An in-depth critical analysis of Morgellons: Delusion or disease?

Morgellons is a poorly understood entity and is characterized by cutaneous findings such as fibers emerging from the skin, which can cause secondary symptoms such as formication and itching. Morgellons is an understudied area with conflicting results; this imposes challenges to clinicians while navigating consultations and understanding, diagnosing, and treating Morgellons. This literature review summarizes the available data on the etiology, epidemiology, clinical presentation, treatment, and social media influence within Morgellons. Medical Subject Headings terms were used to systematically search PubMed, Medline, and EMBASE, and two independent reviewers screened the selected articles, revealing that Morgellons is poorly understood among the scientific community, with a population prevalence of 3.65/100,000. The etiology of Morgellons is controversial, and opinions among psychiatrists and dermatologists are conflicting. Some studies propose a biological origin linked to Lyme disease, whereas others view Morgellons as a delusional disorder without an underlying pathology. The conflicting views can be attributed to the lack of robust research with no consensus on an established pathophysiology, disease classification, or treatment guidelines. Herein, the majority of literature views Morgellons as a delusional disorder, wherein an underlying pathology triggers the delusional experience. However, further studies are required to accurately classify the disease and direct patients to the right specialists to ensure effective treatment and development of treatment guidelines. Nevertheless, a holistic treatment approach, integrating psychosomatic and dermatological modalities, is lacking.