skip to main content

Delusional infestation — SCE Dermatology MCQ

Instant feedback + full explanation. One question, done properly.

HardPsychodermatologyDelusional infestationSCE Dermatology

A 62-year-old woman brings containers of skin debris, stating that insects are emerging from her forearms. Examination shows excoriations within easy reach but no burrows, mites or primary rash. She declines psychiatric referral and has repeatedly used insecticides on her skin. What is the most appropriate management approach. What is the most appropriate treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Validate distress and arrange dermatology-led follow-up

A) Validate distress and arrange dermatology-led follow-up is correct because this presentation (fixed belief in cutaneous infestation with the classic "matchbox sign" of collected skin debris, excoriations confined to reachable skin, and no objective evidence of mites or burrows) is textbook delusional infestation. British Association of Dermatologists guidance recommends a non-confrontational approach that acknowledges the patient's distress and symptoms without endorsing the false belief, builds a therapeutic alliance, and keeps the patient engaged in a dermatology (or joint psychodermatology) clinic so that antipsychotic treatment can be introduced later once trust is established. Direct confrontation or premature insistence on psychiatric referral typically ruptures engagement and leads to loss to follow-up, so validating the person's experience while arranging structured dermatological review is the evidence-based first step. This preserves the therapeutic relationship, which is the strongest predictor of eventual acceptance of treatment.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/skin-conditions