Morgellons disease: A myth or reality?

Sir, The spectrum of psychodermatology is quite wide. One of the more controversial diseases in this group is Morgellons disease; where the patient usually a female, complaints of fibers of glass/other material coming out of her skin. We would like to report a case of Morgellons disease, which responded well to antipsychotic medications. A 50-year-old married female presented with complaints of fibers coming out of her skin. Six months ago her wardrobe collapsed when she was standing next to it. She did not get any external injury but she believes that the glass particles had gotten embedded into her skin. Few days after this incident she started complaining of fibers coming out of her skin. She also complained of occasional burning, itching, disturbed sleep, and tiredness. She visited several doctors and was treated for presumed scabies and dry skin but with no relief of her symptoms. A few months later after reading about her symptoms on the Internet she diagnosed herself to be suffering from Morgellons disease. There was no significant medical history or history of any psychiatric illness in self or family. On enquiry it was found that she had a fixed belief that the fibers were embedded in her skin and were extruding from it. She even brought the alleged fibers to us in a folded piece of paper [Figure 1]. The patient was conscious and cooperative but appeared anxious. On thorough clinical examination there were Letters to the Editor Figure 1: Material brought by the patient on the first day (match box sign) Figure 2: Microscopy of the material no skin lesions found anywhere on her body including excoriations. On examining the material brought by her under the microscope we found dark-colored fine and coarse fibers some of which showed localized nodes and thread‑like extensions. There was no hair, nits, or any other structure of dermatological significance [Figures 2 and 3]. We deduced that the fibers were derived from a broom stick and hence made a provisional diagnosis of Morgellons disease. Psychiatric evaluation revealed that she had moderate depression with muttering to self, sadness of mood, easy irritability, and easy fatigability in view of the monosymptomatic hypochondriasis of the patient. Her investigations reported an increase in serum alkaline phosphatase, deranged random blood sugar, and moderately raised C‑reactive protein. The complete blood count, serum creatinine, BUN, and rest of the liver function tests were within normal limits. She …