Background: Delusional parasitosis (DP) is a false, unshakable belief that pathogens have infested one’s own skin or body. Objective: The objective was to record all patients with DP, a rare presentation of monosymptomatic delusion, in Iraq. Patients and Methods: This was a descriptive study of 21 cases diagnosed with DP in Medical City Teaching Hospital in Baghdad, Iraq, between 2013 and 2021. A detailed history and clinical examination were conducted to exclude actual organic disease. Results: All patients were females with a mean age of 65 years. They believed strongly to have pathogens in their skin or scalp, carrying containers with samples of skin debris, fibers, dead insects, hair waste, and small stones as proofs of their infestation. Careful psychiatric assessment ruled out schizophrenia, substance use disorders, and dementia, and proved the psychiatric diagnosis of monosymptomatic delusion. The patients described their symptoms as something crawling, stinging, and biting sensations. On examination, we often saw shaved scalp hair with injured skin in the form of excoriations, ulcerations, scarring, and pyogenic infections in a localized area. Conclusion: DP is a single symptom-sign complex manifestation in a person with a well-preserved personality apart from a single tactile hallucination of some sort of pathogens infesting their skin. It is commonly a disease of the scalp of elderly females that run a chronic course and rarely remits in a short time. Proper liaison between dermatologists and psychiatrists assisted by laboratory facilities is required for diagnosis and follow-up. Empathetic rapport, psychiatric referral, and early treatment by atypical anti-psychotics significantly improve such conditions.