Patients often will complain of “bugs” biting them. They feel them. Many will see “bugs” and may have detailed stories about the life cycle of the “bugs” that are infesting their skin. It is rare that someone with such complaints actually has real bugs. Instead it is most often a fixed delusion.
These patients do actually see the bugs and they are not lying. They are actually feeling the bugs and they are not lying. That is where it gets tricky. Their brain is misinterpreting information from the eyes as “bugs”. There may be a scab on the skin, that can be examined under the microscope and is just a scab, but that is not what their brain is interpreting it as. The brain sees a “bug”. If one could hook up a computer monitor to their brains to show what the “
brain is interpreting”, one would see the “bugs” that they describe.
How do you tell someone that they are “seeing things” or “they are not real”? For these patients it is real! That is what they are seeing and feeling. It could not be more real. This is where it gets very difficult and you must know how to communicate with patients. First and foremost, one must prove that there are no “real bugs”. I usually take multiple samples and have them examined. Then one must treat the patients with the appropriate medications that make the delusion go away. Very quickly, the “bugs” are no longer seen or felt. Again, the “bugs” are very real to the patient and one cannot discredit them.
Unfortunately, most patients go from doctor to doctor over many years and never accept treatment. This is terrible as the delusion can consume people and significantly impact their lives. In many cases, close contacts will get the same delusion as well. Many of these patients are intelligent people with no psychiatric issues, just this one delusion that can be corrected with medication.
Margellons disease is similar except patients see fibers coming out of their skin. While there have been rare reports of a systemic illness precipitating this disease, nearly all cases appear to be purely psychological. If there is an underlying disease, such as Lyme disease or peptic ulcer disease, one should treat that first and see if the skin symptoms disappear. Sometimes they do and sometimes they do not.
There are many “Morgellons patient groups” that patients find on their own. They are full of people with similar symptoms, all with the same story that they have been to so many doctors and no one can help them for years. This only reinforces the patient’s belief that there is a “need” to kill the “bugs” or figure out the cause of the fibers and further delays them from getting real help.
In short, if you or someone you know thinks that they have bugs, see a board-certified Dermatologist. He/She will likely take some samples. If there are bugs, they will be treated. In all of my years of practice, I have never had someone come in complaining of bugs and actually found bugs in these scenarios. The only exception is scabies, but these are microscopic and it is impossible to see them. If there are no bugs seen, appropriate treatment will be given to make the “bugs” go away. The patient must be willing to accept that if no bugs are found, follow the treatment advice and you will get better.