Morgellons disease (MD) is a complex skin disorder characterized by ulcerating lesions that have protruding or embedded filaments. Many clinicians refer to this condition as delusional parasitosis or delusional infestation and consider the filaments to be introduced textile fibers. In contrast, recent studies indicate that MD is a true somatic illness associated with tickborne infection, that the filaments are keratin and collagen in composition and that they result from proliferation and activation of keratinocytes and fibroblasts in the skin. Previously, spirochetes have been detected in the dermatological specimens from four MD patients, thus providing evidence of an infectious process.
Our study using multiple detection methods confirms that MD is a true somatic illness associated with Borrelia spirochetes that cause Lyme disease. Further studies are needed to determine the optimal treatment for this spirochete-associated dermopathy.
Despite compelling evidence to the contrary, MD continues to be attributed to delusions of parasitosis or delusional infestation -. The earlier studies demonstrating Borrelia spirochetes in MD dermatological specimens have involved only a small number of study subjects, and therefore a study involving a larger number of subjects was needed.
A major strength of our study is that MD patients were identified based on the presence of multicolored fibers within skin lesions or detectable under unbroken skin. Some of our patients did suffer from neuropsychiatric symptoms, and we do not deny that primary delusional infestation can occur in rare cases -. By selecting only MD patients meeting our dermopathy criterion, however, we have presumably excluded primary delusional infestation patients from our study. Although some MD patients suffering from neuropsychiatric symptoms with Borrelia-associated intradermal filaments may claim to have worms, parasites or the like, the skin crawling and stinging sensations that these patients feel coupled with visible skin lesions, anxiety and anthropomorphic thinking may result in complaints that are misinterpreted by clinicians as a primary delusional disorder. Other MD patients in our study had no neuropsychiatric symptoms and yet had the same Borrelia-associated dermopathy, so it appears that in our well-defined MD patient cohort these symptoms, when they occurred, were the result rather than the cause of the infectious dermopathy, as previously described -,.
We undertook a detailed microscopic and molecular study of North American MD patients to investigate the presence of borrelial spirochetes systemically and in dermatological specimens. Based on culture, histology, immunohistochemistry, electron microscopy and molecular testing, we present extensive evidence for spirochetal infection in MD patients. Our study confirms that MD is a true somatic illness associated with Lyme disease. The proposed clinical classification scheme for MD should aid in the diagnosis and treatment of this complex illness.
The authors thank Drs. Stewart Adams, Robert Allan, Gordon Atkins, Robert Bransfield, George Chaconas, Douglas Demetrick, Dorte Dopfer, Christopher Hardy, Doug Kahn, Alan MacDonald, Steve McClain, Elizabeth Rasmussen, Ginger Savely and Janet Sperling for helpful discussion. We thank Joel Israel for technical support and Lorraine Johnson for manuscript review, and we are grateful to Cindy Casey and the Charles E. Holman Morgellons Disease Foundation for funding support.