Delusions of parasitosis
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
- 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)