Two cases of Ekbom Syndrome

Ekbom syndrome is a rare psychiatric disorder that usually presents to dermatology clinics. It is characterized by the perception that one’s body is infested by invisible mites or insects. In here, we present two cases of Ekbom syndrome. Case One: A case of Ekbom syndrome, which has been considered as if she had trichotillomania is presented. A 62-year-old housewife applied dermatology outpatient clinic due to the itching sensation. She claimed that insects were visiting all over her body, especially at nights. Subsequently, she was referred to our clinic for her depressive mood. She has not received any previous psychiatric treatment. In the first mental state examination, the patient seemed age-appropriate, self-care worse, the affect was depressive, mood euthymic, stream of thought nature and content of thought parasitic. Tactile hallucinations were present. Physical examination, pruritic lesions were common in her body. Her neurological examination and laboratory tests were unremarkable. Cranial MRI showed non-specific ischemic gliotic foci. In this patient, we thought depression and delusional parasitosis as the initial diagnosis. Citalopram and risperidone were started. Delusions of parasitosis were reduced. Delusions were limited in the head and abdomen. After 3 months, a burning pain has appeared on her head during the last month. She said that only she could be relaxed by pulling out her hair. Delusions of parasitosis most were concentrated in the head. On physical examination, her pruritic lesions on the body had passed. On her head, she had a balding area, which was about 1.5 cm in diameter. Citalopram dose was increased. After this therapy, her delusion of parasitosis has disappeared. Case Two: A 72-year-old female patient with a history for hypertension, diabetes, bronchial asthma, coronary artery disease, who was operated for multinodular goiter applied with the complaints of delusional parasitosis. She said that insects were visiting all over her body during the 2 years. Firstly, it was started in her hand, arm and face; subsequently it was spread to whole body. According to the history from her daughter, she had been depressed, crying, self-talking during the 2 years. She was always scratching and wounding her own body; and she was thinking that there were insects in these wounding areas. 2 years ago, she had applied dermatology outpatient clinic for this complaints. In her psychiatric examination, the patient seemed age-appropriate, self-care well, affect depressive, stream of thought nature and content of thought parasitic. Tactile hallucinations were present. Her neurological examination and laboratory tests were unremarkable. Mini Mental State Examination score was 25. There were no depressive symptoms and findings. Cranial MRI showed non-specific ischemic gliotic foci. Citalopram and risperidone were started. After increasing the dose of risperidone, her delusions of parasitosis and her wounds have disappeared. As in our case, the majority of cases of Ekbom syndrome present to dermatology clinics. Moreover, patients are often reluctant to see psychiatrists for their skin manifestations. Therefore, it is very important for the dermatologist to keep in mind this disease and consult the patient to psychiatry for the correct diagnosis and treatment for these patients.