Morgellons: a novel dermatological perspective as the multisystem infective disease borreliosis

Abstract

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.

Canine Filamentous Dermatitis Associated with Borrelia Infection

“…Motile spirochetes characterized by molecular means as Borrelia spp were also cultured from MD skin, blood and vaginal specimens, indicating viability and systemic infection and suggesting that MD is a manifestation of LD [15,16]. These detailed molecular and histological studies confirm that MD is a true somatic infectious illness and not a delusional disorder [15][16][17].…”

“…PCR -Australian Biologics, Sydney, Australia: Bb detection by real-time PCR targeting the 16S rRNA gene and endpoint PCR targeting the rpoC gene was performed as previously described [17,26] using the Eco™ Real-Time PCR system with software version 3.0.16.0. DNA was extracted from tissue using the QIAamp 96 DNA Mini QIAcube HT (Qiagen).…”

“…Morgellons disease (MD) is a human dermopathy characterized by spontaneously-appearing, slowly-healing skin lesions containing filaments that are often extraordinarily colorful (blue, white, black, green, purple, pink and red) and lie under, are embedded in, or project from skin [9][10][11][12][13][14][15][16][17]. Many medical professionals consider MD to be a delusional disease and attribute the presence of colorful filaments to excoriation coupled with accidental or deliberate implantation of textile fibers [18,19].…”

“…Many medical professionals consider MD to be a delusional disease and attribute the presence of colorful filaments to excoriation coupled with accidental or deliberate implantation of textile fibers [18,19]. In contrast, dermatopathology studies suggest that the filaments may lie under or project from unbroken skin, making it highly unlikely that they are self-implanted [9][10][11][12][13][14][15][16][17]. Furthermore, the unusual filaments are composed of keratin and collagen, and blue coloration in filaments is the result of melanin pigmentation, as shown by specific histological staining [14,15].…”

“…Musculoskeletal and neurocognitive symptoms associated with Lyme disease and tickborne coinfections are frequently reported in this group of patients, and MD patients demonstrate seroreactivity to Bb antigens [12][13][14]. Histological, electron microscopic and PCR studies of dermatological tissue containing filamentous inclusions and/or projections derived from MD patients verified the presence of Bb sensu stricto (Bbss) and Bb sensu lato (Bbsl) spirochetes in MD clinical specimens [15][16][17]. Motile spirochetes characterized by molecular means as Borrelia spp were also cultured from MD skin, blood and vaginal specimens, indicating viability and systemic infection and suggesting that MD is a manifestation of LD [15,16].…”