Delusional Parasitosis


Delusional Parasitosis, Delusions of Parasitosis, Delusory Parasitosis, Ekbom's Syndrome, Dermatophobia, Parasitophobic Neurodermatitis, Parasitophobia, Entomophobia

  • Epidemiology
  1. More often seen in women over age 50 years
  • Classification
  1. Monosymptomatic Hypochondriacal Psychosis
  • Symptoms
  1. Patient convinced of Parasite infestation
  • Signs
  1. Matchbox Sign
    1. Patient presents container with purported Parasite
  2. Focal erosions on exposed areas of arms and legs
    1. Results from attempts to pick bugs from skin
  • Labs (consider for differential diagnosis evaluation)
  • Management
  1. Confirm diagnosis
    1. Rule-out true parasitic cause of symptoms
    2. Evaluate for differential diagnosis as above
  2. General measures
    1. Establish patient's trust
      1. Listen
      2. Communicate empathy and sensitivity
      3. Avoid offending or further isolating patient
    2. Consider psychotherapy
  3. Pimozide (Orap)
    1. Initial dose: One-half of a 2 mg tablet qd
    2. Titrate dose: Increase dose by 1 mg/week to 4-6 mg qd