Spotlight on Morgellon’s Disease: The Importance of Biopsies, Lab Work, &Compassionate Care
Morgellon’s disease is a condition that has long been a subject of medical debate and controversy. Patients with Morgellon’s often describe feeling as though they have fibers, parasites, or other foreign materials under their skin. These sensations can be accompanied by symptoms such as intense itching, skin lesions, and the appearance of fibers or granules emerging from the skin. While the exact cause remains unclear, Morgellon’s is a real and distressing condition for those who experience it.
The process of diagnosing and managing Morgellon’s disease requires a multifaceted approach. This includes thorough medical testing, such as biopsies and lab work, to rule out potential underlying conditions like mite infestations, bacterial infections, liver or kidney disease, nutritional deficiencies, and even metastatic cancers. This article will explore the importance of these diagnostic steps and emphasize the need for compassionate care, particularly in light of the challenges faced by those who are sometimes misjudged or dismissed.
A Complex and Multifactorial Condition
Morgellon’s disease is not just one condition, but potentially a complex interplay of several factors. Research has shown that patients may experience symptoms related to a number of possible causes, from spirochette infections to neurological or autoimmune conditions, to dermatologic issues. However, the primary challenge lies in distinguishing whether the symptoms are the result of an actual infestation, an underlying systemic issue, or a neurologic condition.
The Importance of Biopsies and Lab Work
Proper medical testing is essential to rule out other conditions and help clinicians get closer to a diagnosis. Biopsies and laboratory work can play a critical role in uncovering the root causes of the symptoms.
Mite or Bacterial Infections: One of the first concerns for clinicians is whether a parasitic infestation, such as scabies or other mite-related conditions, may be responsible for the symptoms. Scabies, for instance, presents with intense itching and burrows under the skin that might resemble the sensation of fibers or particles under the skin. Skin scraping and microscopic examination can help rule out or confirm such infestations. Additionally, bacterial infections like Borrelia burgdorferi, the bacteria responsible for Lyme disease, have been linked to symptoms similar to those of Morgellon’s. In such cases, laboratory blood work and polymerase chain reaction (PCR) testing may be used to detect the presence of bacteria in the body.
Metastatic Cancers: It is essential to rule out underlying cancers that may cause similar dermatologic symptoms. Certain cancers, particularly those that affect the liver or kidneys, may cause pruritus (itching) as a secondary symptom. Biopsy of suspicious lesions or imaging studies may help identify metastatic tumors or other malignancies that might otherwise go undiagnosed.
Liver or Kidney Problems: Chronic liver or kidney diseases can lead to skin changes and itching, which could be mistaken for the symptoms of Morgellon’s. Liver dysfunction may alter bile acid metabolism, contributing to skin rashes and itching. Similarly, kidney disease can lead to pruritus as a result of the accumulation of waste products in the body. Blood work and urine tests can help identify signs of liver or kidney dysfunction that may be contributing to the symptoms.
Nutrient Deficiencies: Another important consideration in patients with Morgellon’s-like symptoms is the possibility of nutrient deficiencies. Vitamin B12 deficiency, for example, has been linked to skin changes and neurological symptoms, including the sensation of crawling or tingling under the skin. Blood tests to measure levels of vitamins, minerals, and other essential nutrients are crucial in identifying any deficiencies that might explain the symptoms.
The Neurological Perspective: Looking More Than Skin Deep
In some cases, the sensations experienced by individuals with Morgellon’s may be due to a neurological condition such as neuropathy or a central nervous system disorder. These conditions can cause paresthesia, a type of abnormal skin sensation that may feel like crawling or itching. Some researchers suggest that Morgellon’s could involve a neurological or even a psychiatric component, with patients experiencing symptoms similar to those seen in conditions such as delusional parasitosis or tactile hallucinations which alter an individual’s perceptions of reality and can be severely distressing and terrifying to the patient, effecting their everyday life and social interactions with far reaching reverberations which should be considered with compassion.
This is why it’s important to approach this with caution. While the possibility of a neurologic or psychiatric disorder cannot be ruled out entirely, it’s crucial to remember that patients’ experiences are real, and the distress caused by these sensations should not be dismissed or invalidated. As discussed below, the term "delusions of parasitosis" can be stigmatizing and counterproductive in fostering trust between patients and healthcare providers.
The Stigma of "Delusions of Parasitosis"
One of the most harmful aspects of Morgellon’s disease is the stigma that patients often face. The term "delusions of parasitosis" is occasionally used to describe patients who report the sensation of being infested with parasites, yet no evidence of infestation is found upon examination. Simply because evidence is not found does not mean no evidence exists. While it’s essential for clinicians to explore the possibility of psychological factors, labeling patients as having "delusions" can be incredibly harmful. This term implies that the patient’s experience is imaginary or purely psychological, which can lead to a lack of empathy and an unwillingness among healthcare providers to further investigate the symptoms.
For individuals with Morgellon’s, this term can feel dismissive and alienating, reinforcing the notion that their symptoms are not taken seriously. It’s important to remember that regardless of the underlying cause, the distress experienced by patients is real. Labeling a condition as "delusional" without further investigation can contribute to feelings of isolation, hopelessness, and a mistrust of the healthcare system. In my experience, most healthcare providers can benefit from a nice bolus of empathy with these effected individuals.
The Need for Compassionate Care
Morgellon’s disease presents a complex diagnostic challenge, but it is also an opportunity for healthcare providers to practice compassion and thoroughness. When a patient presents with symptoms that seem difficult to understand, it’s crucial to listen carefully, perform appropriate tests, and rule out potential physical causes before making any assumptions about the psychological or neurological aspects of the case.
The compassionate approach involves seeing the patient as a whole person, not just as a set of symptoms. Whether the condition is caused by an infestation, an underlying health problem, or a neurological disorder, what matters most is that the patient’s experiences are validated. There is no one-size-fits-all answer, and a multidisciplinary approach that involves dermatologists, infectious disease specialists, neurologists, and even mental health professionals may be necessary.
Conclusion
Morgellon’s disease is a complex and multifactorial condition that requires careful investigation and compassionate care. Biopsies, lab work, and imaging studies are critical tools in ruling out other conditions, such as mite infestations, bacterial infections, liver or kidney disease, cancers, and nutrient deficiencies. Healthcare providers must resist the temptation to prematurely diagnose "delusions of parasitosis," as doing so may cause unnecessary harm and alienation for the patient.
By prioritizing empathy, thorough diagnostics, and a willingness to consider all possible causes, we can help ensure that individuals suffering from Morgellon’s disease receive the care they deserve. The condition may or may not have an identifiable cause, but the experience of the patient is always real, and it is our duty as healthcare providers to listen, investigate, and offer the most supportive care possible.
References
McGovern, R. A., & Sorensen, M. T. (2013). Morgellons disease: A review of the literature. Journal of the American Academy of Dermatology, 68(6), 1053-1057. PubMed
Gibson, L. E., & Schwartz, R. A. (2007). Morgellons disease: A psychiatric illness? The Lancet, 370(9602), 1412-1413. PubMed
Logan, A. C., & Bested, A. C. (2009). Morgellons disease: A functional medicine perspective. Integrative Medicine: A Clinician’s Journal, 8(6), 53-58. PubMed
Rahman, A., & Moore, R. (2007). The diagnostic challenge of Morgellons disease: A case report. Clinical Infectious Diseases, 44(3), 433-435. PubMed
