Delusions of Parasitosis in Geriatric Patients

, Jillian W. Wong² and John Koo³

(1)

Department of Dermatology, University of New Mexico, Albuquerque, NM, USA

(2)

Department of Dermatology, University of California, Davis Sacramento, CA, USA

(3)

Department of Dermatology, University of California, San Francisco, CA, USA

Abstract

Mrs. Jones is a 90-year-old Caucasian female, who was brought in to see you by her son for a 12-month history of chronic biting and stinging sensations all over her body. She had not observed any bugs to bite or sting her skin; however, the sensations she felt are those that could only be created by insects. As a result of being frequently bothered by these sensations, she repeatedly picked at her skin in places she was able to reach. She also reported retrieving several types of “materials” embedded in her skin. They often appeared as insect body parts and clear, coiled fibers, which she claimed “were shed from the bugs.” She had brought some of these objects in plastic zip-lock bags to the dermatology clinic and requested you to examine them as carefully as possible.

Upon further questioning, the patient stated that the infestation had started during her long-term stay at an assisted living facility. After the patient made several complaints to the staff of the facility, extermination teams were hired to search for and exterminate the infestation. Yet, according to the reports of several different companies, no bugs of any kind were found in her room or anywhere else in her housing unit. Previously, three general practitioners had seen the patient in hope of eliminating the bug infestation. Again, none of these practitioners were able to find any ecto-parasites on her skin, and as such, they provided here with reassurance, which she did not accept. Your physical examination revealed multiple superficial excoriations with some scabbing, but no evidence of ecto-parasites.

Reflections on the Case

The most common psychocutaneous condition in the geriatric population is delusions of parasitosis (DoP) – with a documented sex ratio of 3:1 in favor of women [10]. Studies have reported the average age of onset among older adults to be 55.6–65 years [11, 12]. As illustrated by the case of Mrs. Jones, affected patients frequently have an elaborate, firm belief that they are chronically infested with living organisms (e.g., insects, parasites, etc.). These patients seek referrals to dermatology practitioners in hope of having their “skin lesions” examined, usually with scraping and microscopy, for evidence of body parts or fibers thought to belong to the infesting organisms. The primary goal they have for the visit with you can be validation of this fixed belief, which the authors also refer to as a delusional ideation. Most of these patients will also complain of formication sensations (i.e., crawling, biting, and stinging), and of course, will ask for your help to improve such sensations. However, depending on the degree of the delusion, seeking relief from these symptoms is not necessarily the most important goal of the patient.

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