The above image is from a 2011 Paper,
Filament formation associated with spirochetal infection: A comparative approach to Morgellons disease by Stricker and Middleveen.
It is captioned: "Morgellons Fibers at 100× magnification. Note Floral-shaped Fibers on external surface (top) and pavement epithelium on internal surface (bottom) of epidermal section"
Morgellons disease is a contested diagnosis that only a very small number of doctors subscribe to. Patients typically suffer from a long list of symptoms, but most commonly itching and fatigue. The patients associate these symptoms with fibers that they find on their bodies. They, and/or the small handful of doctors who support "Morgellons", associate the fibers with the symptoms and claim it's a distinct disease (Morgellons) causing both. Most doctors (and the CDC) think that the fibers are just clothing fibers and hair, that the symptoms have other, varied causes, and that in some cases the fixed belief in these fibers being linked to their symptoms can even be considered delusional, similar to delusional parasitosis.
The bottom image ("pavement epithelium on internal surface of epidermal section") mentioned in the paper is:
The implication here is that this a piece of skin of a Morgellons patient and this shows the formation of "fibers" from the back of the skin (i.e. under the surface), and this then is evidence that the fibers being found are not environmental contamination, like clothing fibers.
The paper text that mentions the figure is:
That forthcoming paper is the 2012 paper "Morgellons Disease: A Chemical and Light Microscopic Study" by Middelveen, Rasmussen, Kahn, and Stricker.
This does not repeat the image, but instead shows a similar pair of images:
The Paper discusses these photos (and other photos) of "Case 1":
A similar pair of images was used in a presentation by Middelveen at ILADS in 2012
Note the "Reverse" image here is from the 2011 paper, but the "Obverse" is a new image.
Now just to recap what the claim of evidence is here. There is a "sample" (it's not clear where the sample came from), that on one side (the "obverse" or front side) there were multiple "Floral-like formations of early-stage filaments", and on the other (the "reverse", or back side) there was "a layer of pavement epithelial cells". The suggestion here is that the filaments were on the surface of the skin, and they were linked to the epithelial cells.
So I'd like to present an alternate hypothesis - that the "sample" is not of human origin, and is in fact a small piece of oak leaf.
First, let's compare the underneath of an oak leaf with the above "reverse" image.
Very similar collections of "fibers". The fibers on the oak leaf are "stellate trichomes" (star shaped hairs). Some oaks have more trichomes than others. I have a few oak trees in my yard, but unfortunately the wrong kind, looking more like this:
The front of the leaves gives a more interesting comparison though, with the "Obverse" of the morgellons sample.
I think the comparison with a leaf is quite striking in Figure 2A, which I have reproduced here with increased contrast to show what looks like the vein structure of a leaf.
Compare this with the venation of an oak leaf from my yard. Very similar structures.
So, oak leaf, or skin sample? I'm leaning towards a leaf. Finding the right type of tree would help settle the matter. "Case 1" comes from San Antonio, Texas, where oak trees are both native and common. Unfortunately there are not many close-ups of the various oak leaves available. But perhaps someone with a microscope could have a look at some.