PSEUDOPSYCHODERMATOLOGIC DISEASE
Section snippets
CASE 1: PSEUDODERMATITIS ARTEFACTA (LOCALIZED BULLOUS PEMPHIGOID)
A 68-year-old woman with chronic anxiety and neurotic traits presented with a localized area of blisters and erosions on the right shin. The referring dermatologist noted that these blisters and erosions were linear and rectangular in configuration and made a presumed diagnosis of dermatitis artefacta (Fig. 1). The patient denied any manipulation of the affected area. Although her anxiety disorder and neurotic traits were evident on psychiatric interview and mental-status examination, the
CASE 2: PSEUDODELUSIONS OF PARASITOSIS (UNDIAGNOSED MULTIPLE SCLEROSIS)
A 49-year-old woman with an approximately 2-year history of crawling and biting sensations on her face, scalp, trunk, and extremities was referred to the University of California San Francisco (UCSF) psychodermatology clinic for presumed diagnosis of delusions of parasitosis. She had been treated repeatedly with Kwell lotion without response. Out of desperation, the patient shaved her hair to rid herself of "insects," but this did not improve her condition. By the time she came to the UCSF
CASE 3: PSEUDODELUSIONS OF PARASITOSIS (BACTERIAL FOLLICULITIS)
A 60-year-old man was referred to the UCSF psychodermatology clinic by an outside dermatologist for evaluation of possible delusions of parasitosis. The patient reported itching on various parts of the body and was convinced that "bugs" were causing his itch. He brought specimens on slides that contained only dried skin debris. A careful examination of his itchy spots revealed small and subtle follicular-based inflammations, and the biopsy showed folliculitis. When the patient was treated with
CASE 4: PSEUDODELUSIONS OF BROMOSIS (TEMPORAL LOBE EPILEPSY)
A 21-year-old male truck driver presented with a 2-year history of bouts of bad smells that he thought were emanating from his scalp and hair. These episodes were of sufficient intensity that they interfered with his concentration while driving. Because of these intermittent attacks of bad smell, the patient quit his work and withdrew from his social circle. Careful physical examination of his scalp revealed no visible pathology, and neither the author nor other members of the medical staff
CASE 5: PSEUDODELUSIONS OF PARASITOSIS (GROVER'S DISEASE)
A 68-year-old man had been complaining for more than 2 years that there were scabies infesting his skin. He went to several dermatologists and subjected himself to numerous Kwell treatments without any improvement in his condition, until his dermatologists refused to give him any more Kwell lotion (a lotion containing the insecticide lindane). After that, he started to use various caustic chemicals, and he reported that he burned his skin twice in one summer while trying to "eradicate scabies"
CASE 6: PSEUDODELUSIONS OF PARASITOSIS (UNDIAGNOSED VITAMIN B12 DEFICIENCY)
A 56-year-old man presented with a 5-year history of alcohol abuse, which began when his business collapsed. The patient had begun to drink heavily and obtained most of his calories from the consumption of alcohol. The patient also began experiencing sharp epigastric pain, as well as burning of the tongue. What finally convinced the patient to see his internist, however, was the appearance of some disturbing crawling and biting sensations that the patient experienced throughout his entire body.
CASE 7: PSEUDODELUSIONS OF PARASITOSIS (UNDIAGNOSED HYPOTHYROIDISM)
A 45-year-old woman who had been healthy most of her life began to experience rather disturbing symptoms. The patient had begun to notice a gradual fullness in her throat for the last 6 months. In addition to that, she began feeling a lack of energy, as well as an extreme sensitivity to cool temperatures. The patient also seemed to be developing a disturbing sensation of crawling and biting sensations on the skin for the last 2months. The patient went to see her family practitioner who noticed
CASE 8: LETHAL PSYCHOGENIC PRURITUS
A 42-year-old white woman was referred for evaluation of recalcitrant pruritus of 2 years' duration. Her past medical history was significant for childhood eczema and persistent allergic rhinitis. She reported a 2-year history of diffuse myalgias and arthralgias, which recently had been diagnosed as fibromyalgia. Her psychiatric history was extensive, beginning with a brief psychiatric hospitalization at age 16 following an overdose of sleeping pills taken after the breakup of a 1-year romantic
References (0)
Cited by (7)
Delusional Parasitosis
2006, Tropical Infectious DiseasesDelusional Parasitosis
2005, Tropical Infectious Diseases: Principles, Pathogens, & Practice, 2-Volume Set with CD-ROMMorgellons disease: The mystery unfolds
2007, Expert Review of DermatologyPsychodermatology: A guide to understanding common psychocutaneous disorders
2007, Primary Care Companion to the Journal of Clinical PsychiatryThe mystery of Morgellons disease: Infection or delusion?
2006, American Journal of Clinical Dermatology
Address reprint requests to John Koo, MD UCSF Psoriasis Treatment Center 515 Spruce Street San Francisco, CA 94118
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From the UCSF Psoriasis Treatment Center and Department of Dermatology, University of California, San Francisco Medical Center, San Francisco, California (JK, CG); and the Department of Dermatology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (RF)