Management of patients with delusional parasitosis is best handled through the cooperation among dermatologists, general practicioners, internal medicine specialists, psychiatrists, and entomologists or parasitologists. Psychiatrists are needed to confirm the diagnosis of delusional parasitosis and to make the diagnosis of any underlying psychiatric disorder in the case of secondary functional delusional parasitosis. In addition, psychiatrists are able to conduct psychotherapy and provide a long-term commitment during the treatment phase. Sufferers are often reluctant to consult a psychiatrist, and if the suggestion to do so is not done carefully, the patient may seek help from another physician. Dermatologists need to be supportive about the patient's symptoms and suffering and should suggest that a psychiatrist may be able to help the patient live with the problem more comfortably. However, if there is no rash the patient should be referred to an internal medicine specialist. Some patients may be able to live with their infestation without drug or psychiatric treatment by receiving the reassurance given by careful examination of any specimens brought in and by periodic consultations with the physician.
There are some essential points to keep in mind when working with an individual suffering from delusional parasitosis.
- Empathize with the patient's distress and frustration.
- Examine specimens and explain that there are no insects or mites in the specimen(s).
- Remind the sufferer of the numerous steps they have taken and that laboratory studies have shown nothing.
- It is pointless to argue with the sufferer as there is no way to sway them.
- MOST IMPORTANTLY: Never agree with the patient, you will only make the situation worse.
It is essential to rule out the presence of environmental irritants and/or actual parasites, allergens, or other organisms that cause contact dermatitis. Although many arthropods may bite humans, for the majority of species these would be unusual occurrences. The only groups likely to cause ongoing problems include mites, bed bugs fleas and lice and these would all leave an itchy rash or bumps.