Delusions of parasitosis
Alerts and Notices
SynopsisDelusions of parasitosis (also known as delusional infestation or monosymptomatic hypochondriacal psychosis) is a primary psychiatric disorder in which the patient possesses a fixed belief that he or she is suffering from a cutaneous infestation with parasites. Such patients often give elaborate histories that include tactile / visual hallucinations and visits to multiple providers. Often, they have tried various strategies to eradicate the alleged parasites (eg, using pesticides, hiring exterminators).
The typical patient is a socially isolated middle-aged to elderly female, although delusions of parasitosis can affect both sexes and all ages. Patients will often appear anxious and overwhelmed. Skin lesions, when present, are self-induced with the fingernails or other implements.
The clinician should be aware of the "matchbox sign" – patients will often bring lint, pieces of skin, and other debris to an office visit in plastic wrap or matchboxes, claiming that these items represent evidence of parasitic infection. Even though these collections contain no parasites, the patient believes that they represent organisms, pieces of organisms, ova, or larvae.
There are several variations of this disorder:
- Folie à deux ("a madness shared by two") – when a delusion of infestation has been transmitted to a significant other.
- Folie à famille ("family madness") – when a delusion of infestation has been transmitted within a family to more than 2 members.
- Firm belief that a spouse, child, or pet is infested.
Patients with this disorder may have an increased risk of various general medical conditions.
F22 – Delusional disorders
89809008 – Delusion of parasitosis
Differential Diagnosis & Pitfalls
- Scabies / scabies (pediatric) – look for burrows
- Dermatitis herpetiformis – look for clustered vesicles on an urticarial base
- Mite dermatitis
- Grover disease
- Neurotic excoriations – no underlying delusions expressed
- Systemic diseases that may cause pruritus (see pruritus without rash)
- Neurologic disease (multiple sclerosis, brain tumor, neurotoxins)
- Caterpillar and moth dermatitis
- Fiberglass dermatitis (see irritant contact dermatitis)
- Psychotic depression
- Drug-induced delusions of parasitosis (see drug-induced psychosis)
Drug Reaction DataBelow is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
Delusions of parasitosis