Int J Gen Med. 2016; 9: 349–354.
Published online 2016 Oct 14. doi: 10.2147/IJGM.S116608
PMCID: PMC5072536
PMID: 27789971
Morgellons disease: a filamentous borrelial dermatitis
Marianne J Middelveen and Raphael B Stricker
Morgellons disease (MD) is a dermopathy characterized by multicolored filaments that lie under, are embedded in, or project from skin. Although MD was initially considered to be a delusional disorder, recent studies have demonstrated that the dermopathy is associated with tickborne infection, that the filaments are composed of keratin and collagen, and that they result from proliferation of keratinocytes and fibroblasts in epithelial tissue. Culture, histopathological and molecular evidence of spirochetal infection associated with MD has been presented in several published studies using a variety of techniques. Spirochetes genetically identified as Borrelia burgdorferi sensu stricto predominate as the infective agent in most of the Morgellons skin specimens studied so far. Other species of Borrelia including Borrelia garinii, Borrelia miyamotoi, and Borrelia hermsii have also been detected in skin specimens taken from MD patients. The optimal treatment for MD remains to be determined.
Morgellons disease (MD) is an emerging dermopathy with worldwide distribution. The name “Morgellons” is derived from a disease recognized in the seventeenth century in French children by Sir Thomas Browne. These children were noted to have “coarse hairs” protruding from their backs.1 The distinguishing feature of MD is the appearance of skin lesions with filaments that lie under, are embedded in, or project from skin (Figures 1 and and2).2). Filaments can be white, black, or brightly colored.2–6 Fur thermore, MD patients exhibit a variety of manifestations that resemble symptoms of Lyme disease (LD), such as fatigue, joint pain, and neuropathy.2–6 A study found that 98% of MD subjects had positive LD serology and/or a tickborne disease diagnosis,5 confirming the clinical association between MD and spirochetal infection. Conversely, 6% of LD patients in an Australian study were found to have MD.7
Association of MD with Borrelia infection
Borrelia spirochetes have repeatedly been detected in MD skin and tissue samples (Figures 3 and and4).4). Initial studies confirmed the presence of Borrelia burgdorferi sensu stricto (Bb ss) spirochetes within dermatological tissue removed from MD lesions of four North American patients.11,12 A subsequent study reported the detection and identification of Borrelia garinii in Morgellons skin samples obtained from an Australian patient.15 A larger study subsequently reported the detection of Borrelia spirochetes in 25 MD subjects.13 Detection of Borrelia DNA by polymerase chain reaction (PCR) followed by Sanger sequencing in two independent laboratories determined that the Borrelia spirochetes detected in these studies were predominantly Bb ss, but B. garinii and Borrelia miyamotoi were also reported. More recently, studies of MD specimens in two additional laboratories have detected Borrelia DNA of three Borrelia spp., Bb ss, B. garinii, and Borrelia hermsii.16,17 The fact that four different laboratories have been able to detect Borrelia DNA in Morgellons specimens shows that these findings are reproducible.
Treatment of MD
Since a clinical classification of MD has not been universally accepted, optimal treatment for the disease remains unsettled. Nevertheless, several therapeutic principles have emerged: 1) the earlier the treatment is initiated in the course of MD, the better the outcome appears to be; 2) treatment should be aimed at the underlying tickborne disease; 3) prolonged combination antibiotic therapy may be necessary to eradicate dermopathy; and 4) antiparasitic therapy may be useful in some patients with MD. At this point, the most logical treatment is supported by the guidelines of the International Lyme and Associated Diseases Society.43 Although treatment with antipsychotic agents has been proposed for patients with neuropsychiatric symptoms of MD, this treatment generally fails without concomitant therapy of the underlying tickborne disease.15 Additional approaches with agents such as dapsone merit further study.44
Conclusion
In summary, MD is an emerging dermopathy that is associated with Borrelia infection, and the growing number of MD cases reflects the increase in tickborne diseases around the world. Although some medical practitioners erroneously consider MD to be caused by a delusional disorder, studies have shown that MD is a somatic illness that appears to be triggered by Borrelia infection. The optimal treatment for MD remains to be determined.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072536/