Itching, stinging, burning, or crawling sensations without a physical cause is known as formication. Treatment can help alleviate symptoms and reduce discomfort.

Formication is the experience of tactile sensations that don’t have a physical cause; most often, people have the sense of crawling, stinging, or burning on their skin. Formication is a type of tactile hallucination and is sometimes called skin crawling.

If you’ve ever experienced this condition, it can be unpleasant and uncomfortable. The symptoms associated with formication often cause itchiness, which can lead to breaking skin.

Formication has numerous causes, ranging from medical reasons to mental health causes. While treatment can help, it can be challenging because many think the hallucination is real. Treatment for this condition is based on the underlying cause.

Formication is the sensation of bugs, such as ants or other small insects, crawling inside or on your skin. Common symptoms associated with formication include:

  • itchiness
  • burning
  • pain
  • tingling sensation
  • scratching that breaks the skin
  • movement sensations underneath the skin

Individuals with this condition may have skin problems, lesions, or skin breaking due to itchiness. It may be best to consult a dermatologist for skin treatment in these cases.

Like formication, delusional infestation, also known as delusional parasitosis, is a false belief that bugs have infested a person.

2017 research suggests that the difference between delusional infestation and formication is people with formication don’t believe they are ill or sick because of the bugs.

There are several causes of formication. According to a 2023 overview, the most common reasons are those that occur in addition to a primary psychiatric disorder. Secondary causes include many medical conditions that can cause formication.

1. Primary psychiatric disorders

Primary psychiatric disorders are among the most common causes of formication. Schizophrenia can cause tactile hallucinations, where an individual may believe bugs are crawling on them without a physical cause.

Tactile hallucinations can also occur with other mental health disorders, such as:

In these situations, proper treatment of the psychiatric disorder can help alleviate the symptoms of formication.

2. Medical conditions

Several medical conditions can cause formication. 2019 research suggests that medical conditions associated with formication include:

  • anemia
  • hepatitis
  • hyperthyroidism
  • diabetes
  • vitamin B12 deficiency
  • HIV
  • syphilis
  • menopause

If the delusions result from a medical condition, it may be helpful to talk with a medical professional and a psychiatrist to treat both conditions.

3. Substance use

Tactile hallucinations of small insects can occur in people who use amphetamines or cocaine. In a 2022 overview study of drug-induced delusional infestation, they found that cocaine users were likely to report delusional infestation.

In some cases, individuals who used amphetamines prescribed for attention deficit hyperactivity disorder (ADHD) experienced the sensation of insects crawling on or inside their skin. This was common with medications such as methylphenidate, commonly known as Ritalin.

4. Side effects of medications

Some medications can also cause side effects that may cause formication. The same 2022 overview mentioned above reports that some classes of medicines are associated with formication and delusional infestation.

These medication classes include:

  • antibiotics
  • antidepressants
  • Parkinsonian drugs
  • antiviral medications
  • antiepileptics

The researchers believe that each of these classes of drugs is associated with delusional infestation due to the medicines affecting neurotransmitter systems in the central nervous system.

But it’s important to note that side effects of formication are rare for those who take antidepressants and antiepileptics.

Treatment for formication depends on the underlying cause of the condition. If the formication results from a medication’s side effect, other medicines may be prescribed to treat the initial condition.

In the case of substance use, treatment tailored explicitly to substance use may be the most helpful for finding relief from formication.

If you need treatment for formication and it’s part of a psychiatric disorder or some medical conditions, the first treatment often recommended is antipsychotic medications and counseling or mental health treatment.

Treatment can be challenging because many people with this condition believe their hallucinations are real.

Some common antipsychotic medications prescribed for formication include:

Other factors to consider in treatment are that many people can scratch, pick, or create lesions on their skin, which can cause infections and broken skin. Some people may also seek treatment from a dermatologist to help cope with this condition.

When to seek support

If you or a loved one is experiencing tactile hallucinations, it’s essential to seek help immediately.

Sometimes, the underlying causes of formication can signal a medical issue or drug overdose. If you’re having trouble distinguishing what’s real and what isn’t, it’s a sign to seek professional help.

If you need help finding a medical professional or therapist, you can use the FindCare Tool to find one near you.

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Getting help or receiving a diagnosis of formication isn’t always easy, as there are many underlying causes. A medical professional can diagnose formication after a medical history is taken.

If you’re presenting with the symptoms of formication, the medical professional may ask questions about:

  • mental health history
  • current medications
  • current drug and alcohol use
  • medical conditions
  • when the symptoms started
  • how often the symptoms occur
  • when the symptoms occur

To obtain the proper treatment, you must be honest with your healthcare professional.

Formication is a tactile hallucination involving the experience of skin sensations that present as itching, burning, or a crawling sensation without a physical cause.

If you’re experiencing formication, it’s best to seek help from a medical or mental health professional immediately. Treatment is essential because the condition can have underlying medical causes or be a severe side effect of medication or drug use.

Treatment for formication often involves medication, counseling, switching away from the medication causing the condition, and seeking the help of a dermatologist. Relief from formication symptoms is possible, and you can find relief.