One of the most frustrating problems in clinical dermatology is the patient with a delusion of parasitosis. Very little realistic and practical advice has traditionally been offered to the perplexed dermatologist. An approach is described that is based on the thesis that dermatologists can and often should treat such patients. By considering each patient as an individual, and by working to build rapport, the dermatologist is in the best position to offer help. Two illustrative cases and treatment guidelines are reported.