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What causes formication? Related conditions and treatments

Medically reviewed by Leslie Greenberg, MD
Board-Certified Family Physician
Updated May. 7, 2024  •  Published Jan. 23, 2024
Fact Checked
What causes formication? Related conditions and treatments
In this article:

Overview: What does formication feel like?

Formication is a type of tactile hallucination in which people have a sensation of insects or other small creatures like ants or mites crawling on or under the skin. The word “formication” comes from “formica,” the Latin word for ant. To the person experiencing the sensation, it’s a real feeling involving itchy skin, burning, tingling, and even skin pain. Because of the skin discomfort, people with formication often scratch their skin obsessively, sometimes injuring the skin or tearing off scabs. Mood changes, irritability, and even suicidal thoughts are possible if the feeling is intolerable. However, the sensation is not based on anything physical. It is either nerves misfiring or a hallucination. Sometimes, people also have the false belief that there’s an actual infestation. Medical professionals call this condition delusional parasitosis. People with delusions of parasitosis usually can’t be convinced there isn’t an infestation. They may do serious harm to themselves to rid their skin of the nonexistent infestation. People who only have formication are usually not deluded. They can be convinced the feeling is caused by something other than insects, worms, or scabies. 

Key takeaways:

  • Formication is a common symptom that may be caused by psychiatric disorders, recreational drug use, drug withdrawal, medication side effects, neurological disorders, hormonal imbalances, nutrient deficiencies, or other medical conditions.

  • Typically, formication does not require immediate medical attention unless there are severe psychiatric symptoms or a severe skin infection from scratching.

  • Formication generally does not require treatment, but many underlying conditions require treatment. It may resolve with treatment, but this will depend on the accuracy of the diagnosis and the nature of the underlying cause.

  • Treatments of formication vary by cause. Read more about treatments for schizophrenia here, bipolar disorder here, dementia here, and multiple sclerosis here.

  • Do not treat formication at home except under the medical advice of a healthcare professional. Depending on the cause, formication can be partly managed with stress reduction, topical creams, or icing of the affected skin.

  • Use coupons for formication treatments, like pimozide, capsaicin cream, and Cortizone-10 (hydrocortisone), to save up to 80%.

What causes formication?

Formication can be caused by psychiatric disorders, brain disorders, drugs, withdrawal, or by peripheral nerve disorders. In every case, formication is a problem with the nervous system. 

Drug abuse and drug withdrawal are two common causes of formication:

Many prescription medications can cause formication or other bizarre tactile sensations, including:

Another set of common causes of formication is psychiatric disorders that cause psychosis, including:

  • Schizophrenia

  • Bipolar disorder

  • Depression with psychosis

Formication associated with other mental illnesses that can sometimes veer into psychosis. These include anxiety disorders, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). However, when people with these disorders become psychotic, the typical symptoms are delusions (false beliefs about reality) rather than hallucinations.

In some cases, formication is a problem with the nervous system. Some conditions cause nerves to fire incorrectly in the brain, the spine, or beneath the skin. The most common neurologic conditions that cause formication or similar tactile sensations include:

Other medical conditions can cause nerves to malfunction, resulting in bizarre tactile feelings. These usually involve tingling, burning, numbness, or pain. There have been reports of formication in people with these conditions, including:

  • Anemia

  • Thyroid disorders

  • Liver disorders

  • Kidney disorders

  • Menopause

  • Iron deficiency

  • Vitamin B12 deficiency

Most of the above conditions that can cause neuropathy can be ruled out by a visit with your primary care physician for a history, physical, and lab work. It’s important to understand that many of the causes of formication will have other, more obvious symptoms. Psychosis, stroke, shingles, multiple sclerosis, brain injury, dementia—these are all medical conditions that produce a host of symptoms. Many of these symptoms are more severe than tactile sensations.

Should I be worried about formication?

Formication and other bizarre skin sensations can be a sign of many different diseases or disorders. Getting medical help should depend on how long it lasts, how much it reduces the quality of life, and other symptoms.

Occasional or temporary bouts with bizarre tactile sensations without other symptoms may be nothing to worry about, but tell a primary care provider about the symptoms at your next visit. If formication is interfering with daily life, causing distress, or causing you to itch so much that you’re damaging the skin, then see a healthcare professional sooner rather than later.

Most importantly, other symptoms should be red flags. See a doctor if:

  • You are having symptoms of drug withdrawal

  • You or a loved one with formication actually believe there’s some kind of infestation

  • The crawling feeling is accompanied by other skin sensations like severe pain or burning

  • There are other symptoms suggestive of a neurological disorder, such as tremor, weakening muscles, or increasing forgetfulness

Get emergency treatment if there are signs of a stroke, such as sudden weakness, inability to speak, or confusion. Emergency treatment is also needed if a person exhibits beliefs or behaviors that suggest they may harm themselves or other people. 

How is the cause of formication diagnosed?

Diagnosing the cause of formication is difficult. Because there are so many causes, patients have to experience what doctors sometimes call a “chase to eliminate,” that is, ruling out other causes. It’s not unusual for them to start with some of the most serious causes. For formication, a doctor might immediately start assessing for psychosis or other mental health issues. They may start assessing for dementia next. This process of ruling out possible causes may take a while and could result in the wrong diagnosis. 

To make it easier, organize as many details as you can about the condition. You may be asked questions like:

  • Where does the sensation occur?

  • What makes the sensation begin? Finish?

  •  How long does it last? 

  • Does it wake you from sleep?

  • Can you tolerate the feeling?

  • What precisely is the feeling? Is it like bugs crawling? Or stinging? Or is it tingling? Itchiness?

  • What do you think is causing the feeling?

  • What areas of the skin are affected?

  • How often does it occur?

  • Are there other skin symptoms or problems?

  • Are there other symptoms besides skin issues?

  • What medications are you taking? Why are you taking them?

  • Do you have any other medical conditions?

  • Have you recently had a head, neck, or back injury or surgery?

  • Have you ever lost consciousness?

  • Do you use any nonmedical substances?

A primary care provider will conduct a physical examination as well as a symptom review and medical history. They will do a full exam of any affected skin. However, the clinician may refer the case to another specialist, such as a neurologist, psychiatrist, dermatologist, or other specialist. Depending on the suspected cause, these specialists may use several different types of medical tests to find the cause. 

How long does formication last?

Formication may sometimes last only briefly but may also persist or recur for as long as there’s an underlying condition causing the symptom. Many psychiatric causes and neurological causes are chronic and even lifelong problems, so that people may experience tactile sensations similar to formication throughout their lives.

How to stop formication

Healthcare professionals treat the underlying causes of formication rather than the symptom itself. Treatment options vary depending on the condition.

In some cases, treatment may be straightforward. Formication caused by a drug can be reduced or eliminated by stopping the drug. Formication due to drug withdrawal can be managed with medical treatment appropriate to that particular type of withdrawal. Formication, paresthesias (skin prickling), and other withdrawal symptoms typically resolve within days or weeks.

Treatment options for formication caused by psychiatric disorders include antipsychotics, other prescription drugs, and cognitive behavioral therapy.

If the sensation is due to nerve problems, the symptoms of formication can be managed with symptom relief medications such as over-the-counter pain relievers, corticosteroid creams, or topical anesthetic creams. These treatments dull the nerves causing tingling or skin-crawling feelings. In some cases, a healthcare professional may prescribe a low dose of the antipsychotic drug pimozide to reduce the sensations. 

Formication is a common symptom of spinal injury. One study showed that about 1/3 of people with whiplash experienced formication symptoms. For most people, whiplash symptoms resolve in a few weeks. Sometimes not. Other spinal injuries may be chronic conditions and can only be resolved with nerve medications, surgery, or restorative treatments.

In rare cases, there may be an actual physical cause, such as exposure to poisons. These can be treated, and the symptoms usually resolve.

Living with formication 

Sometimes, medical professionals have few ways to help with formication. Whether it’s brief or persistent, formication can be managed with a few simple tips:

  • Get a medical diagnosis

  • Take any prescription drugs as instructed

  • Avoid scratching, as this will irritate the skin and increase itchiness, nerve overactivity, and possibly cause skin injuries

  • Keep perspective—it’s not uncommon for people to talk themselves into delusional ideas about the cause

  • Use over-the-counter pain relievers or topical anesthetics to help reduce or relieve symptoms

  • If you can’t tolerate the feeling, get immediate medical help—at that point, the first order of business is to ensure your safety by seeing a doctor or mental health professional

Most importantly, don’t manage formication on your own

Persistent or recurrent formication can be a sign of serious disease. More ominously, it can be a sign of psychosis, brain injury, brain infection, or dementia. This means that you or the person experiencing formication may not be able to exercise good judgment. Only a doctor, psychiatrist, or neurologist has the skills and perspective to identify the true cause and appropriate treatments. Most importantly, if you can’t stand the feeling of formication, that, too, interferes with your ability to make good decisions. At that point, you need support from a loved one, family member, or mental health professional

What’s next? Additional resources for people with formication

Test and diagnostics

Treatments

Scientific studies and clinical trials

Medically reviewed by Leslie Greenberg, MD
Board-Certified Family Physician

Leslie Greenberg, MD, is a board-certified practicing family physician with more than 25 years of doctoring experience. She was a psychology major at Northwestern University near Chicago, then graduated with an MD from the University of Nevada School of Medicine. She completed her family medicine residency at St. Joseph Hospital in Wichita, Kansas. She has trained more than 350 family medicine resident-physicians, been in private practice, and delivered babies for 22 years.

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