Still more evidence that Morgellons disease is most likely delusional parasitosis, 2012 edition

It’s been nearly a year since I last discussed a most unusual malady. Part of the reason is that the opportunity to discuss it hasn’t occurred recently; usually I need some spark or incident to “inspire” me to write about something, and there just hasn’t been any Morgellons news that’s caught my eye since then. However, another part of the reason, I must admit, is that writing about this particular condition almost always brings sufferers out of the woodwork, castigating me the way antivaccinationists like to castigate me for challenging the scientific basis of their preferred pseudoscience. I catch enough hostility from the antivaccine contingent. Before I’m reading to leap into a fray that’s likely to bring more hostility–who knows? I might even be graced by a visit from a certain particularly deluded and persistent advocate of this condition–my way from an entirely different contingent of woo-meisters. On the other hand, sometimes I need a change of pace, a new area to look at the application of science-based medicine to health and disease.

I’m referring, of course, to Morgellons disease. To recap (for those of you who are familiar with the condition) or to provide some background (for those of you who are not), people suffering (or claiming to suffer) from this condition complain of an intense itching, and the condition is characterized by a number of primary symptoms. These include:

  • Sponanteously Erupting Skin lesions
  • Sensation of crawling, biting on and under the skin
  • Appearance of blue, black or red fibers and granules beneath and/or extruding from the skin
  • Fatigue
  • Short-term memory loss
  • Attention Deficit, Bipolar or Obsessive-Compulsive disorders
  • Impaired thought processing (brain fog)
  • Depression and feelings of isolation

Of course, as I pointed out before, the fibers and granules found in the skin in Morgellons sufferers are always consistent with clothing or scratching. More precisely, no Morgellons advocate has ever demonstrated them to be anything mysterious or even anything not consistent with fibers from clothing or various materials the sufferer comes into contact with. It’s not for nothing that most objective investigations of Morgellons disease conclude that it is some form of delusional parasitosis. Before I move on, let me get one thing straight. Just because I don’t think that Morgellons is due to parasites doesn’t mean that I think that sufferers from Morgellons disease are crazy or “making it up” somehow. In fact, they are suffering. We don’t know why they are suffering, but we can say that it isn’t due to parasites and that the fibers that they on or in their skin are consistent with textiles, such as clothing, and superficial skin injuries due to scratching. Yet there is a large contingent of Morgellons quacks out there who are only too happy to indulge this delusional parasitosis and provide all manner of dubious remedies designed to relieve the symptoms of Morgellons sufferers while also relieving them of their cash.

When last I examined a study looking at Morgellons disease, it was a study that did something very, very obvious. Basically, the investigators looked at skin biopsies and patient-provided specimens. Not surprisingly, most commonly, investigators found that they were skin flakes or serum crust, hair, or textile fibers. There were a couple of insects found among the specimens. Consistent with the literature about Morgellons, there was nothing consistent with a diagnosis of parasite infestation. This time around, there appears to be a study that provides even more evidence that Morgellons disease is not a distinct clinical entity. Basically, it’s a new study that was commissioned by Senator Dianne Feinstein to look into the cause of Morgellons disease. The results were just reported:

ATLANTA (AP) — Imagine having the feeling that tiny bugs are crawling on your body, that you have oozing sores and mysterious fibers sprouting from your skin. Sound like a horror movie? Well, at one point several years ago, government doctors were getting up to 20 calls a day from people saying they had such symptoms.

Many of these people were in California and one of that state’s U.S. senators, Dianne Feinstein, asked for a scientific study. In 2008, federal health officials began to study people saying they were affected by this freakish condition called Morgellons.
The study cost nearly $600,000. Its long-awaited results, released Wednesday, conclude that Morgellons exists only in the patients’ minds.

“We found no infectious cause,” said Mark Eberhard, a Centers for Disease Control and Prevention official who was part of the 15-member study team.

This was a much bigger study, and it was published in PLoS One yesterday. Naturally, I couldn’t resist going to the source, as is my wont. So I did. The study comes from investigators from the CDC, Kaiser Permanente, the Joint Pathology Center, the Department of Veterans Affairs, and the Department of Dermatology at the University of Rochester School of Medicine and is entitled Clinical, Epidemiologic, Histopathologic and Molecular Features of an Unexplained Dermopathy.

This particular study consisted of three major components: a cross-sectional survey, clinical evaluations, and histopathological studies. Eligibility for the study was very broad. Basically, all that was necessary was that the subject be a member of Kaiser Permanente, thirteen years or older, and English-speaking. Cases of Morgellons were defined as any member of Kaiser Permanente who reported during the study period (July 1, 2006 and June 30, 2008) reporting “fibers, threads, specks, dots, fuzzballs, granules or other forms of solid material coming out of his/her skin” AND one or both of the following:

  • a skin lesion such as a rash, wound, ulcer, or nodule; OR
  • a disturbing skin symptom such as pruritus, feeling that something is crawling on top of or under the skin, or stinging, biting, or a pins and needles sensation.

From cases who were identified by predetermined criteria of possibly having Morgellons disease, complete medical histories were taken, and clinical examinations performed. Skin samples were taken by 4 mm punch biopsy, and a dermatoscope used to photograph each biopsy site before and after the procedure. These biopsy samples were subjected to–shall we say?–extensive testing. In addition to standard histopathological analysis, skin biopsy specimens were subjected to scanning electron microscopy. Fibers and other samples were also subjected to infrared spectroscopy (IR) to identify molecular characteristics. Blood samples were taken and serological tests performed, and subjects underwent neuropsychiatric testing. A cross-sectional survey was alos taken using an Internet-based tool.

Perhaps the most surprising thing about this study (to me, at least) was how uncommmon Morgellons disease was. Out of nearly three million Kaiser enrollees screened, investigators only found 104 cases, for a prevalence of 3.65 per 100,000. Given the seeming “prevalence” of the disease on the Internet, one would think that it was far more common than that. It is true that this sample, as large as it is, might not be representative. It is, after all, made up of Kaiser Permanente members, which means that they all at least have a form of health insurance. They also all live in California, specifically in the Bay Area. Even so, it is rather revealing that patients complaining of classic Morgellons symptoms are actually fairly uncommon.

It’s also not at all surprising that another major finding of this paper is that, consistent with previous studies, there was no evidence of any consistent set of abnormalities in the skin of subjects complaining of Morgellons symptoms:

Case-patients had a wide range of skin lesions, suggesting that the condition cannot be explained by a single, well-described inflammatory, infectious, or neoplastic disorder. A substantial proportion (40%) of biopsied lesions had histopathologic features compatible with the sequelae of chronic rubbing or excoriation, without evidence of an underlying etiology. The most common histopathologic abnormality was solar elastosis, a degeneration of dermal connective tissue and increased amounts of elastic tissue due to prolonged sun exposure. However, this finding might be expected among a population residing in California and does not necessarily suggest a causal relationship. Histopathologic examination of skin areas with normal appearance were essentially normal, arguing against systemic or subclinical skin abnormalities. Among the differential diagnoses for the skin presentations detected are neurotic excoriations [16], atopic dermatitis, brachioradial pruritis [17], [18], and arthropod bites.

Previous reports of this condition have described the material emerging from the skin being like fibers, hairs or filaments [1], [19], but we found a more heterogeneous description of materials emerging from the skin, with many case-patients describing materials other than fibers including specks, dots, granules, or worms. We found no difference in the sociodemographic, clinical, or histopathologic characteristics of case-patients who did and did not report fibers. The fibers and materials collected from case-patients’ skin were largely consistent with skin fragments or materials such as cotton and were either entrapped in purulent crust or scabs, suggesting the materials were from environmental sources (e.g., clothing) or possibly artifacts introduced at the time of specimen collection and processing.

There was also no evidence of an environmental cause. Also, not surprisingly, subjects complaining of Morgellons symptoms also had a evidence of co-existing neuropsychiatric morbidity. According to this study, nearly 60% of Morgellons cases had evidence of a cognitive impairment that could not be explained by deficits in IQ, while 63% had clinically significant somatic complaints. Depression was more prevalent than in the general population. Despite these findings, the subjects with Morgellons were more or less normal on most of the tests they were subjected to.

Predictably, although this study is still more evidence that there is not clearly definable physical cause of Morgellons disease, the advocates are not backing down. For example, Randy Wymore, an Oklahoma State University pharmacologist who is one of the most famous and reputable mainstream scientist who thinks there might be something to Morgellons disease is already making excuses. Unfortunately, it’s probable that no amount of evidence will convince such people, at least until we find treatments that are effective in alleviating their symptoms. Maybe not even then.