From the Research
Treatment for formication should prioritize addressing the underlying cause, and gabapentin at doses of 1800 mg to 3600 mg daily can provide good levels of pain relief to some people with neuropathic pain conditions, such as postherpetic neuralgia and peripheral diabetic neuropathy, as evidenced by the most recent and highest quality study 1. When formication is related to medical conditions such as diabetic neuropathy, treating the underlying condition is crucial.
- Discontinuing substance use (like cocaine, methamphetamine, or alcohol) is essential if formication stems from substance use.
- Consulting with a healthcare provider about adjusting or changing medications may help if formication is medication-induced.
- Antipsychotic medications like risperidone or olanzapine may be prescribed at low doses (0.5-2mg for risperidone, 2.5-5mg for olanzapine) if formication is associated with psychosis or delusions.
- For anxiety-related formication, SSRIs like sertraline (50-200mg daily) or escitalopram (10-20mg daily) may be beneficial.
- Topical treatments such as capsaicin cream or lidocaine can provide temporary relief from the sensations.
- Cognitive behavioral therapy can help patients manage the psychological aspects of formication, particularly when it causes significant distress.
- Maintaining good skin hygiene, avoiding scratching, and using moisturizers can prevent skin damage from excessive scratching responses to the sensations. Formication occurs because of abnormal nerve signaling in the skin or misinterpretation of normal sensations by the brain, which is why addressing both physical and psychological factors is important for effective treatment, as supported by studies on neuropathic pain management 2, 3, 4. It is also important to consider drug-induced tactile hallucinations, which can be caused by various medications, including anti-Parkisonian agents, antidepressants, prescription stimulants, antihypertensives, and antiepileptics, as reported in a literature review on the topic 5.