I feel like worms crawling on my skin!!!!!
♦️Who can get this disease?Females-2-3 times more affected with a Bimodal age of onset(20-30yrs,>50yrs)
📍Reasons to develop this disease ?
*Psychiatric disorders:-Bipolar affective disorder (BPAD) ,Hypochondriasis, Body dysmorphic disorder (BDD), depression ,anxiety, Schizophrenia
(31-81% have a comorbid psychiatric condition)
*Neurological disorders:-Cerebro vascular accident (CVA) ,Dementia, Delirium. Multiple sclerosis ,Meningitis ,Encephalitis, syphilis, cerebral trauma &neoplasms
*Substance intoxication:-Amphetamines, coccaine, Hallucinogens, Cannabinoids, synthetic cathinones
*Substance withdrawal:-Alcohol, Benzodiazepines
*Autoimmune disorders:-SLE
*Endocrinological:-Hypothyroidism, Hyper thyroidism ,Pan hypopituitarism, Diabetes mellites
*Neoplasms-Colon cancer, lung carcinoma ,mediastinum cancers ,breast cancer ,lymphoma
*Drugs:-Antibiotics (Clarithromycin, Ciprofloxacin, Erythromycin),L-DOPA, Ropinirole, Pramipexole, Gabapentin, Topiramate, Corticosteroids, interferon, Phenelzine, methylphenidate, amphetamine diet pills
*Other medical conditions:-Hepatic failure ,renal failure ,Leprosy, Hepatitis ,Tuberculosis, Vitamin deficiencies
📌The prototype patient of Ekbom’s syndrome…..
📍A Middle aged woman
📍Claims that she is being infected by some type of parasite, which she occasionally sees & usually feels on/under her skin, head ,eyes etc
📍May describe as a larva OR worm OR flea OR fungus OR simply a small organism
📍The belief qualifies for the definition of delusion
📍Onset-insidious usually ,rarely abrupt
📍Some might have had a real infestation earlier to which they attribute the current symptoms
📍Intense pruritus & dermatitis artefacta
📍Repeated scratching causing excoriations & injuries
📍Overuse of disinfectants /insecticides
📍Excavasations in search of parasites
📍Self mutilation-Self inflicted burn marks and scabs
📍Pits , ulcers , bruises or scars may be seen
📍Hair pulling, alopecia, Onychotillomania, Doctor shopping are usually seen in the patients
📍Repeated bathing & washing of clothes
📍Fear of contaminating other households
📍All the symptoms won't fit into one single organic disease
📍Matchbox sign/Specimen sign(bring specimens/skin particles/hair samples in small boxes)/wrapped in a paper/in plastic bags-for evidence
📍Photos/self recorded videos will be shown by patient as evidences
📍May have hallucinations coexistent(formications-substance abuse, Cocaine bugs)
📍Other than the delusion of parasites, she reasons normally& appear normal
📍Bacterial superinfection
📌Approach to such patients…..
📍It is extremely challenging to diagnose & manage Ekbom syndrome
📍Exclude real infestation(Travel history, contact with infested patients, examination)
📍Find if its primary or secondary delusional parasitosis
(CBC,AEC,TFT,VDRL,LFT,RFT,HIV,VM, Vitamin levels, tox screen, neuroimaging)
📍If secondary,address the underlying cause
📍If primary, treat with empathy by associating with psychiatrist
📍Trying to covince them that they are wrong, will not work
📍Antihistamines ,topical medications for the injuries
📍Specific pharmacotherapy:-Antipsychotics(60-100% remission)
*1st line :-
-Earlier drug of choice🡪Pimozide 1 mg to 10mg(Side effects-Extra pyramidal side effects,Cardiotoxic)
-Now a days, second generation anti psychotics are the first line of management
Risperidone(0.5-6mg)
Quetiapine(25-600mg)
Aripiprazole(2-30mg)
Olanzapine 5mg
*Long acting injectable anti psychotics if poor compliance
📌Conclusion
Ekbom syndrome or Delusional parasitosis is a psychocutaneous disorder which is difficult to manage. Need a holistic approach by a team of dermatologist and Psychiatrist
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