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Crawling sensation under the skin (formication)

Updated: Jun 10, 2023

Formication refers to the sensation of insects crawling on or under the skin, even though there is no actual presence of insects. It is a symptom that can be associated with several underlying conditions. Here are some possible causes of formication:

1# Menopause:

Some women going through menopause may experience formication due to hormonal changes. Fluctuations in estrogen levels can affect nerve endings and lead to abnormal skin sensations. During menopause, the ovaries gradually decrease their production of estrogen and progesterone and testosterone. These hormonal changes can affect the function of the nervous system, including the peripheral nerves responsible for transmitting sensations from the skin to the brain. The alteration in hormone levels can disrupt the normal functioning of these nerves, leading to abnormal sensations like formication. Estrogen deficiency-related formication tends to improve within 2 weeks of starting HRT.

Over the years, during medical training and as a qualified doctor I've encountered women with formication. Interestingly, these women were menopausal age. I remember working in a psychiatric unit as an intern in Bolton Manchester. There was not a shortage of women admitted for tactile hallucination (a sensation that there's something on their skin). I recall a dear 80yr old lady who complained of being covered by spiders, she was so distressed by the sensation that we had to give her medication that heavily sedated her. Looking back, if I knew then what I know now, I would probably have trialled her on a low-dose estrogen patch. Estrogen would certainly have caused fewer side effects than long-term sedation which would have increased her risk of falls and infection.

#2 Neurological conditions:

Certain neurological conditions, such as multiple sclerosis, peripheral neuropathy, or diabetic neuropathy, can cause abnormal sensations, including formication.

#3 Psychiatric disorders: Conditions like anxiety, depression, or psychosis can lead to altered perception and sensory disturbances, including the sensation of bugs crawling on the skin.

#4 Medications:

Certain medications, such as antipsychotics, antidepressants, or antiepileptic drugs, can cause formication as a side effect.

#5 Stress and anxiety:

Psychological stress and anxiety can lead to sensory disturbances and sensations of formication.

#5 Substance abuse:

The use of certain substances like cocaine, amphetamines, or hallucinogens can cause formication as a side effect. These substances can alter the perception of sensations, leading to abnormal skin sensations.

#6 Withdrawal symptoms:

During withdrawal from drugs or certain medications, including opioids or benzodiazepines, individuals may experience formication as part of the withdrawal syndrome.

Please note formication can be a symptom of an underlying medical condition, and a thorough evaluation by a healthcare professional is recommended if the sensation persists or is accompanied by other concerning symptoms. Treatment options for formication depend on the underlying cause and may include addressing the primary condition, medication adjustments, therapy, or lifestyle changes.

Dr Puriy Carr is a GP and Menopause Doctor in Harvey Western Australia
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