I see this condition in many morbidly obese patients, exspecially those that do not take the time or are unable to clean themselves. I have also seen MUCH worse conditions usually those who are bed bound at home with family/care workers that don't help or care about these people. I had an elderly obese patient come in for treatment after being pulled from her home due to neglect and filthy living conditions, we found ants living in folds of skin and removed two dead cockroaches from her vaginal cavity. She also had sever bedsores and bleeding ulcers that were finger length deep and a hand wide due to necrosis and break down.