What is Morgellons?
A Clear Definition
The Medical Advisory Board of the Morgellons Research Foundation has developed the following case definition. It is an evolving document, updated for review by patients, practicing clinicians and interested health agencies, thus will continue to be refined as information becomes available.
The Following Signs or Symptoms are The Basis of Morgellons Disease as defined by patients that fit within a consistent boundary that is also outside the boundary of other "known" diseases. The initial three characteristics parallel a much more entrenched illness, Delusions of Parasitosis (DP) named decades before today's laboratory technology and infection/immunity knowledge, driven by HIV, developed. The more recent findings listed below provide a far broader and more consistent evidence base, strongly supporting the likelihood that DP is a prematurely-assigned label to an organic, rather than purely psychiatric disease.
- Skin lesions, both (a) spontaneously appearing and (b) self-generated, often with pain or intense itching. The former (a) may initially appear as "hive-like", or as "pimple-like" with or without a white center. The latter (b) appear as linear or "picking" excoriations. Even when not self-generated (as in unreachable regions of babies' skin), lesions often progress to open wounds that heal incompletely (e.g., heal very slowly with discolored epidermis or seal over with a thick gelatinous outer layer.). Evidence of lesions persist visually for years if not for life.
- Movement sensations, both beneath and on the skin surface. Sensations are often described by the patient as intermittent moving, stinging or biting. Involved areas can include any skin region (such as over limbs or trunk), but may be limited to the scalp, nasal passages, ear canals, or face.
- "Filaments" are reported in and on skin lesions and at times extruding from intact-appearing skin. White, blue, red, and black are common among described fiber colors. Size is near microscopic, and good clinical visualization requires 10-30 X. Patients frequently describe ultraviolet light generated fluorescence. They also report black or white granules, similar in size and shape to sand grains, on or in their skin or on clothing. Most clinicians willing to invest in a simple hand held commercial microscope have thus far been able to consistently document the filaments.
- Musculoskeletal Effect is usually present, manifest in several ways. Pain distribution is broad, and can include joint(s), muscles, tendons and connective tissue. Both vascular and "pressure" headaches and vertebral pain are particularly common, the latter usually with premature (e.g., age 20) signs of degeneration of both discs and vertebrae.
- Aerobic limitation is universal and significant enough to interfere with the activities of daily living. Most patients meet the Fukuda Criteria for Chronic Fatigue Syndrome as well (Fukuda, Ann. Int. Med., 1994).
- Cognitive dysfunction, includes frontal lobe processing signs interfering with logical thinking as well as short-term memory and attention deficit. All are measurable by Standard Psychometric Test batteries.
- Emotional effects are present in most patients. Character typically includes loss or limitation of boundary control (as in bipolar illness) and intermittent obsessional state. Degree varies greatly from virtually absent to seriously life altering. Noteworthy is the newfound strong possibility that emotional presentation does not precede "cause", but rather that both emotional and physical effects stem from cytokine effects on neurotransmitter levels and receptor number (Buchsbaum, Schizoph. Bull. 1998)
OTHER COMMONLY REPORTED SYMPTOMS AND SIGNS
- Shifting visual acuity. Some have an unexplained frequent need to change a glass prescription.
- Numerous neurological symptoms and clinical findings. A variety of neurological symptoms and signs have been reported. Common physical findings include abnormal Romberg, peripheral neuropathy (feet and fingers), abnormal reflexes, verifiable neuropathic pain and recurrent brain control abnormalities affecting motor function, circadian rhythm, body temperature and respiratory drive.
- Gastrointestinal symptoms, often including dyspepsia, gastroesophageal reflux, swallowing difficulty, and changes in bowel habits (Similar to IBS or Crohn's disease)
- Acute changes in skin texture and pigment. The skin is variously thickened and thinned, with irregular texture and hyperpigmentation pattern. Overgrowth or hyper-growth phenomena are common (nevi, skin tags, microangioma, lipomas, callus formation).
- Arthralgias. Frequently reported, although arthritis is not. Common joints are in fingers, shoulders, knees and lower vertebrae.
COMMON LABORATORY ABNORMALITIES
Various leaders in Morgellon's care are finding a wide range of laboratory abnormalities. Dr. Schaller would rather not list all the credible and important labs here at this time, since it involves many possible patterns and various researchers have their own unique patterns. But Dr. Schaller would like to emphasize the fact that Morgellons patients do NOT have normal lab results if they are tested with more then simple organ failure labs.
Dr. Schaller chooses labs from about 13 pages of options and picks those tests specific to each person.