Patients can seek out medical attention for a wide variety of skin conditions, which may include psoriasis, eczema, rashes, dermatitis, insect bites or any number of related problems, some of which are easier to diagnose and treat than others.
When a person reports uncontrollable sensations of bugs crawling under their skin, this can signal a variety of potential diagnoses, one of which may be formication, a symptom rather than an illness. Formication is often defined as a tactile hallucination, a sensation without an identifiable physical cause that can still feel very real to the patient. It is sometimes referred to as delusional parasitosis.
Suffering “The creepy crawlies”
Formication is the medical term for the sensation of having insects burrowing under, or crawling over, the skin. For the sufferer, it can unfortunately lead to feelings of great physical discomfort, as well as psychological distress, emotional desperation and self-mutilation. The medical history of this condition dates to the late 19th century, and is said to be derived from the Latin word, formicare, which translates as “to creep like an ant.”
Rather than a tactile hallucination, formication can also be classified as a paresthesia, a sensory symptom that may feel like burning, itching, prickling, skin crawling or diminished sensation. While the feeling of bugs crawling under or over the skin is the hallmark of formication, there are other common symptoms, including body aches, exhaustion, anxiety, depression, tremors or muscular stiffness.
One may come across reports of Morgellons Disease, a condition wherein “fibers” or “threads” appear under the skin and may be accompanied by a sensation of bugs crawling under the skin. Curiously, WebMD, NIH and other sources refer to medical controversy regarding whether Morgellons is strictly delusional, or is actually the result of infection...
with a tick-borne spirochete.
According to an article published in Psychology Today, there is an interesting and often unexpected manifestation of formication/delusional parasitosis:
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.
The Causes of Formication
Many causes of formication have been identified, including Parkinson’s Disease, fibromyalgia, anxiety disorders, shingles (herpes zoster), schizophrenia, Lyme Disease, perimenopause (possibly due to lower estrogen levels in the blood), certain types of skin cancers and neuropathy caused by poorly controlled diabetes. Some articles on the subject state that it is more likely to occur at night than during the day.
A very common cause of the sensation of formication is acute withdrawal from certain types of both illicit and legal drugs. Users of methamphetamine often present with faces and arms pockmarked with scabs and sores, which may become infected from uncontrolled scratching. The violent itching often seen in meth users is brought about by acute withdrawal. Cocaine users can also experience the same symptoms.
When withdrawing from alcohol, formication often accompanies delirium tremens, a potentially life-threatening form of acute withdrawal that can lead to seizure activity and other dangerous symptoms beyond itchy skin.
In terms of legally prescribed medications, formication can result from sudden withdrawal...
from pharmaceuticals such as:
- Ritalin
- Wellbutrin
- Opiates
- Lunesta
- Tramadol
- Codeine
- SSRI antidepressants
As we can see, the creepy crawlies can result from various causes, but result in similarly unpleasant symptoms, even though some providers may see these symptoms as completely psychoemotional in nature.
Treatment of Formication
Treating formication can be multifaceted. If the symptoms are caused by withdrawal from a medication, then adept management by the prescriber is essential. In the case of medications for mental health diagnoses, a psychiatrist may be the best choice in this regard.
If formication is caused by withdrawal from alcohol, cocaine, meth, or opiates, ongoing management and treatment of a substance use disorder will be crucial. And if the cause is perimenopause, Lyme, Parkinson’s or any other condition, specialists will be needed to address the root cause.
Finally, for the actual itchiness and discomfort, a dermatologist may be useful in helping to alleviate symptoms that can cause infection and scarring if the patient continues to scratch uncontrollably.
Formication is a complex set of symptoms with a confusing array of possible causes, and treatment is important for the well-being of the patient. Whether it is by nature physical, psychological or a combination of the two in a particular individual, an accurate diagnosis and treatment plan can be carefully created and managed. Formication may be complicated and multifactorial, but it can be controlled, and recovery is entirely possible.
