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Friday, May 10, 2013

LD or Lyme borreliosis as it is sometimes called, is borreliosis in the strictest sense. The dermatology profession now has to consider that in the same manner, the more correct terminology for MD would be 'borrelial dermatitis'. 'Spirochetal dermatitis' could be considered as a suitable term but in the authors opinion is not specific enough as the pathogens appear to specifically belong to members of the genus Borrelia.

Discussion
Borrelial dermatitis or MD is characterized by the progressive onset of skin irritation due to epidermal formation of filaments known to be keratin or collagen4 in nature and arising from the base of the epidermis and can arise from a disrupted hair follicle as demonstrated in Figure 9. Filaments are typically 5–50 microns in diameter. Extrusion through skin and entrapment under the skin leads to pruritus, formication, other tactile disturbances and subsequent skin damage, both internal and external, which at the extreme can manifest as large chronic ulcerations. The clinical appearance of skin can range from an eczema-like appearance through to that of nodular prurigo. Mucosal surfaces may similarly be affected and nail dystrophy may be present. Evidence of multi systemic LD (borreliosis) can be found. Spirochetal presence can be demonstrated and borrelial infection implicated5. Although it is not the authors' belief that MD is primarily a psychotic disorder, it is evident that psychiatric comorbidity is often present in this patient group. Whether this is due to a pre-existing psychiatric diagnosis or one which develops such as acute stress reaction, adjustment disorder or post-traumatic stress disorder during the course of emerging MD symptoms and subsequent attempts at treatment, it is important to recognize psychiatric comorbidity. Timely identification and efficacious treatment of psychiatric symptoms can improve overall psychological well-being, possibly reduce the chance that patients avail themselves of dangerous and idiosyncratic treatments for MD symptoms, increase rapport and follow up with physicians in multiple specialities, and preserve the dignity and respect which is due to the patient. Hylwa and co-authors reported a significant load of psychiatric burden in a study of Mayo clinic patients with "delusional infestation" but psychiatric delusional conditions were not reported44. We argue that Morgellons disease, a disorder by and large dismissed by the profession as delusions of parasitosis, in particular by dermatologists and primary care physicians, and supposedly highly vectored by internet transmission should now be called borrelial dermatitis within the profession and acknowledged as a presentation of a multisystem infective disease (LD) and treated appropriately as such35. Research needs to be directed at identifying the fundamental flaw in filament production at the cellular level, which may involve RNA/DNA dysfunction, in the hope of addressing further treatment.


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