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February 8, 2012

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Creepy, crawling skin? It's in your mind

IMAGINE having the feeling that tiny bugs are crawling on your body, that you have oozing sores and mysterious fibers sprouting from your skin.

Sound like a horror movie? In 2008, US federal health officials began to study people saying they were affected by this freakish condition called Morgellons.

The study cost nearly US$600,000. Its long-awaited results, released late last month, concluded that Morgellons exists only in the patients' minds.

"We found no infectious cause," says Mark Eberhard, a Centers for Disease Control and Prevention official who was part of the 15-member study team.

Sufferers of Morgellons describe symptoms including fatigue, erupting sores, crawling sensations on their skin and - perhaps worst of all - mysterious red, blue or black fibers that sprout from their skin.

Some say they've suffered for decades, but the syndrome wasn't named until 2002, when "Morgellons" was chosen from a 1674 medical paper describing similar symptoms.

Afflicted patients have documented their suffering on websites and many have vainly searched for a doctor who believed them. Some doctors believe the condition is a form of delusional parasitosis, a psychosis in which people believe they are infected with parasites.

Last May, Mayo Clinic researchers published a study of 108 Morgellons patients and found none suffered from any unusual physical ailment. It concluded that sores on many of them were caused by their own scratching and picking at their skin.

The aim was to give scientists a better idea of how common Morgellons actually is. They focused on more than 3 million people living in 13 counties in Northern California, a location chosen in part because all had health insurance through Kaiser Permanente of Northern California, which had a research arm that assisted in the project.

Many of the anecdotal reports of Morgellons came from the area.

Culling through Kaiser patient records from July 2006 through June 2008, the team found - and was able to reach - 115 who had what sounded like Morgellons. Most were middle-aged white women. They were not clustered in any one spot.

That led to the finding that Morgellons occurred in roughly four out of every 100,000 Kaiser enrollees. "So it's rare," Eberhard says.

Roughly 100 agreed to at least answer survey questions, and about 40 consented to a battery of physical and psychological tests over several days.

Blood and urine tests and skin biopsies checked for dozens of infectious diseases, including fungus and bacteria that could cause some of the symptoms. The researchers found none that would explain the cases.

There was no sign of an environmental cause, either, although researchers did not go to each person's house to look around.

What stood out was how the patients did on the psychological exams. Though normal in most respects, they had more depression than the general public and were more obsessive about physical ailments, the study found. However, they did not have an unusual history of psychiatric problems, according to their medical records. And the testing gave no clear indication of a delusional disorder.

So what do they have? The researchers don't know. They opted or "unexplained dermopathy."

But clearly, something made them miserable. "The absence of evidence is not evidence of absence," according to Felicia Goldstein, an Emory University neurology professor and study co-author.

She says patients might be helped by cognitive behavioral therapy that could help them deal with possible contributing psychological issues.


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