Key takeaways:
Formication is the sensation that bugs are crawling on or under your skin when they don’t really exist.
Causes of formication include mental health conditions such as depression, medical conditions like Parkinson’s disease, certain prescription medications, or drug use.
The best way to treat formication is to treat the underlying problem. But there are also medications that can help get rid of the symptoms.
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Have you ever felt spiders crawling up your arm right after you saw one? If so, this is a normal response. But some people have the sensation of bugs crawling on or under their skin constantly. This is a tactile hallucination known as formication.
People with this condition are convinced the bugs are real, even with reassurance from others that they’re a hallucination. This makes formication difficult to treat for the person and their healthcare team.
We’ll cover some of the symptoms, different causes, related conditions, and how formication is treated.
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What are the symptoms of formication?
Formication can show up in various forms. Some individuals may feel it mostly in their hands or feet. Others may experience it across their entire body.
In addition to the sensation of bugs crawling, other symptoms of formication include:
Tingling sensations
Skin itching
Discomfort or pain in the affected areas
Feelings of anxiety or distress
What causes formication?
Formication can be its own psychological disorder, unrelated to another condition. It can also be related to mental and physical health conditions, such as:
Psychosis
Illicit drug use
Medication side effects
Neurologic conditions
Let's break down the possible causes of formication.
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Psychological factors
These include mental health conditions like:
In these cases, people might genuinely believe they have bugs on their skin. And sometimes they might hurt themselves by scratching too much.
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Drug use
Certain drugs, especially cocaine and methamphetamines, can make it feel like bugs are crawling on you. This sensation is so common with these drugs that there are nicknames for it like “cocaine bugs” and “meth mites.” Also, when you're withdrawing from alcohol or opioids, you might feel this way too.
Can cannabis also cause formication?
Yes, cannabis can cause formication — though it's not very common. Some people report feeling like bugs are crawling on their skin during or after using cannabis. This is especially true at high doses of THC or with edibles. This feeling can be part of a broader reaction, like anxiety or paranoia.
If this happens to you, it’s a good idea to pause your cannabis use and talk to a healthcare professional.
Medication side effects
Some medications can cause formication as a side effect. These include drugs like:
Methylphenidate (Ritalin) — used for ADHD
MAO inhibitors — a type of antidepressant
Medications for Parkinson's disease
Certain antibiotics
If you're taking any of these and feel like bugs are on your skin, it could be a side effect.
Medical conditions
Various medical conditions affecting the brain and nerves can also lead to formication. These include:
Parkinson’s disease
Traumatic brain injury
Delirium
Dementia
Stroke
Meningitis
Encephalitis
These conditions can disrupt how your brain normally works and make it feel like bugs are crawling on you.
Perimenopause and menopause
Formication is a recognized symptom of perimenopause and menopause. The sensation is often linked to hormonal changes, like declining estrogen levels. These fluctuations can affect nerve sensitivity and skin health.
Formication related to menopause or perimenopause isn’t dangerous. But it can be distressing. The good news is that it can be managed with lifestyle adjustments, hormone therapy, or other treatments as advised by a healthcare professional.
How is formication diagnosed?
Healthcare professionals usually diagnose formication by starting with a conversation. They’ll typically ask you about your:
Symptoms
Medical history
Medications
Lifestyle
Sometimes the cause is clear, like:
Menopause
Medication side effects
Chronic conditions
Drug use
Since formication is usually a symptom of something else, there’s no single test for it. A healthcare professional might order blood work. Or they may check your skin and nerves to rule out other problems that could be linked to what’s causing you to feel formication.
How is formication treated?
Dealing with formication can be tough. Some people find it hard to accept that their symptoms aren't real, making it tricky to follow treatment advice. However, there are several options available if you're open to help.
First off, healthcare professionals might prescribe medications to ease the symptoms. Antipsychotics like risperidone or olanzapine are often used. If depression is involved, then antidepressants can be used as well. Treating any skin issues caused by formication is also important. This might involve medications for pain or itching. Antibiotics may even be needed if there’s an infection.
Beyond medications and skin care, treatment could include:
Cutting back on personal drug use
Adjusting or stopping medications that might be causing the issue
Taking medications to help with alcohol or opioid withdrawal
Treating any other medical conditions that could be contributing to formication
Counseling and support to address the psychological aspects of the condition
To stop the skin crawling feeling immediately, you can try:
Cool compresses or baths
Wearing loose clothing
Distracting yourself with something else to make the symptoms less noticeable
Complications of formication
Formication itself isn’t dangerous, but it can lead to problems if it goes unchecked. Some people scratch their skin to try to stop the crawling feeling. And this can cause irritation, open wounds, or even infections. It can also take a toll on your mental health — especially if it’s linked to anxiety, poor sleep, or substance use.
In more serious cases, formication can be part of a larger issue like alcohol withdrawal or a neurological condition, which may need medical attention. The sooner you talk to a healthcare professional, the easier it is to get to the root of the problem and avoid these complications.
When to seek care
If you feel a crawling sensation on your skin and it’s not obvious why you’re feeling it, it can be worth checking in with a healthcare professional. You don’t always need medical care if it happens just once or goes away quickly. This is especially true if you can link it to something harmless like an insect bite or dry skin.
But you may need to seek medical care if the feeling:
Doesn’t go away or keeps coming back
Affects your sleep or daily life
Causes you to scratch to the point of skin sores or irritation
Is linked with confusion, anxiety, or substance use
Even if it feels minor, formication can be your body’s way of flagging something that needs attention.
Frequently asked questions
Yes, certain vitamin deficiencies — especially low levels of vitamin B12 — can cause formication. Vitamin B12 is important for nerve health. When levels are low, it can lead to nerve-related symptoms like tingling, numbness, or the feeling of insects crawling on the skin.
Formication isn’t usually dangerous on its own, but it can be a sign of an underlying issue like a vitamin deficiency, nerve disorder, or substance use. It can also lead to complications like skin irritation or infection from scratching. If it’s persistent, worsening, or interfering with daily life, it’s a good idea to check in with a healthcare professional.
It depends on the cause. If it’s triggered by something short term — like medication or stress — it may fade within hours or days. But if it’s tied to a chronic condition or disorder, it can last longer and may need specific treatment to improve.
Caffeine isn’t a common cause of formication. But in high amounts, caffeine can overstimulate the nervous system. This can lead to symptoms like jitteriness, anxiety, or unusual skin sensations, which can sometimes feel similar to formication. People who are sensitive to caffeine may be more likely to experience this. Cutting back may help if you suspect a link.
Yes, certain vitamin deficiencies — especially low levels of vitamin B12 — can cause formication. Vitamin B12 is important for nerve health. When levels are low, it can lead to nerve-related symptoms like tingling, numbness, or the feeling of insects crawling on the skin.
Formication isn’t usually dangerous on its own, but it can be a sign of an underlying issue like a vitamin deficiency, nerve disorder, or substance use. It can also lead to complications like skin irritation or infection from scratching. If it’s persistent, worsening, or interfering with daily life, it’s a good idea to check in with a healthcare professional.
It depends on the cause. If it’s triggered by something short term — like medication or stress — it may fade within hours or days. But if it’s tied to a chronic condition or disorder, it can last longer and may need specific treatment to improve.
Caffeine isn’t a common cause of formication. But in high amounts, caffeine can overstimulate the nervous system. This can lead to symptoms like jitteriness, anxiety, or unusual skin sensations, which can sometimes feel similar to formication. People who are sensitive to caffeine may be more likely to experience this. Cutting back may help if you suspect a link.
The bottom line
Formication is the false perception that bugs are infesting your skin. It can be a very uncomfortable and distressing symptom. And it can be hard to help people understand that the bugs aren’t real. Often, this delusion is the result of an underlying mental health condition, medical condition, or drug use. If someone is open to receiving help, treatment often involves psychiatric medications and treating any contributing medical condition.
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References
Daly, T., et al. (2018). Telogen effluvium with dysesthesia (TED) has lower B12 levels and may respond to B12 supplementation. Journal of Drugs in Dermatology.
Juan, C. J., et al. (2018). Prickling or formication after the use of cocaine. Journal of Spanish Prison Health.
Kemperman, P. M. J. H., et al. (2022). Drug-induced delusional infestation. Acta Dermato-Venereologica.
Magraith, K., et al. (2023). Management of menopause. Australian Prescriber.
Nair, P. A. (2014). Dermatosis associated with menopause. Journal of Midlife Health.
Rusyniak, D. E. (2012). Neurologic manifestations of chronic methamphetamine abuse. The Psychiatric Clinics of North America.
Wong, J. W., et al. (2013). Delusions of parasitosis. Indian Journal of Dermatology.
