68 years female complaining severe itch on face, axilla, back of the neck, genital areas and fingers since 3 months. She is getting intolerable itch at night times and also something crawling on those areas. And if she touches that area, she felt feeling of worms. 1) what is this condition? 2) Any investigations need this case? 3) How to manage this case.

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@Dr. P.kishore Kumar Sir! DELUSIONAL PARASITOSIS Delusions of parasitosis is a condition where an individual has the mistaken belief that they are being infested by parasites such as mites, lice, fleas, spiders, worms, bacteria, or other organisms. Delusions of parasitosis is sometimes called delusional infestation, pseudoparasitic dysesthesia, or parasitophobia. Delusions of parasitosis have also been associated with other psychiatric illnesses including schizophrenia, obsessional states, depression, bipolar disorder and anxiety disorders. Diagnosis: *Match Box Sign" or "Specimen Sign" may hit the diagnosis. Complete physical examination and appropriate laboratory tests can help to identify other diseases that mimic delusions of parasitosis and rule out any true infestations, e.g. with scabies or lice. *Skin scrapings and biopsies *Complete blood count *Chemistry profile *Thyroid function tests *Mineral and vitamin measurements, e.g. vitamin B12, ferritin (iron) *A history of drug abuse with cocaine, methylphenidate, or amphetamines must also be ascertained as these substances can induce the sensation of itchiness and result in skin picking. #This lady is obsessed with CLEANLINESS on account of delusional parasitosis. Treatment: Often management of these patients is best handled through the cooperation of dermatologists, psychiatrists and entomologists.

@Dr. P.kishore Kumar Sir! Please guide me with your final diagnosis.
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Arm region lesion is clearly against Tinea infection. So huge area canb due to scabies but here cardinal sign of scabies is also not present. May b senile pruritis because of senile psychosis

Thank you Doctors This patient came back today . No respond to the following treatment First I diagnosed as scabies or Comicosis(some bedbugs )according to that 1) advised to the patient with hot water scrubbing bath. 2) Advised eco- friendly treatment in house. 3) Application of Permethrin 5% lotion throughout the night. 4) Tab ivermectin 12 mg weekly once. 5) moisturiser with mild steroid. So I referred this case to PSYCHIATRIST. Any suggestions in your side doctors.Thank you.

Kishore Sir I don't think Delusional parasitosis as Dr Subhash diagnosed. This case presents with such classical intertriginous morphology and presentation which should be be considered as Cimicosis, Scabies before we decide it's Delusional.

Intertrigo dd seborrhoic dermatitis.

KIND OF OBSESSIVE COMPULSIVE NEUROSIS

Tinea infection with scabies

Tinea infection?

Timea infection of skin and nails.

This is not sign of tinea infection.its like a drug allergies with photo sensitivity

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