Morgellons disease: a filamentous borrelial dermatitis

Abstract

Morgellons disease (MD) is a dermopathy characterized by multicolored filaments that lie under, are embedded in, or project from skin. Although MD was initially considered to be a delusional disorder, recent studies have demonstrated that the dermopathy is associated with tickborne infection, that the filaments are composed of keratin and collagen, and that they result from proliferation of keratinocytes and fibroblasts in epithelial tissue. Culture, histopathological and molecular evidence of spirochetal infection associated with MD has been presented in several published studies using a variety of techniques. Spirochetes genetically identified as Borrelia burgdorferi sensu stricto predominate as the infective agent in most of the Morgellons skin specimens studied so far. Other species of Borrelia including Borrelia garinii, Borrelia miyamotoi, and Borrelia hermsii have also been detected in skin specimens taken from MD patients. The optimal treatment for MD remains to be determined.

Keywords: Borrelia burgdorferi; Lyme disease; Morgellons disease; dermatitis; spirochetes.

Figure 1

(A) Skin lesions on the hand of a Morgellons disease patient. (B) Skin lesions on the buttocks of a Morgellons disease patient. Note: Figures courtesy of the Charles E. Holman Morgellons Disease Foundation, Austin, TX, USA, used with permission.

Figure 2

Multicolored fibers in Morgellons disease skin lesion. Notes: 400× original magnification. Figure courtesy of the Charles E. Holman Morgellons Disease Foundation, Austin, TX, USA, used with permission.

Figure 3

Spirochete detected with Dieterle silver stain in culture of skin sample from Morgellons disease patient. Notes: 1000× original magnification. Figure courtesy of Marianne J Middelveen.

Figure 4

Borrelia spirochetes immunostained with anti-Borrelia antibody in culture of skin sample from Morgellons disease patient. Notes: 1000× original magnification. Figure courtesy of Marianne J Middelveen.