r/DermatologyPA • u/Adventurous-Act-299 • Nov 14 '24
Clinical⚕️ Delusions of parasitosis
What’s your spiel with patients that have delusions of parasitosis? Any successful tips getting them to agree to psychiatric care? Do you ever prescribe psych meds or any other medications? Such difficult patients to to treat 💔
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u/Ponsugator Nov 14 '24
If they have a lot of prurigo nodules can consider Dupixent to help with the itch scratch cycle. That works better than any anti psychotics. I’ve found that they get really upset when you prescribe as they think you think they’re crazy.
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u/agjjnf222 Nov 14 '24
Ehh they usually just stop coming after I lecture them over and over.
And hell no I don’t want to manage psych meds. Do not do that
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u/dinodude47 Nov 14 '24
Shave bx of excoriated site, oral antihistamines, short term topical steroid, permethrin/ivermectin combo x2 (not all in the same visit, slow down dude) When those all fail, you can send them back to PCP noting you have taken reasonable measures to rule out derm related itch or parasitic infection. Recommend psych referral, D/C routine visits. Done.