Morgellons-like Disease of the Scalp

Morgellons disease remains a poorly understood condition, while the general medical consensus is that it is a form of delusional parasitosis in which individuals have sores they believe contain fibers. In fact, Morgellons disease may represent a culture-bound syndrome, i.e., a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease within a specific society or culture. We present a case of Morgellons-like disease of the scalp and discuss its relationship to psychopathology and specific features of the scalp microenvironment. The propositus suffered from an obsessive-compulsive disorder with a delusional overlay or rather belief system. Lesions were successfully treated with lesional botulinum toxin injections. The particular features of the hair and scalp with a microenvironment of microbes, parasites, and pollutants may contribute to the itching phenomenon and produce some debris that may be misinterpreted in its origins and pathogenicity. This case presentation exemplifies that the presence of multicolored filaments is neither specific nor of any diagnostic value. Botulinum toxin proved effective by virtue of its interference with neuropeptide substance P and acetylcholine as key players in the interaction between emotional shifts and bodily sensations, specifically of the hair and scalp.