Clinical, Epidemiologic, Histopathologic and Molecular Features of an Unexplained Dermopathy

Morgellons is a poorly characterized constellation of symptoms, with the primary manifestations involving the skin. We conducted an investigation of this unexplained dermopathy to characterize the clinical and epidemiologic features and explore potential etiologies.

A descriptive study was conducted among persons at least 13 years of age and enrolled in Kaiser Permanente Northern California (KPNC) during 2006–2008. A case was defined as the self-reported emergence of fibers or materials from the skin accompanied by skin lesions and/or disturbing skin sensations. We collected detailed epidemiologic data, performed clinical evaluations and geospatial analyses and analyzed materials collected from participants' skin.

We identified 115 case-patients. The prevalence was 3.65 (95% CI = 2.98, 4.40) cases per 100,000 enrollees. There was no clustering of cases within the 13-county KPNC catchment area (p = .113). Case-patients had a median age of 52 years (range: 17–93) and were primarily female (77%) and Caucasian (77%). Multi-system complaints were common; 70% reported chronic fatigue and 54% rated their overall health as fair or poor with mean Physical Component Scores and Mental Component Scores of 36.63 (SD = 12.9) and 35.45 (SD = 12.89), respectively. Cognitive deficits were detected in 59% of case-patients and 63% had evidence of clinically significant somatic complaints; 50% had drugs detected in hair samples and 78% reported exposure to solvents. Solar elastosis was the most common histopathologic abnormality (51% of biopsies); skin lesions were most consistent with arthropod bites or chronic excoriations. No parasites or mycobacteria were detected. Most materials collected from participants' skin were composed of cellulose, likely of cotton origin.

This unexplained dermopathy was rare among this population of Northern California residents, but associated with significantly reduced health-related quality of life. No common underlying medical condition or infectious source was identified, similar to more commonly recognized conditions such as delusional infestation.

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Michele L. Pearson¹, Joseph V. Selby², Kenneth A. Katz³, Virginia Cantrell², Christopher R. Braden⁴, Monica E. Parise⁵, Christopher D. Paddock⁶, Michael R. Lewin-Smith⁷, Victor F. Kalasinsky⁸, Felicia C. Goldstein⁹, Allen W. Hightower⁵, Arthur Papier¹⁰, Brian Lewis¹¹, Sarita Motipara², Mark L. Eberhard⁵^*, for the Unexplained Dermopathy Study Team^¶

1 Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America, 2 Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America, 3 HIV, STD, and Hepatitis Branch, Health and Human Services Agency, County of San Diego, San Diego, California, United States of America, 4 Division of Food, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America, 5 Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America, 6 Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America, 7 Environmental Pathology, Joint Pathology Center, Silver Spring, Maryland, United States of America, 8 Office of Research & Development, United States Department of Veterans Affairs, Washington, District of Columbia, United States of America, 9 Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, United States of America, 10 Department of Dermatology, University of Rochester School of Medicine, Rochester, New York, United States of America, 11 Division of Health Studies, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States of America

Abstract Top

Background

Morgellons is a poorly characterized constellation of symptoms, with the primary manifestations involving the skin. We conducted an investigation of this unexplained dermopathy to characterize the clinical and epidemiologic features and explore potential etiologies.

Methods

A descriptive study was conducted among persons at least 13 years of age and enrolled in Kaiser Permanente Northern California (KPNC) during 2006–2008. A case was defined as the self-reported emergence of fibers or materials from the skin accompanied by skin lesions and/or disturbing skin sensations. We collected detailed epidemiologic data, performed clinical evaluations and geospatial analyses and analyzed materials collected from participants' skin.

Results

We identified 115 case-patients. The prevalence was 3.65 (95% CI = 2.98, 4.40) cases per 100,000 enrollees. There was no clustering of cases within the 13-county KPNC catchment area (p = .113). Case-patients had a median age of 52 years (range: 17–93) and were primarily female (77%) and Caucasian (77%). Multi-system complaints were common; 70% reported chronic fatigue and 54% rated their overall health as fair or poor with mean Physical Component Scores and Mental Component Scores of 36.63 (SD = 12.9) and 35.45 (SD = 12.89), respectively. Cognitive deficits were detected in 59% of case-patients and 63% had evidence of clinically significant somatic complaints; 50% had drugs detected in hair samples and 78% reported exposure to solvents. Solar elastosis was the most common histopathologic abnormality (51% of biopsies); skin lesions were most consistent with arthropod bites or chronic excoriations. No parasites or mycobacteria were detected. Most materials collected from participants' skin were composed of cellulose, likely of cotton origin.

Conclusions

This unexplained dermopathy was rare among this population of Northern California residents, but associated with significantly reduced health-related quality of life. No common underlying medical condition or infectious source was identified, similar to more commonly recognized conditions such as delusional infestation.

Citation: Pearson ML, Selby JV, Katz KA, Cantrell V, Braden CR, et al. (2012) Clinical, Epidemiologic, Histopathologic and Molecular Features of an Unexplained Dermopathy. PLoS ONE 7(1): e29908. doi:10.1371/journal.pone.0029908

Editor: Christophe Egles, Université de Technologie de Compiègne, France

Received: April 29, 2011; Accepted: December 7, 2011; Published: January 25, 2012
This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Funding: Funding for this study was provided by the Centers for Disease Control (CDC) and Prevention. Epidemiologists from the CDC participated in the study design, data collection and analysis, decision to publish, and preparation of the manuscript.

Competing interests: One or more of the authors are employed by a commercial, not-for-profit entity (Kaiser Permanente). This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

* E-mail: mle1@cdc.gov
¶ Additional membership of the Unexplained Dermopathy Study Team is provided in the Acknowledgments.

PLoS ONE: Clinical, Epidemiologic, Histopathologic and Molecular Features of an Unexplained Dermopathy