One of the most frustrating problems in clinical dermatology is the patient with a delusion of parasitosis. Over the years, very little realistic and practical advice has been offered to the perplexed dermatologists. We describe an approach 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. We report two illustrative cases and discuss guidelines to treatment.