Patients often will complain of bugs biting them. Many will see the bugs or 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, but a fixed, delusion. These patients do actually see the bugs and they are not lying. Their brain is misinterpreting information from the eyes as bugs. If one could hook up a computer monitor to their brains, one would see the bugs that they describe.
How do you tell someone that they are “seeing things” or “they are not 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”. Then one must treat the patients with the appropriate medications that make the delusion go away–the bugs disappear. 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, and I this, 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.
There are many “groups” for these conditions, which reinforce the patient’s belief that there is a “need” to kill the bugs or figure out the cause of the fibers. This only prolongs the condition in most and delays effective treatment, which many never seek.