BACKGROUND: Morgellons disease (MD) is a complex skin disorder characterized by 
ulcerating lesions that have protruding or embedded filaments. Many clinicians 
refer to this condition as delusional parasitosis or delusional infestation and 
consider the filaments to be introduced textile fibers. In contrast, recent 
studies indicate that MD is a true somatic illness associated with tickborne 
infection, that the filaments are keratin and collagen in composition and that 
they result from proliferation and activation of keratinocytes and fibroblasts 
in the skin. Previously, spirochetes have been detected in the dermatological 
specimens from four MD patients, thus providing evidence of an infectious 
process.
METHODS & RESULTS: Based on culture, histology, immunohistochemistry, electron 
microscopy and molecular testing, we present corroborating evidence of 
spirochetal infection in a larger group of 25 MD patients. Irrespective of Lyme 
serological reactivity, all patients in our study group demonstrated 
histological evidence of epithelial spirochetal infection. Strength of evidence 
based on other testing varied among patients. Spirochetes identified as Borrelia 
strains by polymerase chain reaction (PCR) and/or in-situ DNA hybridization were 
detected in 24/25 of our study patients. Skin cultures containing Borrelia 
spirochetes were obtained from four patients, thus demonstrating that the 
organisms present in dermatological specimens were viable. Spirochetes 
identified by PCR as Borrelia burgdorferi were cultured from blood in seven 
patients and from vaginal secretions in three patients, demonstrating systemic 
infection. Based on these observations, a clinical classification system for MD 
is proposed.
CONCLUSIONS: Our study using multiple detection methods confirms that MD is a 
true somatic illness associated with Borrelia spirochetes that cause Lyme 
disease. Further studies are needed to determine the optimal treatment for this 
spirochete-associated dermopathy.