An Encapsulated Delusion of Photosensitivity

Background: Most dermatologic and psychiatric providers are familiar with the entity of delusional infestation (DI). DI involves the fixed, false belief that one is infested with animate or inanimate matter and is associated with abnormal cutaneous symptoms such as biting or crawling, in the absence of any objective evidence. Although DI is more commonly encountered and discussed in the psychodermatology literature, other types of less well-known encapsulated delusions occur. Patients may present with an isolated belief that they emit a foul odor, known as delusion of bromosis or that they have irregular, ugly or deformed body parts with delusion of dysmorphophobia. These types of delusions are currently classified as delusional disorder, somatic type within the most recent DSM-V. Case: Herein, we report an unusual case of a middle-aged woman who presented to our outpatient psychodermatology clinic with a fixed, false belief that she had persistent and severe sensitivity to light. She had been evaluated by multiple providers for potential medical and dermatologic conditions that could account for her cutaneous symptoms of severe burning that were associated with thirst, subjective fever and self-reported elevations in blood pressure while in sunlight. All laboratory examinations, photo patch testing and skin exams were unremarkable. The patient pursued self-treatment with beta-carotene in surplus amounts, as a natural supplement to help decrease photosensitivity and photodamage that resulted in carotenemia and carotenosis of the skin. Based on current diagnostic criteria, she was diagnosed with delusional disorder, somatic type and treated with pimozide. Conclusion: This case description aims to increase familiarity of providers, especially dermatologists to atypical presentations of somatic delusional disorders they may encounter in order to provide further guidance of treatment and approach to such cases.