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From Medscape Medical News

No Medical Condition, Infectious Source Found for Morgellons

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January 26, 2012 — An investigation of Morgellons, an unexplained constellation of symptoms affecting primarily the skin, by the Centers for Disease Control and Prevention (CDC) has not identified any environmental link, infectious cause, or underlying medical condition to explain the cause of the symptoms, according to an article published online January 25 in PLoS ONE.

Information from 115 patients was collected from enrollees in a large health maintenance organization in Northern California from July 2006 through June 2008. This area was chosen because of a possible cluster of illnesses reported by local officials. The prevalence of the condition was found to be 3.65 (95% confidence interval, 2.98 - 4.40) cases per 100,000 enrollees, with no evidence of geospatial clustering. The condition was reported more commonly among women (77%) and was highest among patients aged 45 to 64 years.

Among non–skin related symptoms, musculoskeletal symptoms and fatigue of greater than 6 months' duration were most common, each affecting approximately 70% of patients. Health-related quality of life was reported as fair or poor among 54% of the patients, and 59% of the patients demonstrated evidence of cognitive impairment. Approximately 50% of patients had evidence of drug use detected (legal and illicit); however, researchers could not determine to what extent this may have played a role in the clinical symptoms. More than 75% of patients reported exposure to solvents during hobbies, but the prevalence of this exposure in the general population is unknown, according to researchers.

Patients demonstrated a wide range of skin lesions not specific to any single disorder. Solar elastosis was the most common histopathologic result (51% of biopsies); however, researchers did not suspect a causal relationship. Materials collected from the patients' skin were composed primarily of cellulose, likely of cotton origin, suggesting an environmental source (eg, clothing). No mycobacteria or parasites were identified, and no clinical or laboratory signs of underlying medical conditions were found that could have been responsible for the skin lesions.

"To date, most of what is known about the condition is based on isolated case reports or anecdotal accounts. A range of potential infectious (e.g., Lyme disease, parasitic) and non-infectious causes has been postulated, but the etiology of this condition remains unknown and there have been no proven effective medical therapies," write Michele L. Pearson, MD, from the Division of TB Elimination, CDC, Atlanta, Georgia, and colleagues.

Patients who report having Morgellons report poorly healing or nonhealing skin lesions, excretion or emergence of fibers or solid material from the skin, and pruritus or other sensations such as stinging, biting, formication, or “pins and needlesâ€. The authors note that the number of reports of patients with this condition are rising, and suggest the disease may have a significant effect on quality of life.

Morgellons is not currently recognized as a distinct clinical disorder with diagnostic criteria, and many dermatologists consider the condition to be synonymous with delusional parasitosis. The etiology of the condition is unknown, and there are no proven medical therapies.

Inclusion for enrollment in the study required active skin symptoms within the preceding 2 weeks, as well as the completion of an Internet survey regarding environmental and travel history; tobacco, alcohol, and drug use; and a mental and physical health assessment. Of the 115 patients identified with Morgellons for this study, 70 completed the Web survey; 41 of these patients participated in clinical evaluation. These patients were examined by both an internist and a dermatologist, and blood, urine, and biopsy samples were collected. In addition, these patients were administered a battery of standardized neuropsychological tests, which were scored and interpreted by trained neuropsychologists.

The study authors acknowledge that because of the lack of standard diagnostic criteria for this condition, the reliance on self-reported symptoms may have led to reporting bias. Another possible limitation was having inclusion criteria that limited participation to those patients with recent symptoms and hampered the researchers' ability to describe the full clinical course of the illness.

"To our knowledge, this represents the most comprehensive, and the first population-based, study of persons who have symptoms consistent with the unexplained dermopathy referred to as Morgellons," write Dr. Pearson and colleagues.

"In the absence of an established cause or treatment, patients with this unexplained dermopathy may benefit from receipt of standard therapies for co-existing medical conditions and/or those recommended for similar conditions such [as] delusions infestation," the authors conclude.

Support for this study was provided by the Centers for Disease Control and Prevention. One or more of the authors are employed by Kaiser Permanente.

PLoS ONE. Published online January 25, 2012. Full text

[Guest guest]

They were doing fine, until they got to the last sentence. When are some researchers going to learn to stop promoting that it means the world is flat just because they, personally, cannot see beyond the horizon?

"In the absence of an established cause or treatment, patients with this unexplained dermopathy may benefit from receipt of standard therapies for co-existing medical conditions and/or those recommended for similar conditions such [as] delusions infestation," the authors conclude.

Sharon

[Guest guest]

Maybe it' fiberglass working it's way out. It's all over the place.They were doing fine, until they got to the last sentence. When are some researchers going to learn to stop promoting that it means the world is flat just because they, personally, cannot see beyond the horizon?

"In the absence of an established cause or treatment, patients with this unexplained dermopathy may benefit from receipt of standard therapies for co-existing medical conditions and/or those recommended for similar conditions such [as] delusions infestation," the authors conclude.

Sharon