Tuesday, August 20, 2013
Over the past 10 years, there have been an increased number of
publications debating the presence of a new medical condition
referred to as "Morgellons Disease" (MD). The term refers to a
paper written by Sir Thomas Browne in 1674 entitled De vermiculis
capillaribus infantium. In this monograph, he describes children
who broke out in "harsh hairs on their backs", using the name
"Morgellons" as a reference to mouscouloun, the hook that is
attached to the end of a spindle. The name Morgellons was then used
by Kellett in 19351 and again by Emslie-Smith in
1946.2 The term found its modern use when Mary
Leitao founded the Morgellons Research Foundation in 2002. She
discovered the article by Browne while looking for a cause for her
2 year old son's unexplained medical condition. She first found
fibers in his skin while examining them with her home-bought
microscope. Her two teenage children subsequently developed
symptoms, though by then, she had begun to develop a nationwide
network of concerned patients and researchers. Although some
believed that Leitao suffered from Munchaesons by proxy, others
with similar symptoms were grateful for an
Descriptive Studies of Morgellons Disease
Publications describing this syndrome began in
2005,4 with basic scientists and primary care
physicians dominating the conversation. Larger descriptive
publications were released, providing a case definition for
Morgellons Disease in 2007 (see Table 1) and a case series of 122
patients in 2010.5
Publications from dermatologists have been more hesitant to use
the new term.6 Many argue that patient-derived
diagnostic terms should not be used to describe conditions which
have not yet been validated by medical
evidence.7 Furthermore, the Morgellons website
describes the use of antimicrobial medications, which patients may
unsafely order online without physician supervision (Reichenberg,
personal observation, 2011), and discourage patients from trying
psychiatric drugs for the treatment of their
In 2012, the CDC published the results of a federally-funded
study on Morgellons disease.9 Of the 115 patients
studied, there was no detectable infectious agent found.
Unidentified material was further analyzed by scanning electron
microscopy with energy dispersive X-ray analysis; most materials
collected were composed of cellulose: 63% had evidence of
clinically significant somatic complaints, and 50% had drugs of
abuse detected in hair samples. The authors explained that they
were unable to conclude "whether this unexplained dermopathy
represents a new condition… or wider recognition of an existing
condition such as delusional infestation, with which it shares a
number of clinical and epidemiologic features."
Criticisms of the study focus on the recruitment biases in that
patients asked to participate were already labeled as 'delusional.'
They also limited patient enrollment to a specific geographic area,
and excluded patients whose symptoms had existed for greater than 3
months.10 In contrast to the findings of the CDC,
Middelveen and colleagues examined tissue from Morgellons patients
and found keratin and collagen filaments.11
Proposed Causes for Morgellons Disease
There have been a few publications that have looked for an
organic cause of the condition. Polymerase Chain Reaction
techniques have demonstrated spirochetes (Borreliaspecies) in the
tissue of patients with MD,12 though these tests
were not approved by the FDA and the organisms may have been part
of normal skin flora.
Some researchers suggest that MD may be a chronic infection with
Borrelia species, or a form of chronic Lyme disease. However, the
concept of chronic Lyme disease is itself controversial, with a
recent international consensus statement concluding that chronic
infection withB. burgdorferiis not supported by carefully conducted
laboratory studies or by controlled treatment
One recent study proposed that patients complaining of "bugs"
may be different than those who complain of
"fibers."14 They found 'Bug' patients to be more
likely to fit the classic description of delusional disorder;
whereas 'fiber' patients may have a dysethetic syndrome - a chronic
pain disorder akin to chronic fatigue or fibromyalgia (dubbed
"Princess and the Pea" patients due to their hypersensitivity to
pain and inability to ignore trivial stimuli).
Treatment of patients who complain of fibers in their skin
The most important first step in the approach to these patients
is to determine if they have any other medical diagnoses or
treatable skin diseases. Skin superinfection is common, as is
contact dermatitis from applied substances. Patients with similar
complaints may actually have schizophrenia, skin picking disorder,
somatic symptom disorder, lichen planus, dementia, drug addiction,
or contact dermatitis. It is important to do a thorough history and
skin examination, and a detailed review of systems can pick up
details that an interview may miss. Laboratory testing should be
guided by these findings.
Practitioners who treat MD with antibiotics report improvement
of symptoms,15 but no blinded studies have been
published. Some describe successful treatment of patients with MD
using pimozide16 and risperdal, drugs commonly
utilized in patients with delusions of parasitosis. The author has
previously found some success treating 'fiber' patients with
antipsychotics, but more recently has shifted to using
antidepressants such as citalopram when depression and anxiety
predominate.17 This approach focuses less on a cure
for the 'fibers' and more on improving quality of life and reducing
The term Morgellons is, in itself, controversial, as are the
proposed treatments for the condition. After the publication of the
CDC study, many physicians have come down strongly in favor of a
psychiatric etiology. Basic science research continues to produce
data that may imply an infectious etiology. Regardless, all parties
agree that these patients are suffering, and should be offered
medical and psychosocial treatments when indicated.
Table 1: Case Definition for Morgellons Disease as provided by
the Morgellons Research Foundation18
- Skin lesions accompanied by intense itching
- Crawling sensations on and under the skin, often compared to
insects moving, stinging, or biting (cutaneous dysethesia)
- Colored Fibers in and on the lesions (or 'fuzz balls' or 'black
- Fatigue significant enough to interfere with daily
- Musculoskeletal pain
- Inability to concentrate and difficulty with short term memory
- Behavioral changes
(Adapted from Savely VR, Stricker, RB. Morgellons Disease: the
mystery unfolds. Expert Reviews in Dermatology 2(5) 585-591
A 42 year old female with a history of lesion on her legs, arms
and buttocks. Photograph provided courtesy of
the Charles E. Holman Foundation.
Image taken at 100x magnification of the patient's skin.
Photograph provided courtesy of the Charles E. Holman
1. Kellett CE: Sir Thomas Browne and the disease called the
Morgellons.Ann Med Hist. 1935;7:467-79.
2. Emslie-Smith AH: Myiasis, fillan, and the Morgellons.Br Med
3. Mom fights for answers on what's wrong with her son July 23,
2006 12:00 am By Chico Harlan / Pittsburgh Post-Gazette
4. Savely VR, Leitao MM, Stricker RB. The mystery of Morgellons
disease. Infection or delusion?Am J Clin Dermatol. 2006;7:1-5.
5. Savely VR, Stricker RB. Morgellons disease: Analysis of a
population with clinically confirmed microscopic subcutaneousfibers
of unknown etiology.Clin Cosmet Investig Dermatol.
6. Koblenzer C. The challenge of Morgellons disease.J Am Acad
Dermatol. 2006:55: 920-2.
7. Accordino E, Engler D, Ginsburg IH, Koo J. Morgellons
disease?Dermatol Ther. 2008;21:8-12.
8. M Magid, J Fridlington, J Reichenberg. Management of
Psychodermatologic Disorders. US Dermatology. Volume 3, Published
online in 2008 by Touch Briefings.
9. Pearson ML, Selby JV, Katz KA, Cantrell V, Braden CR,et al.
Clinical, Epidemiologic, Histopathologic and Molecular Features of
an Unexplained Dermopathy. PLoS ONE 2012;7: e29908.
10. Mayne P, English JS,et al. (2013) Morgellons: a novel
dermatological perspective as the multisystem infective disease
borreliosis [v1; ref status: awaiting peer review,
http://f1000r.es/116] F1000Research 2013, 2:118 (doi:
11. Middelveen MJ, Mayne PJ,et al: Characterization and
evolution of dermal filaments from patients with Morgellons
disease.Clin Cosmet Investig Dermatol. 2013;6:1-21.
12. Middelveen MJ, Burugu D,et al. Association of spirochetal
infection with Morgellons disease [v1; ref status: indexed,
http://f1000r.es/8g] F1000 Research. 2013; 2:25.
13. Feder H. Johnson B,et al. A Critical Appraisal of Chronic
Lyme Disease.N Engl J Med. 2007;357:1422-30.
14. JS Reichenberg, M Magid,et al. Patients labeled with
delusions of parasitosis compose a heterogenous group: A
retrospective study from a referral center.J Am Acad Dermatol.
15. Harvey WT. Morgellons disease.JAAD. 2007;56:705-6.
16. Koblenzer CS. Pimozide at least as safe and perhaps more
effective than olanzapine for treatment of Morgellons disease.Arch
17. Delacerda A, Reichenberg J, Magid M. Successful Treatment of
Patients Previously Labeled as Having Delusions of Parasitosis With
Antidepressant Therapy.Journal of Drugs in Dermatology.
18. Savely VR, Stricker, RB. Morgellons Disease: the mystery
unfolds.Expert Reviews inDermatology. 2007;2:585-91.