Morgellons disease is a controversial and poorly defined symptom cluster of skin 
lesions and somatic symptoms, most notably 'fibers' in the skin. Because of 
widespread coverage in the media and on the Internet, there are an increasing 
number of patients presenting to dermatologists. We present three patients who 
believed that they had fibers in their skin. We offer a discussion of delusions 
of parasitosis to demonstrate similarities between these conditions. It has been 
suggested by a limited number of healthcare providers that an unknown infectious 
agent underlies this symptom complex yet no available evidence supports this 
assertion. Laboratory values that would be reflective of an infectious process 
(e.g. elevated white blood cells, sedimentation rate, C reactive protein) are 
routinely normal and biopsies often reflect only nonspecific findings such as 
acute and chronic inflammation with erosion or ulceration. Patients with 
Morgellons disease generally lack insight into their disease and reject the need 
for psychiatric help. The goal is to build trust and refrain from minimizing 
what the patient experiences. Attentive examination of the patient's skin and 
fragments they present is necessary to rule out a true underlying pathologic 
process and to establish a trusting relationship. A supportive, 
non-confrontational approach is ideal. The patient is best treated by a team of 
practitioners of several specialties, including dermatologists, psychiatrists, 
and counselors.