The feeling of bugs crawling on your skin (formication) can be caused by anxiety, dry skin, medicines, or withdrawal. See a doctor if it persists.
Name
Formication, a type of paresthesia.
Common causes
- Anxiety or stress.
- Dry skin or eczema.
- Menopause.
- Medication side effects.
- Drug or alcohol withdrawal.
- Diabetes or nerve damage.
- Parkinson’s disease.
What to do
Moisturize and avoid scratching.
See a doctor
If it persists, to rule out medical or nerve causes.
Check
Rule out scabies or real bugs.
Formication
The sensation of insects crawling on or under the skin is called formication, from the Latin word for ant. It is a type of tactile hallucination or paresthesia. People may feel itching, tingling, burning or crawling.
Medical causes
- Menopause and perimenopause due to falling estrogen.
- Peripheral neuropathy: diabetes, vitamin B12 deficiency.
- Skin conditions: eczema, scabies, dry skin.
- Medications, including some antidepressants, antihistamines and stimulants.
- Parkinson’s disease.
- Multiple sclerosis.
- Shingles or postherpetic neuralgia.
- Migraine with aura.
- Fibromyalgia.
- Anxiety and panic.
Substances
Stimulants like cocaine, methamphetamine (“meth mites”), and alcohol or benzodiazepine withdrawal can cause it. Chronic opioids also cause itching.
Delusional infestation
Also known as delusional parasitosis or Ekbom syndrome, this is a fixed belief of being infested with parasites despite no evidence. It requires psychiatric treatment, and people may bring “samples” to doctors.
What to do
- Do not scratch, which can cause infection.
- Keep skin moisturized.
- Note when it happens, medications and substances used.
- Rule out real bug problems: scabies, bed bugs and lice.
See a doctor if
It lasts more than a few days, interferes with sleep or comes with a rash, numbness, weakness, confusion or substance use. The doctor may order blood tests (glucose, B12, thyroid, kidney and liver) and skin exams.
Treatment
Treat the underlying cause. Medications such as antipsychotics may be used for delusional infestation, or gabapentin for neuropathic symptoms.
Support
If distress is high or you feel unsafe, call 988 in the US.
Medical background
The sensation of insects crawling on or under the skin is called formication. It can be caused by menopause, diabetes, peripheral neuropathy, Parkinson’s disease, skin conditions, anxiety, drug withdrawal and stimulants such as methamphetamine and cocaine. Certain medicines can also trigger it.
Getting help
A doctor can check blood sugar, thyroid, vitamin B12 and medication lists. If a person firmly believes parasites are present without evidence, the condition may be delusional infestation (Morgellons is a term used by some patients), which is treated with antipsychotic medicines and support from a psychiatrist. Seek urgent help if there is confusion, hallucinations or thoughts of self harm. In the US, call or text 988 for crisis support.
Based on data from the American Academy of Dermatology and the National Institute of Neurological Disorders and Stroke
