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This letter concerns a patient population that manifests a particular set of symptoms we have encountered with increasing frequency, and that OSU-CHS is actively researching.
The condition has been labeled as Morgellons Disease and it is unclear if this is a single disease or a multi-faceted syndrome.
What is unclear is if there actually is a patient population manifesting a particular set of symptoms. The only consistent distinguishing feature, the fibers, has been shown to be simple environment contamination, since fibers are everywhere and it is impossible to keep them out of lesions.
Until recently, most of these patients have been grouped as a subset of the diagnosis of Delusions of Parasites delusional parasitosis; DOP. Delusions of Parasites is the mistaken belief that one is infested with parasites.
If people simply have lesions, and find fibers in them, they may form the mistaken belief that their fibers are connected with their disease. DOP is a poor diagnosis in this case, and I have often spoken against this.
The Morgellons research foundation seek to characterise their campaign as a fight between two choices, either Morgellons is a new disease, or it is DOP. This serves to increase sympathy for sufferer, as clearly their symptoms particularly the lesions are real, and they do in fact find fibers in their lesions.
But the reality is more complex. Many of the sufferers clearly have some form of dermatitis artefacta, or neurotic ecoriations, and the causes of those symptoms are many and varied, and DOP plays only a small part in them.
After obtaining careful patient histories and thorough physical exam, we have determined that Morgellons patients have several important distinctions ruling out the diagnosis of DOP. Like I said, DOP plays only a small part here. So ruling it out only rules out a small part of the possible causes of the symptoms.
There are a LOT of other things that need to be ruled out before we can decide someone has a disease new to science. This population of patients frequently exhibit the following symptoms: A classic sign of Neurotic Excoriations. Pruritis itching has many causes. That lesions should itch is not at all surprising.
Itching can cause lesions via what is known as the itch-scratch-itch cycle, whereby the patient obtains temporary relief via scratching, but irritates and damages the skin in the process, causing the itching to return later. Eventually the damage to the skin causes lesions to form.
These fibers, which many healthcare providers initially thought to be textile contaminants, are often present in the deep tissue of biopsies obtained from unbroken skin of individuals with this condition. Careful examination of these fibers further reveals that they are frequently associated with hair follicles, and are definitely not textile in origin.
They are nerve fibers. It is unclear how this has been determined, how many fibers have been examined, and what the source of those fibers was.
Wymore has simply failed to identify some fibers out of the hundreds he has looked at. He is not an expert on fiber analysis, and even the experts can not identify every fiber they look at.
Not being able to identify a fiber tells you nothing. These neurological symptoms include peripheral tingling, paresthesias and varying degrees of motor involvement which appear to progress. That describes just about everyone over the age of If you were to ask any patient of middle age or above: The cause could be anything from very common conditions such as Carpel Tunnel Syndrome, arthritis, diabetes, hypothyroidism or atherosclerosis, to less common, but not unusual, conditions such as a brain tumor, motor neurone disease, or autoimmune disorders like multiple sclerosis or lupus erythematosus.
Worldwide it can be an indication of parasitic infection, which explains its popularity with some Morgellons believers, who often claim their doctors are too quick to discount exotic illnesses such as parasitic worms. Some people have elevated levels of IgE, which seems to be related to a higher incidence of allergies, eczema and asthma.
One can see some correlation here with conditions that have symptoms that might lead people to believe they have Morgellons.
There is another simple explanation for elevated IgE levels, Dr. Morgellons patients differ from classical, delusional parasitosis patients in several areas. They do not respond to antipsychotics, If they simply had eczema with itching a perfectly normal conditionand found some fibers on their skin, then antipychotics would not help.
Again though, this is not DOP vs. A vast number of conditions could cause these symptoms, many of which would not respond to antipsychotics. Also, this is based on what evidence?
Clinical studies, or anecdotes? Again, what is the evidence? I suspect this is based on anecdotal self-reporting by the patients.Dear Twitpic Community - thank you for all the wonderful photos you have taken over the years. We have now placed Twitpic in an archived state.
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“Remarkably, not all people with this disease have overt skin lesions, as some individuals report intact skin. The troubling sensations and accompanying physical structures, are the consistent clues to this infectious process.”.
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