Treating A Patient Who Feels There Are Parasites Under Her Skin

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Author(s): 
Tracey Vlahovic, DPM

   Consider the risk/benefit ratio for these patients in order to improve their quality of life. For pimozide alone, the full remission rates have ranged from 33 to 90 percent. However, it is a challenge to have the patient agree to this therapy and it takes patience and empathy on the part of the treating physician. Encouraging the patient to shift his or her focus from the “infestation” to the suffering he or she is experiencing is a place to begin the pharmacologic management conversation.

   In the past, this patient had refused psychiatric consult. In general, if the patient improves with wound care and pharmaceutical management of the delusion, the physician can recommend psychiatric consultation once the delusions have been reduced. Ideally, both a psychiatrist and attending clinician would evaluate the patient in the same visit. However, this may prove challenging due to the trust issues of these patients.

   This patient moved on to another physician and I suspect a multiple number of physicians after that. Management of these patients is challenging and can be frustrating. Even though the clinician may have the best interest of the patient in mind, the patient’s delusion is so fixed and unwavering that it is a true barrier to her current care and quality of life.

   Dr. Vlahovic is an Associate Professor and J. Stanley and Pearl Landau Faculty Fellow at the Temple University School of Podiatric Medicine. She is board certified by the American Board of Podiatric Surgery.

References

1. Sandoz A, LoPiccolo M, Kusnir D and Tausk FA. A clinical paradigm of delusions of parasitosis. J Am Acad Dermatol. 2008; 59(4):698-704.
2. Edlich RF, Cross CL, Wack CA and Long WB. Delusions of parasitosis. Am J Emerg Med. 2009; 27(8):997-999.
3. Shmidt E and Levitt J. Dermatologic infestations. Int J Dermatol. 2012; 51(2):131-41.

   Dr. Vlahovic writes a DPM Blog for Podiatry Today at http://bit.ly/w3MdZj .

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Vincent DiPaolo, DPMsays: April 27, 2012 at 5:31 pm

Very interesting case Tracey. I've never seen anything like this and I've been in practice for 32 years. Thanks for sharing this very, very unusual case with your colleagues.

Vinny DiPaolo
Plainview, Texas

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