“My itch is terrible, but I know what causes it. My itch is caused by a bug.” This sixty-three-year-old man had incessant widespread crawling and biting sensations in his skin for three years. He blamed tiny bugs that were not directly visible on the skin, but could be seen by him when he brushed them off into a wash basin.

It was a serious matter for which he had previously consulted three dermatologists, an infectious disease specialist, a pathologist, a microbiologist, a psychiatrist, an entomologist, and three parasitologists. No one had ever been able to identify any insect, ectoparasite, fungal element, or glass wool in his many many samples. Nonetheless, he spent most of each day cleaning, spraying, and vacuuming his home to eliminate his “pathogens.” He had bought an industrial vacuum cleaner, special air filters, and cartons of disinfectant sprays … anything to kill the bugs. At night he was unable to sleep due to scratching. His life was truly miserable.

At each visit he came equipped with a basin of water, colored blue with a food dye. He averred that the bugs were grossly visible when he brushed them off into the basin if the overhead lights were turned off, illumination being provided by transverse lighting from his flashlight. Strangely, these bugs had no bodies that he could see, but were essentially jagged legs.

Repeated examinations with a 2.75 power lens of the patient's “parasites” floating in the water revealed only dead keratin flakes of his outer skin.