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June 4, 1997

Baffling Skin Ailments May Originate in Psyche

Author Affiliations

JAMA contributor

JAMA. 1997;277(21):1660-1662. doi:10.1001/jama.1997.03540450016006

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A PATIENT brought tiny vials to the office of John Koo, MD. "Here are some of the parasites that are crawling all over me," the man told Koo, who is associate clinical professor and vice chair of dermatology at the University of California, San Francisco, School of Medicine.

Koo peered into the vials. "I don't see anything," he told the patient.

"Of course not," the patient retorted. "These parasites are invisible."

Psychopathology plays a role in numerous skin complaints, Koo and other speakers said at the annual meetings of the American Academy of Dermatology (AAD) and the Association for Psychocutaneous Medicine of North America (APMNA) held in San Francisco in March. Such cases often prove challenging and time-consuming, speakers said, and their treatment frequently demands an inventive approach.

While parasitosis is the most common delusion seen in dermatology practices, patients also seek help because they think they emit bad smells