Clinical Aspects and Diagnostic Challenges of Ekbom Syndrome: A Narrative Review

Abstract

Background: Ekbom syndrome is an uncommon but likely underdiagnosed psychiatric disorder in which patients hold a persistent belief that they are infested with living organisms, most commonly affecting the skin. Due to the predominance of dermatological symptoms, diagnosis is often delayed, as patients initially seek care from non-psychiatric specialists before being referred for psychiatric evaluation. The syndrome may occur in a primary form, without an identifiable underlying condition, or as a secondary manifestation of other disorders, including psychiatric and somatic diseases. Symptom overlap with other conditions further complicates the diagnostic process.

Aim: The aim of this review is to summarize current knowledge on Ekbom syndrome, including its clinical presentation, diagnosis, and treatment, and to compare it with selected case studies illustrating how the disorder presents and is managed in clinical practice.

Material and methods: A literature review was conducted using the PubMed database. Case reports published between 2020 and 2025 were included, along with earlier highly cited studies where relevant.

Results: The findings indicate that diagnosis is frequently delayed due to patients’ strong belief in a somatic origin of their symptoms. Diagnostic pathways vary considerably, highlighting the lack of a standardized approach. While most patients fit the typical demographic profile, atypical presentations in terms of age and symptomatology also occur. Treatment, most commonly involving antipsychotic medications or addressing underlying conditions in secondary cases, is generally effective once the correct diagnosis is established.

Conclusions: Ekbom syndrome remains a diagnostic challenge, particularly for non-psychiatric clinicians. Improving awareness across medical specialties is essential to reduce underdiagnosis and facilitate earlier initiation of appropriate treatment.