Friday, January 27, 2012

CDC publishes Morgellon's Study

Skin lesions and fibers on patients with unexplained
dermopathy. (from  Pearson et al. PLoS ONE)
Yesterday the Centers for Disease Control officially released their long-awaited study of people suffering from a condition that has come to be called Morgellons.  Preferring to use the term "unexplained dermopathy," researchers provided no scientific support for the condition, leaving open the possibility that many such cases may be psychological in origin.

While the conclusions of study may be shocking to members of the media, public health experts and entomologists who regularly see people with non-existent bug problems are not surprised. A smaller study published last May found no connection between similar unexplained dermopathies and skin parasites.  And professional entomologists who regularly interact with the public are very familiar with samples of supposed biting insects and far-ranging descriptions pests that fit no profiles of real insects or mites. As I discussed in a post last year, some of these samples come from people with a special kind of delusion called delusory parasitosis, while others come from people experiencing allergic reactions, drug side effects, or other medical conditions. All of these can produce sensations closely resemble tiny bites or creeping sensations on the skin like a plague of bugs.

In recent years, some people with these unexplained skin conditions have sought an alternative explanation for skin lesions and the accompanying itching sensations.  The name Morgellons is a lay term supposedly originating from an obscure 1690 reference in a medical monograph referring to a similar condition of the time called "the morgellons." Though the condition is poorly defined, it usually involves seeing unidentified fibers associated with the skin, and many feel it is related to some as-yet-undescribed parasite.

The findings of this week's study in the online journal PLoS ONE, include:
  • Approximately 50% of patients who underwent clinical examinations had fibers in or on skin lesions (open or crusted sores). However, when the fibers and other particles collected from participants were photographed and analyzed, they were found to be either hairs, cellulose, or polyester.  There was no evidence that the fibers preceded the lesions, caused the lesions, or occurred in normal skin.
  • Evidence of prior drug use (i.e., from amphetamines, barbituates, benzodiazepines, cannabinoids, cocaine, opiates or propoxyphen) was found in 50% of clinical participants.  Drug use could account for some cases of unexplained dermopathy--formication (the sensation of tiny bugs, like ants, crawling on the skin) is a well-known side effect of drug use withdrawal.
  • Over 75% of case patients reported some exposures to solvents through hobby activities. The  prevalence of such exposures among the healthy adult population in the U.S. is unknown and not enough data on type and duration of solvent exposure was collected to draw conclusions.
  • The rate of functional impairment and disability found in case-patients was higher than the general population and similar to that detected among people with serious mental illness.

Prevalence of cases with Morgellons-like symptoms was low in the California study group, approximately 3.65 cases per 100,000 people (or one in 27,000 people).  While being the largest, most comprehensive study of  unexplained dermopathy to date, the study had limitations.  It lacked a control group and was mainly descriptive in nature.  Nevertheless the researchers say that they could find no unifying of definitive cause of the condition among people reporting Morgellon-like symptoms. The authors were unable to confidently say whether unexplained dermopathy represents a new medical condition or is another manifestation of delusory parasitosis; however a peer review panel concluded that in the absence of a single, well-described, published case with fibers emerging from intact skin, "it will be difficult to justify the resources needed to start a new study."

Ultimately this study will not end the debate over unexplained dermopathies, like Morgellons. People who believe they suffer from the condition will point to the inability of the researchers to definitively say that "there is no such thing." Dermatologists, physicians and mental health experts will point to the lack of evidence for the condition, the innocuous origin of the "fibers" seen in Morgellons cases, lack of any parasites in skin biopsies and data that suggests a correlation of the condition with psychosomatic illness and drug interactions.

The study concludes with the recommendation that, given there is still no definitive explanation for unexplained dermopathy, sufferers may benefit from standard medical therapies or those recommended for treatment of delusory infestations.  For sufferers of the latter I find the recommendations of Misha Heller and colleages especially humane and sensible. In their letter published in the Archives of Dermatology, they note that the most important step toward successful treatment of delusional patients is developing a strong doctor-patient relationship of trust.  Without adequate rapport, they say, patients are unlikely to comply with prescriptions for anti-psychotic medications, which can make all the difference in the life of someone suffering from delusory parasitosis.

All of this can be baffling to pest management professionals. After all, we're not doctors, nor are we trained to diagnose medical or mental health conditions in patients. Nevertheless, this is an issue that affects nearly all of us at some time over our careers.  When you encounter a customer who claims to have Morgellons, or who points to tiny pests that can not be seen, it's important to stick to what you know.
  • Don't allow yourself to be persuaded to apply unnecessary insecticides to control insects that cannot be detected or do not exist. 
  • Advise your customer to seek medical assistance for bite-like symptoms (Keep in mind, however, that many doctors are not well informed about pests or even delusory parasitosis. If you know a local MD or dermatologist who is informed about this condition, refer them). 
  • Inspect the home, making use of sticky cards and pitfall traps, to ensure it is free of bed bugs, biting mites, and other biting insects. Remember, providing a customer assurance that their home is pest free can be as great a service as pest control itself.


Reylan | Employment Posters said...

First it will start from itching then it will become swollen because of the bacteria that consumes the flesh of your skin.

Stinger said...

I think this is a very touchy issue, I even have a difficult time trying to say the right thing at times and I've been in the biz for over 20 years. The issue has also taken on a whole new meaning with the Bed Bug creepy factor. People now think they have Bed Bugs and start itching and then it starts. Whenever I go to a hotel now, the first thing I do is to inspect the beds and sorrounding areas. I also put my luggage on the sink counter and hang my clothes on the shower rod. It makes everyone think before they do anything. But is is a problem that needs to be handled with care. Good info, thank