Skip to main content

Advertisement

SpringerLink
Log in

Morgellons disease: a narrative review

  • Review Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Morgellons disease is characterized by the persistent delusion of skin infestation, ultimately inflicting wounds and impairing quality of life. There is insufficient and conflicting research pertaining to this condition, imposing challenges on clinicians in understanding, diagnosing, and treating it. In this review, we summarize the available literature on Morgellons disease including its historical evolution, epidemiology, proposed pathophysiology, underlying structural and functional brain pathologies, typical and atypical clinical presentations, diagnosis, and treatment. A comprehensive review of the literature was conducted on PubMed, Embase, and Scopus using specified keywords. Selected articles were screened by two independent reviewers based on set inclusion and exclusion criteria. Conflicts were resolved by a third reviewer as needed. No limit to the date of selected articles was set due to the scarce literature available on the subject. Morgellons disease is an underdiagnosed entity, owing mostly to the lack of an established pathophysiology and treatment guidelines. While many authors classify it as a type of delusional infestation (DI), others correlate MD with an underlying spirochetal infection, namely Lyme disease. Neuroimaging studies have revealed abnormalities in the “fronto-striato-thalamo-parietal network”, a finding common to patients with DI, in addition to alterations in structures related to the “Itch Processing Pathway”. Patients tend to extract fibers from their skin lesions and place them in a match box hence the term “match box sign”. The diagnosis is that of exclusion, requiring extensive work up to rule out secondary causes and differential diagnoses. Treatment is largely based on the use of antipsychotics, with or without cognitive behavioral therapy. Despite being a diagnosis of exclusion, clinicians must be aware of this entity and have a profound understanding of the pathogenesis underlying it. Upon clinical suspicion, secondary Morgellons should always be ruled out through a thorough history taking, physical examination, and laboratory exams. Despite the challenges brought by the heterogeneous presentation of the condition and the paucity of research revolving around it, the great impact that Morgellons disease has on patients’ quality of life forms a pressing need for its adequate detection, diagnosis, and treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

References

  1. Nunziato CA, Egeland BM, Gurman A, Henry SL (2021) Morgellons disease: the spread of a mass psychogenic illness via the internet and its implications in hand surgery. Hand 16:NP5–NP9. https://doi.org/10.1177/1558944720976648

    Article  PubMed  PubMed Central  Google Scholar 

  2. Norman FF, López-Vélez R (2021) Delusional parasitosis: an unrecognized and underdiagnosed entity? Enfermedades Infecc Microbiol Clínica 39:221–222. https://doi.org/10.1016/j.eimc.2021.03.001

    Article  Google Scholar 

  3. Orsolini L, Gentilotti A, Giordani M, Volpe U (2020) Historical and clinical considerations on Ekbom’s syndrome. Int Rev Psychiatry 32:424–436. https://doi.org/10.1080/09540261.2020.1757306

    Article  PubMed  Google Scholar 

  4. Chan S, Xiao A, Patel S, et al (2020) Is Morgellons an organic disease? Structural and functional abnormalities implicated in the pathophysiology of delusional infestation. Dermatol Online J 26. https://doi.org/10.5070/D32611049673

  5. Tohid H, Shenefelt PD, Burney WA, Aqeel N (2019) Psychodermatology: an association of primary psychiatric disorders with skin. Rev Colomb Psiquiatr Engl Ed 48:50–57. https://doi.org/10.1016/j.rcpeng.2018.12.003

    Article  PubMed  Google Scholar 

  6. Krooks JA, Weatherall AG, Holland PJ (2018) Review of epidemiology, clinical presentation, diagnosis, and treatment of common primary psychiatric causes of cutaneous disease. J Dermatol Treat 29:418–427. https://doi.org/10.1080/09546634.2017.1395389

    Article  CAS  Google Scholar 

  7. Middelveen MJ, Martinez RM, Fesler MC et al (2020) Classification and staging of Morgellons disease: lessons from syphilis. Clin Cosmet Investig Dermatol 13:145–164. https://doi.org/10.2147/CCID.S239840

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Vulink NC (2016) Delusional infestation: state of the art. Acta Derm Venereol 96:58–63. https://doi.org/10.2340/00015555-2412

    Article  PubMed  Google Scholar 

  9. Aung-Din D, Sahni DR, Jorizzo JL, Feldman SR (2018) Morgellons disease: insights into treatment. Dermatol Online J 24. https://doi.org/10.5070/D32411041998

  10. de Albornoz C, Calahorro CM, López-Delgado D, Gutiérrez-Rojas L (2019) Morgellons disease treatment with quetiapine. Med Clínica 152:118–119. https://doi.org/10.1016/j.medcli.2018.03.017

    Article  Google Scholar 

  11. Chu C (2018) Morgellons disease—dredged up from history and customized. JAMA Dermatol 154:451. https://doi.org/10.1001/jamadermatol.2017.6393

    Article  PubMed  Google Scholar 

  12. Ma J, Roelofs KA, Badilla J (2019) Morgellons disease leading to corneal perforation and enucleation. Can J Ophthalmol 54:e285–e288. https://doi.org/10.1016/j.jcjo.2019.04.002

    Article  PubMed  Google Scholar 

  13. Md SAH, Md SDR (2018) Delusional infestation versus Morgellons disease. Clin Dermatol 36:714–718. https://doi.org/10.1016/j.clindermatol.2018.08.007

    Article  Google Scholar 

  14. Lai J, Xu Z, Xu Y, Hu S (2018) Reframing delusional infestation: perspectives on unresolved puzzles. Psychol Res Behav Manag 11:425–432. https://doi.org/10.2147/PRBM.S166720

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bailey CH, Andersen LK, Lowe GC et al (2014) A population-based study of the incidence of delusional infestation in Olmsted County, Minnesota, 1976–2010. Br J Dermatol 170:1130–1135. https://doi.org/10.1111/bjd.12848

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Kohorst JJ, Bailey CH, Andersen LK et al (2018) Prevalence of delusional infestation—a population-based study. JAMA Dermatol 154:615. https://doi.org/10.1001/jamadermatol.2018.0004

    Article  PubMed  PubMed Central  Google Scholar 

  17. Savely VR, Stricker RB (2007) Morgellons disease: the mystery unfolds. Expert Rev Dermatol 2:585–591. https://doi.org/10.1586/17469872.2.5.585

    Article  Google Scholar 

  18. Mohandas P, Bewley A, Taylor R (2018) Morgellons disease: experiences of an integrated multidisciplinary dermatology team to achieve positive outcomes. J Dermatol Treat 29:208–213. https://doi.org/10.1080/09546634.2017.1349868

    Article  Google Scholar 

  19. Kellett CE (1935) Sir Thomas Browne and the disease called the Morgellons. Ann med hist 7(5):467

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Ferreira BR, Roccia MG, Cardoso JC et al (2017) History of Morgellons disease: the same name for different psychodermatologic diseases? Wien Med Wochenschr 167:49–51. https://doi.org/10.1007/s10354-017-0552-8

    Article  PubMed  Google Scholar 

  21. Accordino RE, Engler D, Ginsburg IH, Koo J (2008) Morgellons disease? Dermatol Ther 21:8–12. https://doi.org/10.1111/j.1529-8019.2008.00164.x

    Article  PubMed  Google Scholar 

  22. Middelveen MJ, Fesler MC, Stricker RB (2018) History of Morgellons disease: from delusion to definition. Clin Cosmet Investig Dermatol 11:71–90. https://doi.org/10.2147/CCID.S152343

    Article  PubMed  PubMed Central  Google Scholar 

  23. Fair B (2010) Morgellons: contested illness, diagnostic compromise and medicalisation: Morgellons disease: a contested illness. Sociol Health Illn 32:597–612. https://doi.org/10.1111/j.1467-9566.2009.01227.x

    Article  PubMed  Google Scholar 

  24. Edlich RF, Cross CL, Wack CA, Long WB (2009) Delusions of parasitosis. Am J Emerg Med 27:997–999. https://doi.org/10.1016/j.ajem.2008.07.013

    Article  PubMed  Google Scholar 

  25. Reichenberg JS, Magid M (2014) The Morgellons debate. John Wiley & Sons Ltd, Oxford, UK, pp 220–223

    Google Scholar 

  26. Elkan D (2007) Morgellons disease: real or delusion? New Sci 195:46–49. https://doi.org/10.1016/S0262-4079(07)62349-5

    Article  Google Scholar 

  27. Pearson ML, Selby JV, Katz KA et al (2012) S. PLoS ONE 7:e29908. https://doi.org/10.1371/journal.pone.0029908

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Stricker R (2010) Morgellons disease: analysis of a population with clinically confirmed microscopic subcutaneous fibers of unknown etiology. Clin Cosmet Investig Dermatol 67. https://doi.org/10.2147/CCID.S9520

  29. Yan BY, Jorizzo JL (2018) Management of Morgellons disease with low-dose trifluoperazine. JAMA Dermatol 154:216. https://doi.org/10.1001/jamadermatol.2017.5175

    Article  PubMed  PubMed Central  Google Scholar 

  30. Gartner AM, Dolan SL, Stanford MS, Elkins GR (2011) Hypnosis in the treatment of Morgellons Disease: a case study. Int J Clin Exp Hypn 59:242–249. https://doi.org/10.1080/00207144.2011.546263

    Article  PubMed  PubMed Central  Google Scholar 

  31. Middelveen MJ, Filush KR, Bandoski C et al (2019) Mixed Borrelia burgdorferi and Helicobacter pylori biofilms in Morgellons disease dermatological specimens. Healthcare 7:70. https://doi.org/10.3390/healthcare7020070

    Article  PubMed  PubMed Central  Google Scholar 

  32. Fesler MC, Middelveen MJ, Stricker RB (2018) Clinical evaluation of Morgellons disease in a cohort of North American patients. Dermatol Rep 10. https://doi.org/10.4081/dr.2018.7660

  33. Middelveen MJ, Du Cruz I, Fesler MC et al (2018) Detection of tick-borne infection in Morgellons disease patients by serological and molecular techniques. Clin Cosmet Investig Dermatol 11:561–569. https://doi.org/10.2147/CCID.S184521

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Caputo V, Bonoldi E, Citterio A, Rongioletti F (2022) The challenge of Morgellons disease: a patient with clinicopathologic correlation. Clin Dermatol 40(6):686–690. https://doi.org/10.1016/j.clindermatol.2022.07.003

    Article  PubMed  Google Scholar 

  35. Stricker R, Middelveen M, Mayne P, Kahn (2013) Characterization and evolution of dermal filaments from patients with Morgellons disease. Clin Cosmet Investig Dermatol 1. https://doi.org/10.2147/CCID.S39017

  36. MJ Middelveen D Burugu A Poruri et al (2013) Association of spirochetal infection with Morgellons disease [v1; ref status: indexed, http://f1000r.es/8g] F1000 Res 2 25 https://doi.org/10.12688/f1000research.2-25.v1

  37. Middelveen M, Stricker R (2016) Morgellons disease: a filamentous borrelial dermatitis. Int J Gen Med 9:349–354. https://doi.org/10.2147/IJGM.S116608

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Middelveen MJ, Bandoski C, Burke J et al (2015) Exploring the association between Morgellons disease and Lyme disease: identification of Borrelia burgdorferi in Morgellons disease patients. BMC Dermatol 15:1. https://doi.org/10.1186/s12895-015-0023-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Stricker R, Middelveen (2011) Filament formation associated with spirochetal infection: a comparative approach to Morgellons disease. Clin Cosmet Investig Dermatol 167. https://doi.org/10.2147/CCID.S26183

  40. Middelveen MJ, Haggblad JS, Lewis J et al (2021) Dermatological and genital manifestations of lyme disease including Morgellons disease. Clin Cosmet Investig Dermatol 14:425–436. https://doi.org/10.2147/CCID.S299526

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Dong X, Dong X (2018) Peripheral and central mechanisms of itch. Neuron 98:482–494. https://doi.org/10.1016/j.neuron.2018.03.023

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Heller MM, Wong JW, Lee ES et al (2013) Delusional infestations: clinical presentation, diagnosis and treatment. Int J Dermatol 52:775–783. https://doi.org/10.1111/ijd.12067

    Article  PubMed  Google Scholar 

  43. Foster AA, Hylwa SA, Bury JE et al (2012) Delusional infestation: clinical presentation in 147 patients seen at Mayo Clinic. J Am Acad Dermatol 67:673.e1-673.e10. https://doi.org/10.1016/j.jaad.2011.12.012

    Article  PubMed  Google Scholar 

  44. Hylwa SA, Foster AA, Bury JE et al (2012) Delusional infestation is typically comorbid with other psychiatric diagnoses: review of 54 patients receiving psychiatric evaluation at Mayo Clinic. Psychosomatics 53:258–265. https://doi.org/10.1016/j.psym.2011.11.003

    Article  PubMed  Google Scholar 

  45. Halvorson CR (2012) An approach to the evaluation of delusional infestation. Cutis 90(4):E1-4

    PubMed  Google Scholar 

  46. Kohen D (2003) Book review. J Psychopharmacol (Oxf) 17:462–462. https://doi.org/10.1177/0269881103174012

    Article  Google Scholar 

  47. Al-Imam AML (2016) A systematic literature review on delusional parasitosis. J Dermatol Dermatol Surg 20:5–14. https://doi.org/10.1016/j.jdds.2015.11.003

    Article  Google Scholar 

  48. Freudenmann RW, Lepping P (2009) Delusional infestation. Clin Microbiol Rev 22(4):690–732. https://doi.org/10.1128/cmr.00018-09

    Article  PubMed  PubMed Central  Google Scholar 

  49. Reichenberg JS, Magid M, Jesser CA, Hall CS (2013) Patients labeled with delusions of parasitosis compose a heterogenous group: a retrospective study from a referral center. J Am Acad Dermatol 68:41-46.e2. https://doi.org/10.1016/j.jaad.2012.08.006

    Article  PubMed  Google Scholar 

  50. Robles DT, Olson JM, Combs H et al (2011) Morgellons disease and delusions of parasitosis. Am J Clin Dermatol 12:1–6. https://doi.org/10.2165/11533150-000000000-00000

    Article  PubMed  Google Scholar 

  51. Savely V (2010) Delusions may not always be delusions. Arch Psychiatr Nurs 24:215. https://doi.org/10.1016/j.apnu.2010.04.006

    Article  PubMed  Google Scholar 

  52. Adnan M, Khan S, Patel M et al (2013) Agrobacterium. Rev Med Microbiol 24:94–97. https://doi.org/10.1097/MRM.0b013e3283642449

    Article  Google Scholar 

  53. Dewan P, Miller J, Musters C et al (2011) Delusional infestation with unusual pathogens: a report of three cases: delusional infestation with unusual pathogens. Clin Exp Dermatol 36:745–748. https://doi.org/10.1111/j.1365-2230.2011.04086.x

    Article  CAS  PubMed  Google Scholar 

  54. Paquette M (2007) Morgellons: disease or delusions? Perspect Psychiatr Care 43:67–68. https://doi.org/10.1111/j.1744-6163.2007.00113.x

    Article  PubMed  Google Scholar 

  55. Sandhu RK, Steele EA (2016) Morgellons disease presenting as an eyelid lesion. Ophthal Plast Reconstr Surg 32:e85–e87. https://doi.org/10.1097/IOP.0000000000000258

    Article  PubMed  Google Scholar 

  56. Courtney GR, Bhavik DP, Stoopler ET (2011) An oral ulceration associated with Morgellons disease: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 112:e19–e23. https://doi.org/10.1016/j.tripleo.2011.03.045

    Article  Google Scholar 

  57. Dovigi AJ (2010) Intraoral Morgellons disease or delusional parasitosis: a first case report. Am J Dermatopathol 32(6):603–605. https://doi.org/10.1097/dad.0b013e3181ca4a13

    Article  PubMed  Google Scholar 

  58. Moriarty N, Alam M, Kalus A, O’Connor K (2019) Current understanding and approach to delusional infestation. Am J Med 132:1401–1409. https://doi.org/10.1016/j.amjmed.2019.06.017

    Article  PubMed  Google Scholar 

  59. Al-Imam A (2018) A case report of Morgellons disease. Iran J Psychiatry Behav Sci 12. https://doi.org/10.5812/ijpbs.9170

  60. Dowben JS, Kowalski PC, Keltner NL (2017) Formication, tactile hallucinations, delusional parasitosis, and Morgellons: enough to make your skin crawl. Perspect Psychiatr Care 53:220–221. https://doi.org/10.1111/ppc.12246

    Article  PubMed  Google Scholar 

  61. Simpson L, Baier M (2009) Disorder or delusion? Living with Morgellons disease. J Psychosoc Nurs Ment Health Serv 47:36–41. https://doi.org/10.3928/02793695-20090706-03

    Article  PubMed  Google Scholar 

  62. Beuerlein KG, Balogh EA, Feldman SR. Morgellons disease etiology and therapeutic approach: a systematic review. Dermatol Online J. 2021 Aug 15;27(8). https://doi.org/10.5070/d327854682

  63. Zhang JF, Gopalakrishnan K, Molloy DJ (2021) Treatment of Morgellons disease with doxycycline. Clin Case Rep 9(12):e05148. https://doi.org/10.1002/ccr3.5148

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon

    Jana Dib El Jalbout & Rim Karam

  2. Faculty of Medicine and Medical Sciences, University of Balamand, Koura, Lebanon

    Heba Sati & Perla Ghalloub

  3. Department of Internal Medicine, Lebanese American University Medical Center Rizk Hospital, Beirut, Lebanon

    Grace El Bejjani

  4. Jawaharlal Nehru Medical College, Belgaum, Karnataka, India

    Arpit Mago

  5. Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon

    Marita Salame

  6. Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon

    Lara Saoudi

  7. Instituto Carlos Chagas, Rio de Janeiro, Brazil

    Antonio Baez Desangles

  8. Department of Dermatology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo, São Paulo, Brazil

    Nancy Emmanuel

Authors
  1. Jana Dib El Jalbout
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heba Sati
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Perla Ghalloub
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Grace El Bejjani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rim Karam
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Arpit Mago
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marita Salame
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lara Saoudi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Antonio Baez Desangles
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Nancy Emmanuel
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JDEJ, HS, PG, GEB, RK, AM, MS, LS, ABD, and NE wrote the original draft. JDEJ reviewed and edited the published manuscript under the supervision of NE.

Corresponding author

Correspondence to Nancy Emmanuel.

Ethics declarations

Ethics approval

Not applicable.

Consent to participate

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Jana Dib El Jalbout and Heba Sati contributed equally to this work.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dib El Jalbout, J., Sati, H., Ghalloub, P. et al. Morgellons disease: a narrative review. Neurol Sci 45, 2579–2591 (2024). https://doi.org/10.1007/s10072-024-07361-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-024-07361-7

Keywords

Search

Navigation