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Therapeutics in Dermatology
A reference textbook in dermatology

Delusional parasitosis

5 June 2012, by CONSOLI S.G.

The skin is an organ that plays a special role in one’s relational life; it is visible, may be touched and is easily accessible. It is particularly associated with one’s emotional, socio-affective and psychological life. Commonplace emotional difficulties may be expressed through the skin such as when one blushes in public for example, but it may also be used to express more rare and serious psychological troubles, as in cases of self-mutilation.

Thus, some patients are convinced that their skin is infested by parasites. These ideas, which patients rapidly take for reality, are favoured by anxiety and depressive conditions in patients who are often isolated, energetic and meticulous and who have recently lived through a stressful event (bereavement for example).

Because the purpose of treatment is to eliminate the delusion, physicians often prescribe psychotropic drugs referred to as neuroleptics, which act rapidly and whose dosage may be adjusted depending on results, side effects and the patient’s age.

Neuroleptics are sometimes combined with antidepressants.

Another treatment objective is to improve the patient’s living conditions, which might have caused the onset of the delusion. This is why chemical treatment with neuroleptics and sometimes antidepressants should be combined with psychotherapeutic discussions to try and alleviate the patient’s isolation, solitude and sensory deprivation (improvement of hearing and sight for example) or relational conflicts (familial for example).

Treatment objectives must therefore be both dermatological and psychiatric. Dermatologists must prescribe local treatments for the patient’s skin that might have been damaged by the patient attempting to remove non-existent parasites.

The dermatologist is also responsible for referring the patient to a psychiatrist and backing up and encouraging the patient in this approach and in taking any other steps to improve his/her living conditions. However, dermatologists rarely take the responsibility for prescribing neuroleptics and/or antidepressants alone.

Requesting the help of a psychiatrist (who may prescribe neuroleptics and/or antidepressants contrary to psychologists) is therefore generally indispensible. The psychiatrist must be accustomed to working with the dermatologist and must be prepared to take the time to set up meetings to provide the patient with psychological support.

Rapid improvement and cures are often observed in patients with delusional parasitosis, but patients must continue seeing the dermatologist and psychiatrist in the framework of a trusting patient-physician relationship to consolidate the process and avoid relapses.

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