How to successfully handle the initial encounter with a delusional infestation patient

Managing a delusional patient is one of the most challenging situations experienced by dermatologists. This is exacerbated by the scarcity of psychodermatology training offered in residency and similar training programs. A few practical management tips can be easily employed in the initial visit to avoid an unsuccessful encounter. We highlight the most important management and communication techniques needed for a successful first encounter with this traditionally tricky patient population. Topics such as diagnosing primary versus secondary delusional infestation, how to prepare before entering the exam room, how to write the initial patient note, and when is the ideal time to introduce pharmacotherapy are discussed. Tips on preventing clinician burnout and creating a stress-free therapeutic relationship are reviewed.