Delusional Parasitosis

Delusion of parasitosis (DP) is a condition associated with a fixed, false belief that the patient is infested by parasites. Because the skin is the major target for parasite infestation, these patients typically present to dermatologists, infectious disease specialists, or family practitioners. Patients also approach travel/tropical medicine specialists, "experts" in exotic parasites, even when a travel history does not exist. Patients are resistant to psychiatric referrals but typically go from one doctor to another. It is important to make sure that the patient does not have an organic skin disorder and the delusion is not secondary to another mental or physical illness. DP is considered a delusional disorder, somatic subtype, and treated with antipsychotic medication, with poor compliance and mixed outcomes. DP may also be understood as a chronic somatoform disorder (monosymptomatic hypochondriasis), in which some underlying emotional disturbance is expressed via physical symptoms. Treatment of the latter sometimes involves antiparasitic medication, stress reduction, and self-help techniques, as well as a family assessment.