont have bugs, but some of us did/do....
once i got this house in better shape, my symptoms disappeared.( after i broke the cycle) so there IS something to bugs, when one has NO other health issues, dont tell me its false and 'end of study' crap, YOu baraka have said many times all your health problems, a bug may get lost in you, who knows. but dont tell me EVERYBODY is in your catagory!! im not lumping everybody into mine!

[JimDoe]

Originally Posted by Baraka Obam

If we keep yelling bugs we will keep getting this same result, our insistance that the infection are bugs is also the end of scientific study.

For those of you crying bug, you will get nothing done for yourself or us as a group.

I will not even say it feels like crawling under the skin, these idiots even ask, does it feel like bugs, have youu seen any bugs, NO, I have never seen a bug, there are no bugs on earth. LOL

We have so many other issues these guys are blind.

Looks like if you keep cryin fibers and sores and bio film you get the same as well.