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WORMS ON MY SKIN????

 I feel like worms crawling on my skin!!!!!

♦️What is my disease ??EKBOM’S SYNDROME/DELUSIONAL PARASITOSIS 

♦️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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