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April 2009

Treatment of Delusional Parasitosis With Aripiprazole

Arch Dermatol. 2009;145(4):500-501. doi:10.1001/archdermatol.2009.20

Delusional parasitosis (DP) is a psychiatric condition in which patients believe they are infested with skin parasites. Since patients seeking dermatologic care are convinced that they have a skin disorder and frequently reject psychiatric care, dermatologists should be trained in managing DP. We report 2 cases that responded rapidly to the new antipsychotic agent aripiprazole.

A 42-year-old woman with systemic lupus erythematosus reported a 2-year history of bugs biting her scalp, axilla, and pubis. She observed lice burrowing in her skin and brought samples wrapped in tissue paper to the dermatologist. Her medication had not changed prior to the onset of symptoms. Physical examination findings were negative for nits or lice. Microscopic findings of the samples provided by the patient were negative. We reassured her by saying that we would analyze samples and perform some tests if she accepted admission to our unit. Blood and urine tests and chest radiography revealed no abnormalities. She was diagnosed with primary DP, and aripiprazole treatment was started at 5 mg/d, with an increase to 10 mg/d 2 weeks later. In a 1-month follow-up visit, she explicitly said that parasites no longer troubled her. Six months later, she was in complete remission. No adverse effects were detected, and the treatment was withdrawn. After 6 months without therapy, the patient did not relapse.

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