BACKGROUND: In recent years, there has been a reported increase in affliction of 
the skin with small fibres or other particles. The condition has been referred 
to as Morgellons disease. Patients present with stinging, burning or crawling 
sensations of the skin, with perceived extrusion of inanimate material alongside 
fatigue and other systemic symptoms. Sufferers often experience significant 
morbidity and reduction in quality of life.
OBJECTIVES: We aimed to explore the various clinical presentations, management 
strategies and outcomes employed to treat this condition in our patients.
METHODS: We conducted a retrospective case notes review of 35 patients referred 
to our multidisciplinary psycho-dermatology clinic at the Royal London Hospital 
between January 2004 and January 2017.
RESULTS: The majority of patients were women (25) 71.4%, with a mean age of 
54.6 years (26-80 years). Most (26) 74.2% were living alone. The average 
duration of illness prior to presentation was 3.8 years (4 months-20 years). 
Many patients had perceived precipitating factors (54.2%) and often 
self-diagnosed (28.5%). Psychiatric co-morbidities included 42.8% with 
depressive symptoms and 25.7% with anxiety. Substance misuse was elicited in 
five patients (14%). Management of patients included both the treatment of skin 
disease and psychosocial co-morbidities. Out of the 35 patients who attended 
(14) 40% cleared or showed significant improvement. Sixteen (45.7%) patients 
were stable and under review. One patient declined treatment and three did not 
attend review. One patient died from disease unrelated to her skin condition.
CONCLUSIONS: Morgellons disease is a condition, which is widely discussed on the 
internet and patients often self-diagnose. The course of the disease can be 
chronic and debilitating. For a positive outcome, it is important that a strong 
physican-patient relationship is cultivated. As demonstrated in this case 
series, managing patients holistically in an integrated multidisciplinary 
dermatology setting helps achieve positive outcomes.