Therapeutics in Dermatology
A reference textbook in dermatology

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Delusional parasitosis

5 June 2012, by CONSOLI S.G.

Victims of delusional parasitosis (also referred to as Ekbom’s syndrome or parasitophobia) acquire a delusional belief that they are infested with parasites. The term “parasitophobia” is slowly being abandoned because the phobia of parasites is characterised by feelings of anxiety at the sight of parasites, but that disappear when parasites are avoided. Delusional parasitosis is often accompanied by the experience of sensations of pruritus, tingling or formication all over the skin. The skin may be dried out by the patients’ use of detergents and anti-parasitic agents, but free from lesions. Nevertheless, patients may present with sores from itching and even wounds that may sometimes be secondarily infected, caused by the patient attempting to remove the imagined parasite.

The nosology of the delusion varies depending on authors. For Anglo-Saxons, the condition can be classified as a non-schizophrenic, somatic type delusional disorder similarly to body dismorphic disorder and delusional hypochondria (delusional disorders) [1]. For French authors, there are definite links between delusional parasitosis, paranoia and delusional hypochondria. In all events, dermatologists are the care providers of choice for patients suffering from delusional skin infestations as described by K.A. Ekbom and they may be confronted with the disorder relatively frequently [12].

Diagnosis is based on the following:

-no parasites are observed following careful examination of the patient;

-the delusion is monothematic, with no other psychotic disorder and the patients are generally relatively well adjusted socially;

-patients present with no organic diseases and do not consume toxic substances;

-the disorder is typically observed in women over 60 years old, isolated emotionally and who presents with changeable mood and personality disorders characterised by oversensitivity (vulnerability, wariness, and psychological inflexibility).

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