Perceptions of the clinical management of delusional infestation (DI) were compared with clinical outcomes in this 10-year case series from a single centre in Dundee, UK. An online questionnaire (survey-monkey, a TM brand of online survey available for free for basic use) was sent to Scottish Dermatologists to gauge their opinions and confidence in the management of DI. Also, a retrospective review of medical case notes of patients seen by dermatologists in one institution was undertaken and clinical outcomes were reported by patients’ general practitioners. The survey showed that 61% of responding dermatologists encountered 1–5 cases of DI per year. 24% respondees were ‘confident’ in managing patients with DI, 54% were ‘somewhat confident’. Forty-seven patients (62% female, 70% single) were seen over the 10 years; 43% brought a self-collected specimen to clinic, 68% of patients had a psychiatric comorbidity, 23% of patients had primary DI and 11/47 (23%) were seen by a psychiatrist. Clinical outcomes as rated by patients’ GPs were reasonable or good in 2/3 patients. A poor outcome was seen in 12 patients and associated with chronic pain in 50% (p<0.01) and psychiatric comorbidity in 100% (p<0.01). We conclude that good outcomes can be achieved in some patients with DI without psychiatric input and without psychoactive treatment.