“Patients with Morgellons disease frequently describe crawling, stinging, insect-like sensations, or sensations of “something trying to penetrate the skin from the inside out”.20,25 These sensations are accompanied by slow-healing skin lesions that appear spontaneously. Skin lesions can be minor to disfiguring and associated with fibrous material either in strands or balls of wound-up fibers.20,25 Granules have been observed that may demonstrate attached fibers. “Black specks” or “black oil” associated with lesions have been reported. Fibers may be present under unbroken skin as well as in lesions and scabs.20,25 Microangiomas found upon examination are reported.24 Healed lesions demonstrate hyperpigmented scar tissue.25 Patients report changes to their hair48 and changes to finger and toenails.49 The nail changes in Morgellons disease resemble those associated with syphilis. In that condition, the nail wall becomes raised, with inflammation and suppuration of tissue surrounding the nail resulting in nail plate destruction, separation of the nail, and defective growth at the nail matrix.50 Nail changes in Morgellons disease provide further evidence of spirochetal involvement, as noted above.
Patients with Morgellons disease experience symptoms consistent with systemic pathology, including fatigue, cognitive disability (described as “brain fog”), fibromyalgia, joint pain, vision decline, neurological disorders, hair loss, disintegration of teeth, intermittent fever, low body temperature, and sleep disturbances.20,24,48 Frequent physical findings include reduced exercise capacity, peripheral neuropathy, delayed capillary refill, abnormal Romberg’s sign, decreased body temperature, cardiac arrhythmias, and tachycardia.23 Many patients with Morgellons disease report inability or impaired ability to work. Most patients have been diagnosed with psychiatric or psychosomatic illness, and report that physicians are dismissive and attribute lesions to delusional parasitosis and self-mutilation.20,24,48 While some patients with Morgellons disease do demonstrate behavioral aberrancies including a delusional component, many do not, and psychiatric manifestations are possibly from an underlying pathogenic process.22 Symptoms in some patients such as headaches, visual abnormalities, short-term memory loss, and emotional lability are consistent with central nervous system involvement.24
Patients with Morgellons disease regularly demonstrate abnormal laboratory findings, including occasional low-grade anemia, test results indicating endocrine dysfunction such as diabetes and thyroid dysfunction, test results indicative of immune dysfunction such as low CD57+ natural killer cells and inflammatory markers, such as elevated C-reactive protein, complement C4a, tumor necrosis factor-alpha, interferon-gamma, and interleukin-6.23,25