Medical term for sensation of bugs crawling on skin

Formication, essentially a tactile hallucination, is an abnormal skin sensation similar to that of insects crawling over or within the skin. From the Latin formicare meaning "to creep like an ant," formication (not to be confused with fornication!) was described in 1890: "A variety of itching, often encountered in the eczema of elderly people. It is described as exactly like the crawling of myriads of animals over the skin."

Formication is a specific form of the general set of abnormal skin sensations known as paresthesias and tactile hallucinations. It is associated with several disorders: a physical or psychological side effect of substance abuse, diabetic neuropathy, diseases of the spinal cord and peripheral nerves, and extreme alcohol withdrawal with delirium tremens.

This illusion or hallucination that ants or other insects are creeping on or under the skin is a common side effect of large-scale use of cocaine, amphetamines ("amphetamites"), or crystal meth (also known by street names such as "ice," "glass," "chalk," "crank," "meth mites," or "coke bugs.")

Formication is also a side effect of many prescription drugs (see below). People suffering from formication, particularly if they are delirious or intoxicated, may pick and scratch themselves to such an extent that they trigger self-induced bleeding and excoriations of the skin on areas easy to reach: the face, scalp, neck, thighs, and forearms. This-self-mutilation often leads to gouged out pits and ulcers.

Patients often seek numerous opinions from medical doctors, exterminators, and entomologists, and then often complain about the incompetence of the advice received, while treating the specialist with hostility and suspicion.

The false sensation of bugs crawling on or within the skin was first reported in chronic cocaine users in 1889. Patients with drug-induced formication often have an associated fixed delusion of parasitosis: a form of psychosis in which sufferers hold a delusional belief they are infested with parasites and claim to have seen "bugs" or "worms" crawling under or out of their skin. Some have even used common household scissors to cut out the imagined worms.

Delusions of parasitosis that are not related to drug abuse are more common among middle-aged and elderly women. Patients with this disorder may be fully functional, but nevertheless have a false belief that they are infested with parasites. They may profess to have the parasites in a collection of material (typically pieces of skin, scabs, hair, lint, dried blood, living organisms such as flies or ants, and other debris) and request that it be studied under a microscope or sent to a laboratory for identification. This clinical presentation is called the "matchbox sign" because patients have often used a matchbox to collect the material. Now small plastic bags are commonly used for this purpose.

Delusional parasitosis may be a shared illness, in which some of the patient's close contacts also believe they too are infested. When two family members are involved, usually husband and wife or parent and child, the delusion is known as folie à deux ("a madness shared by two"). The psychological film Bug (2007) portrays a folie à deux involving a man and woman who believe they are infested with government-implanted, nano-technological insects.

Reassuring patients that no parasitosis exists can be difficult because they typically refuse to believe that their disease is functional rather than organic. Although results of objective laboratory tests may satisfy the doctor, patients frequently deny negative test results. Referral for psychiatric therapy must be approached with delicacy in patients with delusional parasitosis. Management of drug-induced formication obviously involves abandoning the offending drug.

Drugs that have been reported to cause formication are Adderall, cocaine, crystal meth, methamphetamine, Ecstacy, MDMA, Keppra, Lunesta, Ritalin, Tridyl, Wellbutrin, and Zyban.

Formication, or a sensation that your skin is "crawling," is a physical symptom that occurs without a physical cause. This symptom is also called a tactile hallucination. Formication can occur with mental health conditions, neurological diseases, or menopause. It can also be a side effect of medication or recreational drugs.

This article discusses formication, including the symptoms, causes, diagnosis, treatment, and complications that can occur.

Where Did "Formication" Come From?

The term "formication" is from the word "formica"—the Latin word for "ant." Formication is often described as feeling like ants are crawling on a person's skin.

Formication Causes

Formication has a variety of causes, from mental health conditions to side effects of medications or recreational drugs.

Formication can occur as a symptom of mental health disorders. These can include:

• Anxiety disorders
• Depression
• Delusional parasitosis
• Schizophrenia
  

Formication can be a side effect of methamphetamine use. This condition is often called "meth mites" because it commonly affects people who use large amounts of this drug on a daily basis.

Formication can also occur with the use of cocaine, crystal meth (a condition known as "coke bugs"), and heroin. These sensations can also occur during drug or alcohol withdrawal.

Formication is often caused by medications used to treat mental health conditions. Most commonly, it occurs with the use of antipsychotics, such as Abilify (aripiprazole), Haldol (haloperidol), Zyprexa (olanzapine), fluphenazine, and Risperdal (risperidone).

This side effect can also occur with the use of selective serotonin reuptake inhibitors (SSRIs), which are often used to treat depression. Examples include Paxil (paroxetine), Celexa (citalopram), Luvox (fluvoxamine), Prozac (fluoxetine), and Zoloft (sertraline).

Formication can also occur with other conditions, such as:

• Menopause
• Fibromyalgia
• Diabetic peripheral neuropathy
• Herpes zoster (shingles)
• Lupus
• Parkinson's disease
• Lewy body dementia

The main symptom of formication is feeling like bugs are crawling on your skin. This condition can also cause other sensations such as:

• Itching
• Pricking
• Tingling
• Pins and needles

When to See Your Healthcare Provider

If you have recently developed symptoms of formication, or your symptoms are worsening, see your healthcare provider. Your symptoms may be treatable, and it is important to address the cause as soon as possible.

Diagnosis and Treatment of Formication

There is no specific test for formication. Your healthcare provider will review your medical history and current medications and ask questions about your symptoms. It's important to be honest with your provider, even if you are consuming a lot of alcohol or using illegal substances.

Treatment of formication depends on the underlying cause. If it's a side effect of medication, other medications might be tried instead. Formication that occurs from drug use or withdrawal will often resolve on its own, once the drug use has stopped and the body has detoxed.

Mental health conditions can be treated with medication and counseling. Menopause symptoms are often treated with supplements or hormone replacement therapy, while shingles is treated with antiviral medications.

However, formication caused by progressive conditions, such as Parkinson's disease, Lewy body dementia, lupus, or peripheral neuropathy from uncontrolled diabetes, might be permanent.

Complications of Formication

Formication often causes an itching sensation, which leads to scratching. Too much scratching can cause skin irritation and open wounds, which are then vulnerable to infection.

Other complications can include:

• Irritability
• Difficulty sleeping
• Trouble concentrating
• Poor quality of life
• Fatigue
• Depression
• Anxiety
• Body aches
  

Summary

Formication is a sensation of "skin crawling." It is a type of tactile hallucination. Formication can be caused by the use of illegal substances, alcohol or substance withdrawal, medical or mental health conditions, menopause, or as a side effect of drugs. It can lead to difficulty sleeping, skin wounds, irritability, and poor quality of life. To treat formication, the underlying cause must be addressed. In some cases, this symptom may be permanent.

A Word From Verywell

If you feel like your skin is "crawling," you could have formication. Keep track of your symptoms and notice if they occur after a medication change or after consuming alcohol. These can be clues about the cause of your discomfort. Talk to your healthcare provider about your concerns to determine the best treatment options.

Frequently Asked Questions

• How do you get rid of formication naturally?

  There's no one-size-fits-all approach to treating formication. First, the underlying cause must be identified, which will likely require a visit to your healthcare provider. Natural remedies may or may not be appropriate to treat your condition.

• Why does my skin crawl at night?

  Skin crawling sensations are often worse at night for a couple of reasons. First, there are fewer things to distract you when your body isn't in motion, making these sensations more obvious. In addition, blood flow to the skin increases at night, which can make itching from formication worse.

• Can anxiety cause skin crawling?

  Skin crawling, or formication, can be a symptom of anxiety disorders. It can also be a side effect of medications used to treat anxiety.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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4. Rusyniak DE. Neurologic manifestations of chronic methamphetamine abuse. Psychiatr Clin North Am. 2013;36(2):261-275. doi:10.1016%2Fj.psc.2013.02.005

5. National Alliance on Mental Illness. Medication frequently asked questions.

6. Tao MF, Sun DM, Shao HF, Li CB, Teng YC. Poor sleep in middle-aged women is not associated with menopause per se. Braz J Med Biol Res. 2015;49(1):e4718. doi:10.1590%2F1414-431X20154718

7. Mumtaz S, Liggins S. Formication. Br J Oral Maxillofac Surg. 2018;56(8):775-776. doi:10.1016/j.bjoms.2018.08.004

By Aubrey Bailey, PT, DPT, CHT
Aubrey Bailey is a physical therapist and professor of anatomy and physiology with over a decade of experience providing in-person and online education for medical personnel and the general public, specializing in the areas of orthopedic injury, neurologic diseases, developmental disorders, and healthy living. 

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