Morgellons disease (MD) is a term that has been used in the last decade to describe filaments that can be found in human epidermis. It is the subject of considerable debate within the medical profession and is often labeled as delusions of parasitosis or dermatitis artefacta. This view is challenged by recent published scientific data put forward between 2011-2013 identifying the filaments found in MD as keratin and collagen based and furthermore associated with spirochetal infection. The novel model of the dermopathy put forward by those authors is further described and, in particular, presented as a dermal manifestation of the multi-system disease complex borreliosis otherwise called Lyme disease. A differential diagnosis is drawn from a dermatological perspective. The requirements for a diagnosis of delusional disorder from a psychiatric perspective are clarified and the psychological or psychiatric co-morbidity that can be found with MD cases is presented. A concurrent case incidence is also included. Management of the multisytem disease complex is discussed both in general and from a dermatological perspective. Finally replacement of the term 'Morgellons' by 'borrelial dermatitis' is proposed within the profession.