Is It a Skin Disorder or Paranoia?

In a thought-provoking presentation at the 2025 Society of Dermatology Physician Assistant (SDPA) annual summer meeting, Dr. Theodore Rosen, vice chair of dermatology at Baylor College of Medicine, shared a staggering case that challenges the boundaries between skin health and mental health.

Imagine a patient so convinced that tiny alien spaceships have landed on her head that she resorts to injuring herself in a desperate attempt to expel them. Dr. Rosen described the patient's severe delusion, known as delusions of parasitosis, or Ekbom syndrome. This affliction manifests as fixed, false beliefs that persist despite clear evidence to the contrary.

Understanding Delusions of Parasitosis

In the realm of dermatology, patients may fear that parasites or bugs are infesting their skin, leading to extreme actions. Dr. Rosen emphasized that these cases require a referral to mental health professionals, not dermatologists. He noted that while medications like risperidone, aripiprazole, and pimozide are potential treatments, they often show limited effectiveness, and mental health support is critical.

First-line treatment recommendations lean toward olanzapine, which has a 75% response rate, though it too isn't foolproof. Patients are advised to monitor their progress over weeks while under strict medical supervision.

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