No Evidence of Skin Infestation in Delusional Infestation

Although dermatitis seen in 61 percent of skin biopsies from patients with delusional skin infestation

WEDNESDAY, May 18 (HealthDay News) -- In patients with suspected delusional skin infestation, histologic examination of skin biopsies and examination of patient-provided samples show sparse objective evidence of skin infestation, according to a study published online May 16 in the Archives of Dermatology.

Sara A. Hylwa, from the Mayo Clinic in Rochester, Minn., and colleagues reviewed the results of skin biopsies and patient-provided specimens from 108 patients diagnosed with delusional skin infestation, including delusions of parasitosis, between 2001 and 2007. Of the study participants, 80 received biopsies, 80 had self-procured skin specimens, and 52 received biopsies and provided specimens. Physicians (generally dermatologists) evaluating the patient assessed the patient-provided specimens, and 20 samples were submitted for pathologic evaluation.

The investigators found no evidence of skin infestation in any biopsy specimen. Dermatitis was identified in 61 percent of the biopsied samples; excoriation, ulceration, or erosion in 48 percent; and nonspecific dermal inflammation in 31 percent of biopsies. Of the patient-provided samples, 13 percent contained insects, which were all noninfesting, except one, which was a pubic louse. Cutaneous debris, environmental detritus, or plant material comprised the remaining findings.

"Intriguingly, the majority of skin biopsy results did show dermatitis, raising the possibility that skin inflammation and its attendant tactile discomfort might be the trigger provoking delusional symptoms in susceptible individuals," the authors write.

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