Patients have an unshakable belief that they are infested with insects, worms, mites, lice, or other organisms. They often provide vivid descriptions of how the organisms enter their skin and move around their bodies and bring samples of hair, skin, and debris such as dried scabs, dust, and lint on slides or in containers (the matchbox sign) to prove that the infestation is real. The condition is considered a somatoform type of delusional disorder. Patients may have other psychiatric or physical disorders (eg, structural brain disorders, toxic psychosis; 1).
It is important to establish an empathetic and supportive relationship with the patient. Although often rejected, the most effective treatment is with antipsychotic drugs (see table Conventional Antipsychotics). Typically, the patient seeks confirmation that the drug treats the infestation itself, and any suggestion that the treatment is for something else is met with resistance, rejection, or both. Thus, effective treatment often requires diplomacy and a delicate balance between offering proper treatment and respecting the patient’s right to know.