Concerns for Infestation (CI): Dermatologic Evaluation of Patients with Unwanted, Uncomfortable, and Unexplained Sensations

Many chapters in this comprehensive volume are written for health professionals working with patients who already have the diagnosis of delusional infestation. Those chapters address the behavioral and pharmaceutical management of this disorder. This chapter takes a different perspective: here, we discuss the early (and thorough) evaluation of patients who are concerned about a possible infestation. These are patients who have unwanted cutaneous sensations (such as generalized pruritus), and they are concerned that an infestation may be the cause. This chapter helps clinicians evaluate patients who have unwanted, unexplained, and uncomfortable cutaneous sensations—and who express concern that they are infested with some sort of organism This chapter takes the approach of the clinician, typically a dermatologist or an infectious disease physician, often based at an academic center, who accepts the task to conduct a thorough evaluation to identify the cause of the abnormal sensations, often despite several rounds of these medications. If the cause is indeed an infesting organism, then this is the time to find the organism, identify it, and provide the patient with a definitive diagnosis and definitive treatment. On the other hand, many skin diseases, many systemic diseases, many medications (and other pharmacologically active substances), and many psychological conditions can induce widespread pruritus and other dysesthesias.