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Delusional infestation (DI) is one of the most challenging situations dermatologists and other dermatology providers may face in their practice. Dermatologists must know how to properly communicate with these patients. The process of acquiring delusional states can be a gradual development and not all delusional patients in dermatology are the same. The objective of this manuscript is to introduce the ‘Koo-Brownstone Staging System’ for Delusional Infestation (Morgellons disease) with the goal of improving communication and management for these patients. This staging system has been derived based on more than three decades of experience of the senior author supported by additional years of experience of the first author. The following stages are presented and explained: formication only (stage 1), overvalued ideation of parasitosis (stage 2), pre-delusional (stage 3), delusional (stage 4) and terminally delusional (stage 5). This staging system has been derived based on expert clinical experience rather than a direct reporting from this patient population themselves. This staging system will enhance awareness on the part of the health providers to enable them to categorize a given patient, which becomes critical in optimizing communications and management.

journal of dermatological treatment

The Koo-Brownstone staging system as a tool to assist in the management of patients with a possible diagnosis of dermatological delusions: an experts suggestion