Treatment of Delusional Parasitoses

To the Editor.  —Ms Lamberg¹ addressed several important issues related to delusional parasitoses. I would like to contribute another potential source of patient discomfort that may need to be included during a patient's medical history review.As director for the Arthropod-borne Disease Program for the New York State Health Department, I have had perhaps 20 patients referred to me in recent years by phone or even personal visit from physicians caring for patients who present with complaints of unverifiable infestations, but for whom examinations for valid infestations such as scabies have proven negative or have not been pursued.I have used a fairly standard approach toward these patients (typically older women) to elicit information that may serve to explain their sensations of parasitosis (itching, crawling, often with pinprick biting sensations). Often they will refer to, or arrive with, "tiny worms" or "parasites" collected on adhesive tape, plastic bags, or even vacuum bags!