Other Infections

Morgellons Skin Disease Not Caused by Infection or Environment, CDC Says

The mysterious skin condition know as Morgellons syndrome does not appear to be caused by either infectious pathogens or environmental exposures, according to a Centers for Disease Control and Prevention (CDC) study reported in the January 25, 2012, online edition of the open-access journal PLoS ONE.

In January 2008, the CDC began an investigation to better understand a recent unexplained skin condition, or dermopathy, characterized by symptoms including skin sores or rashes, abnormal skin sensations, and the presence of fibers in affected areas.

The CDC partnered with Kaiser Permanente of Northern California (KP) -- a large group health plan -- which covers San Francisco and the surrounding region, an area where many such cases had been reported. The Armed Forces Institute of Pathology also worked on the comprehensive clinical and laboratory study.

According to a CDC summary of the research, investigators contacted KP members who had reported abnormal sores or skin sensations accompanied by fibers, whether or not they used the term "Morgellons" to describe their symptoms.

The analysis of case patients included 115 KP participants age 13 or older enrolled during 2006-2008. Most (77%) were women, the same percentage were white, and the median age was 52 years (ranging from 17 to 93 years).

Participants answered questions, completed standardized physical and mental health surveys, and underwent skin biopsies. The Unexplained Dermopathy Study Team then looked for any possible common causes or risk factors that might help explain the condition.

Results

• The skin condition was rare, with a prevalence of 3.65 cases per 100,000 enrollees.
• There was no clustering of cases within the 13-county area served by KP.
• Most case patients reported multi-system complaints, including 70% who reported chronic fatigue.
• 54% rated their overall health as fair or poor (mean Physical Component Scores and Mental Component Scores of 36.63 and 35.45, respectively).
• 59% of case patients showed evidence of cognitive impairment and 63% had evidence of clinically significant somatic (physical) complaints.
• Half of the patients had traces of various drugs (prescription, over-the-counter, illicit, or alternative remedies) detected in hair samples.
• 78% reported exposure to various solvents (e.g., paint thinner, lighter fluid).
• The most common histopathological abnormality was solar elastosis (sun damage), seen in 51% of skin biopsies.
• The most commonly affected areas were the forearms, back, chest, face, and lower legs.
• The median number of sores was 17 per case patient.
• No single underlying medical condition or infectious source was identified.
• Skin lesions were most consistent with arthropod (e.g., spider) bites or chronic excoriations (abrasions that could result from scratching).
• No parasites or mycobacteria were detected, and presence of bacteria was not consistent across cases.
• Most of the fiber material collected from patients' skin was composed of cellulose -- plant fibers -- likely of cotton origin
• There were no sociodemographic, clinical, or histopathological differences between case patients who reported presence of fibers and those with similar skin symptoms who did not.

Based on these findings, the study authors concluded, "This unexplained dermopathy was rare among this population of Northern California residents, but associated with significantly reduced health-related quality of life."

"No common underlying medical condition or infectious source was identified," they continued, likening it to more commonly recognized conditions such as "delusional infestation," or the belief that one has parasites on or under the skin.

"Upon thorough analysis, most sores appeared to result from chronic scratching and picking, without an underlying cause," according to the CDC summary. "Neuropsychological testing revealed a substantial number of study participants who scored highly in screening tests for one or more co-existing psychiatric or addictive conditions, including depression, somatic concerns (an indicator of preoccupation with health issues), and drug use."

"There was no indication that it would be helpful to perform additional testing for infectious diseases as a potential cause," the CDC concluded. "Future efforts should focus on helping patients reduce their symptoms through careful attention to treatment of co-existing medical, including psychiatric conditions, that might be contributing to their symptoms."

Patients who suffer from the skin condition -- like people with other unexplained conditions such as chronic fatigue syndrome -- object to the idea that "it's all in their heads" and many hope for further study to find a treatable etiology.

"I want to commend the CDC for doing this study and trying to get a handle on this disease, which has baffled many people and is a big problem," said Raphael Stricker, a Bay Area Lyme disease specialist who treats many people with Morgellons told the San Francisco Chronicle. "But the only thing it really tells us clearly is that we need to do more work, because we don't really understand this disease."

Investigator affiliations: Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, GA; Division of Research, Kaiser Permanente Northern California, Oakland, CA; HIV, STD, and Hepatitis Branch, Health and Human Services Agency, County of San Diego, San Diego, CA; Division of Food, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA; Environmental Pathology, Joint Pathology Center, Silver Spring, MD; Office of Research & Development, US Department of Veterans Affairs, Washington, DC; Department of Neurology, Emory University School of Medicine, Atlanta, GA; Department of Dermatology, University of Rochester School of Medicine, Rochester, NY; Division of Health Studies, Agency for Toxic Substances and Disease Registry, Atlanta, GA.

1/27/12

Reference

ML Pearson, JV Selby, KA Katz, et al. Clinical, Epidemiologic, Histopathologic and Molecular Features of an Unexplained Dermopathy. PLoS ONE 7(1):e29908. January 25, 2012.

Other Sources

Centers for Disease Control and Prevention. CDC Study of an Unexplained Dermopathy Background and Summary. January 25, 2012.

E Allday. Morgellons disease probably a delusion, feds say. San Francisco Chronicle. January 26, 2012.