1. Skin lesions, both spontaneously appearing and self-generated, with intense itching. The former may initially appear “pimple-like” with or without a white center. The latter appear as linear or “picking” excoriations. Even when not self-generated, lesions often progress to open wounds that effectively treat abnormally and usually incompletely. (e.g., effectively treat very slowly with discolored epidermis or seal over with a thick gelatinous outer layer.)
2. Crawling sensations, both under and on the skin surface, often conceptualized by the patient as “bugs moving, stinging or biting” intermittently. Besides the general dermis, Morgellons may also involve the scalp, ear canal and body hair or hair follicles. The sensations are at times related to the presence of easily seen insects, arthropods, and other human and non-human associated parasites that require serious attention from the observing clinician.
3. Fatigue significant enough to interfere with the day-to-day activities.
4. Cognitive difficulties, including measurable short term memory and attention deficit, as well as difficulty processing thoughts correctly, described by patients as “brain fog”.
5. Behavioral effects are common in many patients. Many have been or will be diagnosed as Attention Deficit Disorder, Attention Deficit Hyperactivity Disorder, Bipolar Disorder, or Obsessive-Compulsive Disorder. A minority do not show this pattern. Almost all, if previously seen by well-read physicians without prolonged observation, will have been labeled as “Delusional Parasitosis”. Temporal relationship to skin lesion onset is not known.
6. “Fibers” are reported in and on skin lesions. They are generally described by patients as white, but clinicians also report seeing blue, green, red and black fibers, that are fluorescent when viewed under ultraviolet light (Wood’s lamp). Objects described as “granules”, similar in size and shape to sand grains, can occasionally be removed from either broken or intact skin by physicians, but are commonly reported by patients. Patients report seeing black “specks” or “dots” on or in their skin, as well as unusual 1-3 mm “fuzz balls” both in their lesions and on (or falling from) intact skin.