So-called "morgellons syndrome" is an interesting phenomenon. This syndrome is not at this point generally recognized by the medical community, but its sufferers describe many different systemic symptoms, such as "brain fog" and fatigue, and characteristic skin lesions which they describe as containing or extruding an unknown substance. The patients are most often diagnosed as having delusions of parasitosis, a diagnosis which understandably is not often acceptable to the patient.
One of the most consistent facts to date about the disorder is that there has been no significant scientific literature published about morgellons as a distinct entity. In the literature---such as it is---morgellons suffers one of two fates: it is attributed to delusions of parasitosis; or it is presented as unverified and unverifiable opinions from self-appointed experts. But there is a hint and a trickle of information. The CDC has an ongoing investigation into "unexplained dermatopathy", and a recent commenter has sent a new article my way.
The article, entitled, "Morgellons disease: Analysis of a population with clinically confirmed microscopic subcutaneous fibers of unknown etiology" was published this month in the Journal of Clinical, Cosmetic, and Investigational Dermatology. I would give you a PMID or DOI, but the journal is not indexed by PubMed. The publisher describes it as "open access" and emphasizes that, "[t]he journal is characterized by the rapid reporting of clinical studies, reviews and original research in skin research and skin care." The journal even has a "testimonials" page. That's unique. I'm pretty sure most of the journals I read don't have that. All of the testimonials agree that the service is excellent. In addition, the journal appears to publish very efficiently:
"I was very impressed with how promptly the paper was published."
"I was impressed at the rapidity of publication from submission to final acceptance."
When evaluating a study, it's important to note the source and the authors first. This journal would appear to value rapid communication over quality. That's not generally a favorable quality, but it isn't a deal-breaker either.
What about the authors?
Raphael Stricker is a disgraced hematologist who after losing his career to data manipulation took up the chronic Lyme disease banner. He is part of ILADS, which has been demanding that actual experts shut up and get out of the way so they can continue their evidence-free treatment of supposed chronic Lyme disease. Savely has written earlier crappy articles about morgellons. She is a nurse practitioner who "treats" people with "chronic Lyme disease" and morgellons.
None of this means the authors can't do some serious science, though, so let's look at the article itself.
The article starts with this:
Morgellons disease is a poorly understood multisystem illness characterized by stinging, biting, and crawling sensations under the skin.
That is an unfounded assertion. Morgellons is simply a label used by some for a set of symptoms. There is not, as of yet, any agreed-upon disease called "morgellons". And where do they get their data? From the Morgellons Research Foundation, an organization founded by the person who named the disease. This foundation has not yet done any real science, and is not a valid source of epidemiologic data. Quoting MRF should be easy for Stricker, who is on their board.
The article then goes on to assert that morgellons is characterized by mysterious fibers under the skin. They make the same somewhat mystical assertion that is common on morgellons websites:
this material is often labeled as "textile fibers" on pathologic examination. However, a more thorough analysis of the fibers performed by the Federal Bureau of Investigation forensics laboratory has revealed that the fibers do not resemble textiles or any other manmade substance. In fact, the fibers are virtually indestructible by heat or chemical means, making analysis difficult by conventional methods.6
The citation for this rather bold and unusual assertion?
6Wymore R. Personal communication. May 4, 2009.
Yeah. Wymore is this guy in Oklahoma who is supposedly doing all sorts of groundbreaking research into morgellons, but somehow none of it gets published. He doesn't happen to be a dermatopathologist or materials scientist or anything else relevant to the field, so maybe he's just in over his head.
So apparently the purpose of this study was "to identify prevalent symptoms in patients with clinically confirmed subcutaneous fibers in order to develop a case definition for Morgellons disease." Is it just me, or is that a bit circular? So how did they identify cases?
The convenience sample included all patients seen in the first author's San Francisco medical office who met the inclusion criterion. The subject inclusion criterion was a positive examination for microscopic subcutaneous fibers as visualized by the first author using a 60 × handheld lighted magnifier. There were no exclusion criteria for the sample group because the inclusion criterion was narrowly defined to promote a homogeneous sample.
So the author, who works at a clinic that specializes in, among other things, morgellos as she defines it chose subjects who she thought had fibers in their skin. I look at skin every day. I'm no dermatologist---and I know it. I know that if I see something under the scope that looks funny to me, I need to call a dermatologist. I wonder if she sent any of these fibers to an expert (other than Wymore or TEH FBI!!!)? No?
As a brief aside, take a look at these images:
Image from the Savely and Strickland paper.
Image from American Family Physician of "neurotic excoriation"
The authors of the morgellons study claim that the rash in their image occurs in area that cannot be reached by the patient. Compare to the photo of a patient with neurotic excoriations (that is, a rash caused by compulsive scratching). Both images are quite typical of "an outside job", that is, they both look as if they have been chronically scratched. There is nothing in the morgellons patient photo that would argue against this.
I can't go on much longer, because my brain hurts, but one of the most remarkable "findings" is this:
Sixty-four (52.5%) of the subjects had positive Lyme tests by Western blot. Another 44.3% (n = 54) were highly suspect for Lyme disease based on the presence of 5/7 of the defined criteria for a Lyme diagnosis, as outlined in the Materials and methods section. These results imply that 96.8% of the sample may have been infected with B burgdorferi [the organism that causes Lyme disease]
Fascinating. In 2008 there were 74 cases of Lyme disease reported in the entire state of California, and yet somehow, one nurse practitioner in San Francisco managed to find find 64 cases in a brief period of time. Remarkable.
This article is so remarkably bad it's almost like they were trying to parody science. Please...don't try any harder.