Imaginary bugs, real distress: delusional parasitosis.

To the Editor: Delusional parasitosis (DP) (Ekbom syndrome, psychogenic parasitosis, chronic tactile hallucinosis) is a false but unshakable conviction of personal infection by ‘bugs’ of some sort; that is, ectoor endoparasites or other pathogens. This condition may be increasing in frequency, but the subject is virtually absent from the South African medical literature. Failure to diagnose DP consumes time and financial resources, and prolongs distress and frustration of the doctor and patient. Diagnosis of underlying psychiatric or organic disease can be missed or delayed if DP is not investigated and managed appropriately. We have encountered 4 cases recently (Table I).