Sir,
Ekbom Syndrome is also called delusory parasitosis, psychogenic parasitosis, or dermatozoic delusion [
We describe one case of a patient with delusory parasitosis who consulted many dermatologists for pruritic skin lesions.
A 56-year-old man presented to our clinic with a four-month history of recurrent pruritic papular eruption evolving in erosive lesions covered by crusts. The lesions had begun on his face, and gradually progressed to his upper arm. The disease was reported as heavily troublesome, and significantly impaired the everyday activities of the patient. He had a history of choroidal melanoma diagnosed 7 years ago and treated by protontherapy. There were no local or systemic complications of his melanoma. The man denied any drugs intake. The patient had been seen by several physicians and had experienced different treatments without improvement. Physical examination revealed several erosions, hematic and serous crusts on a slightly erythematous background. The lesions were located on the left half of the face (
Erosions located on the left half of the face.
Multiple erosions with hematic and serous crusts located on the right upper limb.
Delusory parasitosis is uncommon psychiatric disorder that may represent a challenge for the dermatologist, as it was in our case. It is characterized by the fixed belief to be infested with parasites or small living creatures, although there is no medical evidence for this [
The Ekbom syndrome is relatively rare. The majority of the patients are women. The average age at the beginning of the disease is 55,6 years [
Patients usually experience itching, which they attribute to the presence of animals in or under the skin. They often try to self-treat the disorder by scratching or by using disinfectants or pesticides. This causes skin lesions and itching, which in turn confirm the patient’s belief of being infested and leads to a vicious circle of skin lesions, itching and delusional beliefs [
There are many psychiatric disorders associated such as anxiety, phobia, hypochondria, non-organic and organic delirious disorder [
Some cases are associated to organic diseases like hypothyroidism, diabetes, cortical lesions, mental retardation, kidney failure, hepatitis, severe anemia, intoxication by medication and cardiopathies, substance abuse, infectious and endocrine disorders [
The management of this condition is difficult, as patients with this disorder reject psychiatric diagnosis and treatment and often consult many specialists (dermatologists, internists or allergists). Antipsychotic drugs lead to improvement; pimozide was recommended as the drug of choice. Full remission is obtained in only half of the cases with antipsychotic treatment. Psychotherapy support is also needed [
Delusory parasitosis must be known by the dermatologist. This syndrome requires a multi-disciplinary approach.
The examination of the patient was conducted according to the Declaration of Helsinki principles.