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Int J Gen Med. 2016; 9: 349–354.
Published online 2016 Oct 14. doi:  [10.2147/IJGM.S116608]
PMCID: PMC5072536
PMID: 27789971
Morgellons disease: a filamentous borrelial dermatitis
Marianne J Middelveen and Raphael B Stricker

 
Morgellons disease (MD) is a dermopathy characterized by multicolored filaments that lie under, are embedded in, or project from skin. Although MD was initially considered to be a delusional disorder, recent studies have demonstrated that the dermopathy is associated with tickborne infection, that the filaments are composed of keratin and collagen, and that they result from proliferation of keratinocytes and fibroblasts in epithelial tissue. Culture, histopathological and molecular evidence of spirochetal infection associated with MD has been presented in several published studies using a variety of techniques. Spirochetes genetically identified as Borrelia burgdorferi sensu stricto predominate as the infective agent in most of the Morgellons skin specimens studied so far. Other species of Borrelia including Borrelia garinii, Borrelia miyamotoi, and Borrelia hermsii have also been detected in skin specimens taken from MD patients. The optimal treatment for MD remains to be determined.
Keywords: Morgellons disease, dermatitis, Lyme disease, Borrelia burgdorferi, spirochetes

Introduction
Morgellons disease (MD) is an emerging dermopathy with worldwide distribution. The name “Morgellons” is derived from a disease recognized in the seventeenth century in French children by Sir Thomas Browne. These children were noted to have “coarse hairs” protruding from their backs.1 The distinguishing feature of MD is the appearance of skin lesions with filaments that lie under, are embedded in, or project from skin (Figures 1 and ​and2).2). Filaments can be white, black, or brightly colored.2–6 Fur thermore, MD patients exhibit a variety of manifestations that resemble symptoms of Lyme disease (LD), such as fatigue, joint pain, and neuropathy.2–6 A study found that 98% of MD subjects had positive LD serology and/or a tickborne disease diagnosis,5 confirming the clinical association between MD and spirochetal infection. Conversely, 6% of LD patients in an Australian study were found to have MD.7

The similarity between MD and an animal disease, bovine digital dermatitis (BDD), an acknowledged spirochetal infection that is associated with ulcerative lesions exhibiting keratin projections, was previously explored.6 Treponemal spirochetes are the primary etiologic agents of BDD.8,9 A causal relationship between spirochetal infection and filament formation was confirmed by duplication of the clinical disease via experimental infection with pure cultured treponemes.8,9 This prompted further investigation into the possibility of a spirochetal etiology for MD to discover if a similar disease process occurred at the cellular level.

Association of MD with Borrelia infection
Borrelia spirochetes have repeatedly been detected in MD skin and tissue samples (Figures 3 and ​and4).4). Initial studies confirmed the presence of Borrelia burgdorferi sensu stricto (Bb ss) spirochetes within dermatological tissue removed from MD lesions of four North American patients.11,12 A subsequent study reported the detection and identification of Borrelia garinii in Morgellons skin samples obtained from an Australian patient.15 A larger study subsequently reported the detection of Borrelia spirochetes in 25 MD subjects.13 Detection of Borrelia DNA by polymerase chain reaction (PCR) followed by Sanger sequencing in two independent laboratories determined that the Borrelia spirochetes detected in these studies were predominantly Bb ss, but B. garinii and Borrelia miyamotoi were also reported. More recently, studies of MD specimens in two additional laboratories have detected Borrelia DNA of three Borrelia spp., Bb ss, B. garinii, and Borrelia hermsii.16,17 The fact that four different laboratories have been able to detect Borrelia DNA in Morgellons specimens shows that these findings are reproducible.

MD and psychiatric diagnoses
There are over 250 peer-reviewed articles linking LD and associated tickborne diseases to mental illness.36–38 A spectrum of psychiatric illnesses occurs in patients with neuroborreliosis, including paranoia, schizophrenia, bipolar disorder, delusions, sensory hallucinations, major depression, and mania.39 Neurological symptoms associated with LD range in severity from marginal to critical, and can include cognitive impairment, dementia, insomnia, irritability, anxiety, depression, personality disorders, psychosis, and suicidal or homicidal tendencies.37 The effects of microbial infection can impact neuronal functioning, and as a result of infection a prolonged inflammatory process can drive the chronic progression of neurodegenerative diseases.37,40

Levels of certain proinflammatory cytokines have been reported to increase in the cerebrospinal fluid of patients with neurological manifestations of LD.41 Similarly, elevated inflammatory markers that correlate with excess of immune cytokines have been described in MD patients.42 The outer membrane lipoproteins of Borrelia are proinflammatory and can mimic host antigens, theoretically resulting in autoimmune reactivity.37 The fact that elevated anti-nerve antibody reactivity can be found in pretreatment LD patients and in posttreatment patients with persistent symptoms supports this theory.37

Although MD may result from an infectious process, there may be a psychiatric component as well, and some (but not all) MD patients exhibit neuropsychiatric symptoms. In a study of 25 Morgellons patients, 23 had prior psychiatric diagnoses including bipolar disorder, attention deficit disorder, obsessive-compulsive disorder (OCD), and schizophrenia.42 The fact that MD patients may show neuropsychiatric symptoms complicates the diagnosis and explains why some health care providers consider MD to be a delusional disorder. To further complicate matters, some patients with MD who do not exhibit psychiatric abnormalities have been misdiagnosed with other conditions such as lichen sclerosus or prurigo nodularis.

Furthermore, lack of scientific knowledge has led patients to interpret the physical presence of dermal filaments and symptoms of formication as parasitic infection. In these cases, the false belief of parasitic infestation is not genuinely delusional because patients are in fact misinterpreting symptoms caused by aberrant production of human biofibers. Furthermore, we find that electrostatic energy and mechanical energy can cause movement of filaments, interpreted by some patients as the movement of a living organism, and small insects such as fruit flies can adhere to open lesions, leading some patients to believe they are infested. If such patients do have a psychiatric condition such as OCD, then the false belief can be intensified or reinforced.

Conclusion
In summary, MD is an emerging dermopathy that is associated with Borrelia infection, and the growing number of MD cases reflects the increase in tickborne diseases around the world. Although some medical practitioners erroneously consider MD to be caused by a delusional disorder, studies have shown that MD is a somatic illness that appears to be triggered by Borrelia infection. The optimal treatment for MD remains to be determined.