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Is the Morgellons Mystery Solved?

I feel that I don't fully understand Morgellons disease - even the basic question of whether it is a real, physical condition or one that is "all in the mind." Has anything been learned about the cause and treatment of Morgellons disease?

Answer (Published 3/26/2012)

Morgellons disease is an informal diagnosis that has been adopted by some patients as an explanation for a constellation of symptoms including slow healing sores, joint pain, persistent fatigue, a sensation of things crawling through the skin, as well as the emergence of "fibers" from the skin. Morgellons is not a recognized condition in mainstream medicine. Many of these patients believe they have been infected with some unidentified agent.

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The latest opinion on Morgellons comes from the Centers for Disease Control and Prevention (CDC), based on physical and psychological evaluations of patients living in California who reported symptoms. The CDC conducted the study with Kaiser Permanente and the Armed Forces Institute of Pathology. Findings were published in the journal PLoS One. The good news from this study, which began in 2008, is that none of the symptoms is due to an infection, insects, or an environmental cause. However, that conclusion is unlikely to satisfy patients who are convinced that they have some kind of physical disease. Nor are they likely to be happy with data showing that the extrusions from the skin turn out to be pieces of cotton and other fibers that probably become encrusted in healing wounds.

The investigators reported that the most common skin abnormality found among the 115 patients who took part in the study was skin damage from the sun. Many of the sores patients attributed to Morgellons appeared to be the result of chronic scratching and picking at the skin without an underlying cause.

However, neuropsychological evaluations  found that a "substantial number" of study participants scored high on screening tests for one or more co-existing psychiatric or addictive conditions, including depression, somatic concerns (preoccupation with health issues), and drug use. Given all of these findings, the researchers concluded that there is nothing to be gained by searching for an infectious agent as the cause of the symptoms. 

The CDC study results square with the findings of a Mayo Clinic review published in the September 2011 issue of the Archives of Dermatology. After analyzing skin samples from 108 Morgellons patients, the researchers concluded that with the exception of one patient (who turned out to have lice), none was infested with bugs or parasites. (Here, too, the investigators found that the skin extrusions turned out to be textile fibers and ordinary skin debris.)

The Mayo Clinic team concluded that the patients were suffering from delusional parasitosis, the false conviction that the body is harboring hidden parasites.

The history of Morgellons offers an interesting glimpse into how the Internet links people with shared symptoms: in 2001 a woman whose young son had strange threadlike extrusions coming out of his skin as well as sores that wouldn't heal couldn't get any help (or a diagnosis) from the doctors she consulted. Her own Internet research led her to a 17th century medical study describing the symptoms and identifying them as Morgellons disease. She then created a website and was inundated by email from people who said they had the same thing.

We know a lot more about this problem now than we did then. As a result, I hope doctors and patients will better understand each other when dealing with the strange symptoms of Morgellons. Physicians should not dispute the reality of their discomfort or discount their symptoms as imaginary, and I would be inclined to send such patients to hypnotherapists or to shamans for help.

Andrew Weil, M.D.

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