Delusional parasitosis (DP) is a psychiatric syndrome in which the patient falsely believes he or she is infested with parasites despite clear evidence to the contrary. Patients with DP generally think that mites, lice, or other insects have invaded their skin and most frequently seek treatment from dermatologists or family practitioners. These patients are usually reluctant to seek psychiatric care or to accept a referral to a psychiatrist. This article provides a comprehensive biopsychosocial understanding of the complexities of DP and suggests a practical strategy for evaluation and treatment by the family practitioner. Treatment with antipsychotic drugs, such as pimozide, is discussed as is a treatment team approach involving a psychiatrist, dermatologist, and family practitioner.