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A 67 year old woman presented with an intensely itchy maculo-papulo erythematous rash, adamant that it was due to insects beneath her skin. The eventual diagnosis was delusional parasitosis, a predominantly psychiatric disorder whereby patients hold the fixed belief that they are infested by parasites. This manifests in subsequent pruritis, excoriation, and rash, but the underlying pathophysiology remains unknown. Although rarely diagnosed, associated conditions include diabetes, cardiac failure, and nutritional deficiencies. The prevalence is underestimated, but symptoms often cause much distress for patients, and early identification and treatment offer considerable clinical benefit.benefit.