Morgellons disease: Analysis of a population with clinically confirmed microscopic subcutaneous fibers of unknown etiology

Abstract

Background: Morgellons disease is a controversial illness in which patients complain of stinging, burning, and biting sensations under the skin. Unusual subcutaneous fibers are the unique objective finding. The etiology of Morgellons disease is unknown, and diagnostic criteria have yet to be established. Our goal was to identify prevalent symptoms in patients with clinically confirmed subcutaneous fibers in order to develop a case definition for Morgellons disease.

Methods: Patients with subcutaneous fibers observed on physical examination (designated as the fiber group) were evaluated using a data extraction tool that measured clinical and demographic characteristics. The prevalence of symptoms common to the fiber group was then compared with the prevalence of these symptoms in patients with Lyme disease and no complaints of skin fibers.

Results: The fiber group consisted of 122 patients. Significant findings in this group were an association with tick-borne diseases and hypothyroidism, high numbers from two states (Texas and California), high prevalence in middle-aged Caucasian women, and an increased prevalence of smoking and substance abuse. Although depression was noted in 29% of the fiber patients, pre-existing delusional disease was not reported. After adjusting for nonspecific symptoms, the most common symptoms reported in the fiber group were: crawling sensations under the skin; spontaneously appearing, slow-healing lesions; hyperpigmented scars when lesions heal; intense pruritus; seed-like objects, black specks, or "fuzz balls" in lesions or on intact skin; fine, thread-like fibers of varying colors in lesions and intact skin; lesions containing thick, tough, translucent fibers that are highly resistant to extraction; and a sensation of something trying to penetrate the skin from the inside out.

Conclusions: This study of the largest clinical cohort reported to date provides the basis for an accurate and clinically useful case definition for Morgellons disease.

Keywords: Lyme disease; Morgellons; delusions of parasitosis; pruritus; skin lesions; subcutaneous fibers.

Figure 1

Morgellons patient’s lower legs. Similar lesions covered her trunk and arms. There were no excoriations or secondary infections. Photo courtesy of Cindy Casey, Charles E Holman Foundation, Austin, Texas. Reproduced with permission.

Figure 2

Morgellons patient’s back. Note that lesions and scars occur in areas that could not have been reached by the patient. Photo courtesy of Cindy Casey, Charles E Holman Foundation, Austin, Texas. Reproduced with permission.

Figure 3

Close up of a leg lesion showing a twisted fiber just under the epidermis. Magnification 100 ×. Photo courtesy of Cindy Casey, Charles E Holman Foundation, Austin, Texas. Reproduced with permission.

Figure 4

Black fibers and one red fiber, just under the epidermis of a healing lesion. Magnification 200 ×. Photo courtesy of Cindy Casey, Charles E Holman Foundation, Austin, Texas. Reproduced with permission.

Figure 5

Fiber under epidermis (top) and separate from a skin lesion (bottom). Magnification 30 ×. Photo courtesy of Randy Wymore, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma. Reproduced with permission.