A Cohort-Based Study of Patients With Delusional Infestation: Characterizing the Patient Population

Delusional infestation (DI) is a rare psychodermatologic disorder in which the exact epidemiologic data and effective management strategies are not yet well understood.

To investigate a recent cohort of DI patients to understand current trends in patient characteristics, presentation, and management of DI.

A retrospective chart review of patients with DI seen at the University of Michigan tertiary care dermatology clinics was performed between January 2021 and May 2024. We included patients who met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnostic criteria for DI who reported at least 1 complaint of living or nonliving delusions for at least 1 month.

We identified 81 DI patients (incidence 59.5/100 000 person-years; 84% female). Mean symptom onset was age 51.5, with a 3-year mean diagnostic delay. Most reported living delusions were notably parasites (24%) and bugs (22%). Common diagnostics were punch biopsies (35%) and mineral oil prep (15%). Depression (58%), anxiety (53%), and substance use (35%) were frequent, but only 31% formally saw psychiatry. Topical or oral antiparasitics were used in 58% (26% improved); second-generation antipsychotics in 31% (12% improved); first-generation antipsychotics (eg, pimozide) in 21% (18% improved). Pharmacotherapy response rates were modest; relapse rates were unclear.

We report a 2-fold increase in the incidence of DI and significant female predominance in our study population. The majority of patients experience symptoms of living infestation, with non-specific "bugs" or "parasites" being the most common delusion.