Drug-Induced Formication and Delusions of Parasitosis

, Jillian W. Wong² and John Koo³

(1)

Department of Dermatology, University of New Mexico, Albuquerque, NM, USA

(2)

Department of Dermatology, University of California, Davis Sacramento, CA, USA

(3)

Department of Dermatology, University of California, San Francisco, CA, USA

Abstract

Mr. Northwood is a 25 year-old Caucasian man, who presented with a chief complaint of being infested by “bugs.” He reported intense, bothersome sensations of crawling, stinging, and biting, which were felt frequently all over this body. He otherwise had a clean bill of health and denied any psychological stress or emotional issues. Upon further questioning, he admitted to regular, heavy use of cocaine for the past 2 years. After he had started experimenting with cocaine, he started to notice these symptoms, which were tolerable at the time. However, the sensations progressively worsened to the point where he could no longer resist the urge to scratch or to pick at his skin. His general practitioner could not determine the cause, and as a result, referred him to your psychodermatology clinic for help.

You gently suggested that the temporal association between his period of cocaine use and the appearance of his symptoms might explain the etiology of his condition. However, Mr. Northwood insisted that there were “bugs” involved, and brought up the fact that a few of his fellow cocaine users were noting similar symptoms suggestive of infestation. After a long discussion, you convinced him that a referral to a drug rehabilitation program was needed. As for the formication symptoms, you discussed possibly taking pimozide at the next visit, after he had had a normal electrocardiogram (EKG) test. A few weeks later, you were notified that Mr. Northwood never showed up to his initial visit at the rehab facility. Thereafter, all attempts to reach the patient were not successful.

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