by James Hubbard, M.D., M.P.H.

I never heard of this in medical school, so when I saw my first patient with delusional parasitosis, I was quite bewildered. Here sat a well-dressed, anxious looking guy, scratching all over, who said he scabies and handed me the proof in a tissue. It was a flake of skin.

“And look, Doc. See the bites.” I looked and saw where he’d been scratching—digging and clawing actually—into his skin. But no bugs of any sort.

I got the local dermatologist to see him. I mean he had to have something I was missing. The dermatologist checked him thoroughly and diagnosed delusional parasitosis. I had to look it up.

Delusional parasitosis is when a person is convinced, beyond reason, beyond all evidence to the contrary, that he is infected with some sort of biting bug or parasite.

“What’s the treatment?” I asked the derm.

“There is none. Even the psychiatrists don’t know what to do.”

In those many years since, I’ve seen a few more cases, and it’s always the same. There’s nothing there. Usually, they’ve been to many, many doctors before me. “And nobody helps me, Doc. A bunch of quacks, they are.”

Books adIn fact, some have told them the truth, but they never, ever believe it. Other doctors have just gone along with the delusion and given them some prescription to get them out of the office. Because no matter what you say, or what you do, or what the proof to the contrary is, this person is going to stay convinced he has parasites.

I keep writing he, but actually the problem can occur in either sex. Often drugs, like methamphetamine or cocaine, play a role. But many times delusional parasitosis happens in an otherwise normal person. Sometimes the person is so convincing that they’ve got friends and family believing. Family members may even get the imaginary bug.

Since stress is often a trigger I expect delusional parasitosis to be more of problem during prolonged disasters, which is why I bring it up here.

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Delusion or Reality?

Fortunately, there are some prescription medicines that lately have been found to work—of course, if you can ever convince the person to take the meds. They’re antipsychotics best prescribed by someone, like a psychiatrist, who knows their best dosages and what to do about side effects.

But before medications, the first thing that has to be done is to rule out actual parasites—or anything that could be biting. With blood tests and a physical exam, things that can cause itching, like uncontrolled diabetes, thyroid problems, vitamin deficiencies, dry skin, and skin diseases, need to be ruled out or treated.

With no medical help available, it may be next to impossible to rule out everything. And delusional parasitosis is rare. But since I’ve been writing about itchy parasites lately, I just wanted you to know it’s a possibility. And unless it’s drug related, nothing you do is going to help.

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Photo by Carlos Ferriera on Flickr.