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Delusional Parasitosis

It feels like bugs, worms, or mites are biting, crawling over or burrowing into, under or out of your skin. They must be there, because you can feel them and maybe you can even see them. They may also infest your home or furniture. You may be the only one that knows they are there. No one seems to believe they exist except you. Nothing seems to get rid of them. So what are they?

Obviously, they are not easily seen like mosquitoes, ticks, fleas, or other large insects that bite people and cause itchy bumps to develop. Barely visible mites can also bite people and leave itchy tracks or rash-like splotches in the skin. Usually, we can prevent bites from common biting insects by excluding them from our homes with window and door screens. Insect repellents will keep them off our bodies, and they can be killed with appropriate applications of pesticides labeled specifically for use against particular insects.

But what if none of these normal approaches work? What if, after trying every reasonable approach and with helpful hints from friends or medical professionals, the individual's problem persists? What if the condition seems to be spreading to other family members or to your friends? Then it is time to seek the proper type of professional help.

Who can assist with this sort of problem? Actually, quite a few different types of specialists can. Most entomologists recognize various life stages of insects or mites, or can use references to discover what they are. Medical entomologists, in particular, spend their careers working with insect and mite parasites. Parasitologists study these and other groups of organisms like worms, protozoans, and other invertebrates that live at the expense of their host animals. Samples should be sent to entomologists, parasitologists, or other biologists for verification or identification of any organisms present. Local Public Health Offices or laboratories often have experts that may be able to assist with such identifications. Dermatologists are trained to deal most effectively with skin disorders.

If you have visited any or perhaps several of these professionals and no one is able to find the offending organism, it is very unlikely that they are all incompetent. It is time to reassess your situation, particularly if you have no itchy lumps (papules) or rashes. Parasites nearly always leave an itchy lump or rash. Not all itching or sensations of crawling or burrowing are caused by arthropods or other parasites infesting your skin. Itching and the sensation of things crawling on or under the skin may be associated with many seemingly unrelated medical conditions and have more to do with the nerve pathway between the skin and the brain than with the skin. These skin sensations could be due to the following conditions among others (see Table 1):


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