In patients with delusions of parasitosis, given recent literature, would you attempt to trial biologic dupilumab therapy over, or in conjunction with, standard atypical anti-psychotics if they have prominent peripheral eosinophilia or severe secondary excoriative dermatitis?

Based on the available literature, I would not recommend dupilumab instead of atypical antipsychotic therapy for primary delusional parasitosis. I would consider dupilumab only as adjunctive therapy in selected patients with marked secondary inflammatory skin disease or refractory pruritus, recogniz...

I would not expect true primary delusional infestation to respond to systemic immunomodulatory therapies like dupilumab; however, most cases of delusional infestation that I encounter are secondary to another untreated or under-treated pruritic disease. Any patient presenting with delusional infesta...