Differential Diagnosis for Feeling of Bugs Crawling on the Skin
Single Most Likely Diagnosis
- Formication: This is a tactile hallucination that creates a sensation of ants or insects crawling on or under the skin. It is often associated with substance abuse (especially cocaine or methamphetamine), withdrawal, or certain psychiatric conditions. The direct link to the sensation described makes it the most likely diagnosis.
Other Likely Diagnoses
- Dry Skin (Xerosis): Severe dryness can cause itching and irritation, potentially leading to a sensation that might be described as bugs crawling on the skin.
- Eczema/Dermatitis: Inflammatory skin conditions can cause intense itching and skin sensations that might be misinterpreted as crawling bugs.
- Neurological Conditions (e.g., Neuropathy): Certain neurological disorders can cause abnormal sensations in the skin, including tingling, burning, or itching, which might be described as feeling like bugs.
- Psychiatric Conditions (e.g., Anxiety, Psychosis): In some cases, psychiatric conditions can lead to tactile hallucinations or misinterpretation of skin sensations.
Do Not Miss Diagnoses
- Lyme Disease: Early stages of Lyme disease can cause a variety of skin sensations, including itching or crawling feelings, especially around the area of the bite.
- Scabies: A parasitic infection caused by the mite Sarcoptes scabiei, leading to severe itching and a crawling sensation, especially at night.
- Diabetic Neuropathy: A serious complication of diabetes that can cause a range of abnormal skin sensations due to nerve damage.
- Vitamin Deficiency (e.g., Vitamin B12 Deficiency): Certain vitamin deficiencies can lead to neurological symptoms, including abnormal skin sensations.
Rare Diagnoses
- Ekbom Syndrome (Delusional Parasitosis): A rare psychiatric condition where the person has a fixed, false belief that they are infested with parasites, leading to a sensation of bugs crawling on or under the skin.
- Hookworm Infestation: While rare in many parts of the world, hookworm infestation can cause a crawling sensation as the larvae penetrate the skin.
- Kleine-Levin Syndrome: A rare sleep disorder that can include a range of symptoms, potentially including hallucinations or abnormal skin sensations during episodes.