It is enough to make YOUR skin crawl

Two groups, one from Bethesda, MD and the other from Modena, Italy, provide an interesting contrast in the scientific investigation of a rare and mysterious disease. They arrive at polar opposite conclusions about the origins and causation of the bizarre and outwardly creepy condition known as Morgellons disease (MD) from their studies. Symptoms of this strange disease, described as early as the 1600’s, include the eruption of black or multicolored fibers from skin lesions. Patients also report a sensation of movements under the skin, literally having their skin crawl. Up until the past few years, the vague fatigue, joint pain, general neuropathy and reported skin fibers, were dismissed as delusional and patients treated for psychosis. However, the very creepy nature of this disease may well be the basis for any underlying psychosis present and hallucinations may result from the actual disease onset.

The rise of tick-borne diseases

Lyme disease (LD) and the spirochete bacteria causing the disease, Borrelia burgdorferi, are now well studied. Deer ticks are the major vectors for human transmission and classical signs of infection typically begin with a red round rash at the site of the initial tick bite. Although infrequent, some patients experience long lasting symptoms, including joint pain and memory loss. Although these symptoms are very reminiscent of the vague issues reported by MD suffers, a direct connection between the two diseases has only recently been uncovered.

Delusion or reality? Scientific evidence supports both.

Perhaps because the majority of described cases of MD are middle-aged white women, doctors have generally assumed that this condition is a delusional disorder and patients are left to suffer without interventional treatments. Evidence recently published in the journal Ultrastructural Pathology (June 2106) suggests that at least in the one patient they studied, the erupting fibers viewed with sophisticated high-powered electron microscopy paired with x-ray micro-elemental analysis reveal considerable similarity to her dog’s hair. They conclude that psychotherapy, not antibiotic therapy, would be the desired treatment for a disease in the Munchausen by proxy family of mental disorders. However, they have based their conclusion on a single patient and without any other clinical monitoring or analysis for Borrelia spp. signatures.

Two publications from a leading LD disease research team offer a different story. They initially hypothesize that MD is a cutaneous, i.e. skin, form of LD, after spiral shaped bacteria were discovered in skin samples from four MD patients. In the first publication from BMC Dermatology in 2015, the authors utilize multiple methods to detect traces of Borrelia spp. from a cohort of 25 MD patient samples. Strong PCR based evidence, combined with definitive re-culturing experiments, lead these scientist to conclude that MD is a true somatic dermopathology with Borrelia burgdorferi as chief causative agent. Further, they are able to pinpoint the likely cell types most affected by the spirochetes as keratinocytes and skin fibroblasts, the major producer of hair collagen and keratin, explaining the variations in color seen as fibers emerge from patient lesions.

The most recent study from this group provides additional evidence for this theory. Citing similarities between human MD and bovine digital dermatitis (BDD), a known spirochete induced condition, and citing a previous study demonstrating a 98% correlation of MD patients with clinical tick-borne disease biomarkers verses only 6% of LD patients with correlative MD symptoms; they investigate the possibility that an additional trigger exists for the development of MD. With startling clarity, they visually demonstrate the emergence of fibers and the presence of morphological spirochetes in specific skin cells. Others have found additional infectious bacteria or pathogens in MD samples, leading to the speculation that MD is driven by co-infections or environmental factors, such as compromised immune status, existing inflammatory states or genetic backgrounds. Interestingly, genetic regulation of known collagen and keratin promoters and transcription factors are positively influenced by inflammatory signaling molecules, indicating a possible rational explanation for development of long fibers composed of collagen/keratin bundles.

Leaving patients in the wind

With the longstanding controversy surrounding etiology of MD clearly unresolved, patients will still be at risk for mental illness diagnoses. Both research and clinical reports indicate that LD is associated with some neurological issues spanning the spectrum from schizophrenia to depression but these data haven’t translated to MD yet. The idea that people experience creepy crawly skin and erupting unknown long strings is like a scene from an alien horror movie. It is understandable that clinical definitions of MD have currently excluded the possibility that this disease is potentially treatable with antibiotics. Let us use science to carefully unravel this mysterious illness before labeling people lunatics.

Additional Reading

Roncati, et al, The first investigative science-based evidence of Morgellons psychogenesis. Ultrastructural Pathology (2016), 40, 249.

Middelveen, et al, Exploring the association between Morgellons disease and Lyme disease: identification of Borrelia burgdorferi in Morgellons disease patients. BMC Dermatology (2015), 15, 1.

Middelveen, et al, Morgellons disease: a filamentous borrelial dermatitis. Intl J of General Medicine (2016), 9, 349.

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