Microsoft Word - September 2020 - COMP 862 - proof.docx SKIN September 2020 Volume 4 Issue 5 Copyright 2020 The National Society for Cutaneous Medicine 481 COMPELLING COMMENTS Delusions of Parasitosis Influenced by Crowdsourcing Diagnostic Platform CrowdMed Julian Stashower, BA1, Katherine Belote, MD1, Barrett Zlotoff, MD1 1University of Virginia School of Medicine, Charlottesville, Virginia A distraught 48-year-old female presented to our clinic with signs and symptoms consistent with delusions of parasitosis. Physical exam showed geometric, bilateral, superficial excoriations with overlying crust and scattered hypopigmented macules on the chest, abdomen, back, buttocks, and upper and lower extremities, with sparing of the face and interscapular back. An already challenging patient encounter was made even more difficult when the patient claimed that she had identified the source of her discomfort. She explained that with the help of paid, non-physician users on the website CrowdMed, she had discovered that parasites were living underneath her skin. CrowdMed is a popular subscription-based crowdsourcing platform that reports having dealt with thousands of patients. Websites such as CrowdMed can provide opportunities for patient education and facilitate the spread of knowledge. However, when used inappropriately, crowdsourcing websites like CrowdMed can put strain on doctor-patient relationships. Patients on CrowdMed distribute cash awards to contributors that they feel helped the most, which may motivate contributors not to provide correct information, but information that patients will like. Additionally, nearly half of all active individuals who offer patients advice on CrowdMed have no medical affiliation of any kind.1 This is concerning for both patients and providers alike as the information being given may not be medically accurate or provided by credible sources. The stress and confusion caused by receiving conflicting opinions from crowdsourcing websites and dermatology practices could lead to physician mistrust, especially since patients may not readily discard paid-for medical advice. With thousands of patients now looking to crowdsourcing websites such as CrowdMed for medical guidance, we feel it is important that clinicians be aware that they exist and query patients about their use. Equipped with this information, providers can prepare to counsel patients that report having consulted a crowdsourcing website prior to their visit. In our case, we were able to forge a therapeutic alliance with the patient by utilizing an approach described in the literature by Drs. ABSTRACT Thousands of patients look to crowdsourcing websites such as CrowdMed for medical guidance. These websites can provide opportunities for patient education and facilitate the spread of knowledge. However, when used inappropriately, crowdsourcing websites like CrowdMed can put strain on doctor- patient relationships. We present a case that highlights how a patient’s delusions of parasitosis were influenced and supported by the crowdsourcing website CrowdMed. SKIN September 2020 Volume 4 Issue 5 Copyright 2020 The National Society for Cutaneous Medicine 482 Viraat Patel and John Koo and will consider initiation of pimozide or risperidone if necessary and appropriate.2 Conflict of Interest Disclosures: None Funding: None Corresponding Author: Julian Stashower, BA University of Virginia School of Medicine 1215 Lee Street Charlottesville ,VA 22908 Phone: 703-673-8741 Fax: 434-244-4504 Email: jas2wf@virginia.edu References: 1. Meyer AND, Longhurst CA, Singh H. Crowdsourcing Diagnosis for Patients With Undiagnosed Illnesses: An Evaluation of CrowdMed. J Med Internet Res. 2016;18(1). doi:10.2196/jmir.4887 2. Patel V, Koo JYM. Delusions of parasitosis; suggested dialogue between dermatologist and patient. Journal of Dermatological Treatment. 2015;26(5):456-460. doi:10.3109/09546634.2014.996513