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Delusions of parasitosis — Clinical Guidelines

Overview

Delusions of parasitosis (DoP) is a psychocutaneous condition characterized by a fixed false belief in parasitic infestation of the skin, often accompanied by sensations of biting, stinging, or crawling without objective evidence 2 3.

Diagnosis

Fixed, false belief in parasitic infestation 2 3.

Absence of actual dermatological pathology despite patient's complaints 2 3.

No specific laboratory tests; diagnosis primarily clinical 2 3.

Differential diagnosis includes true dermatological conditions mimicking parasitic infestations 2 3.

Management

First-line treatment: Antipsychotic agents, particularly pimozide 6 (treatment of choice) 6.

Adjunctive treatments: Building therapeutic rapport and psychological support are crucial 2 4.

Dosage: Specific dosing details for pimozide not provided in abstracts 6.

Avoidance: Refrain from prescribing additional antiparasitic medications unless there is a concurrent, confirmed parasitic infestation 7.

Special Populations

Pregnancy: No specific guidance provided in abstracts [].

Pediatrics: No specific guidance provided in abstracts [].

Elderly: No specific guidance provided in abstracts [].

Comorbidities: Focus on managing psychiatric comorbidities with antipsychotics; caution with potential drug interactions 6.

Key Recommendations

Initiate treatment with antipsychotic agents, specifically pimozide, for delusional symptoms 6 (Evidence: Strong).

Prioritize establishing a therapeutic alliance and psychological rapport with the patient to enhance treatment acceptance 2 4 (Evidence: Moderate).

Avoid prescribing antiparasitic medications in the absence of confirmed parasitic infestation to prevent reinforcing delusional beliefs 7 (Evidence: Expert opinion).

References

1 Modingam P, Faillie JL, Campillo JT. Serious adverse events reported with benzimidazole derivatives: A disproportionality analysis from the World Health Organization's pharmacovigilance database. PLoS neglected tropical diseases 2024. link 2 Patel V, Koo JY. Delusions of parasitosis; suggested dialogue between dermatologist and patient. The Journal of dermatological treatment 2015. link 3 Schairer D, Schairer L, Friedman A. Psychology and psychiatry in the dermatologist's office: an approach to delusions of parasitosis. Journal of drugs in dermatology : JDD 2012. link 4 Mostaghimi L. Treating patients with delusions of parasitosis: a blueprint for clinicians. Cutis 2010. link 5 Szepietowski JC, Salomon J, Hrehorów E, Pacan P, Zalewska A, Sysa-Jedrzejowska A. Delusional parasitosis in dermatological practice. Journal of the European Academy of Dermatology and Venereology : JEADV 2007. link 6 Lorenzo CR, Koo J. Pimozide in dermatologic practice: a comprehensive review. American journal of clinical dermatology 2004. link 7 del Giudice P, Chosidow O, Caumes E. Ivermectin in dermatology. Journal of drugs in dermatology : JDD 2003. link

Delusions of parasitosis