What are the aims of this leaflet? 

This leaflet has been written to help you understand more about your concerns of infestation. It covers what might be contributing to your symptoms, and what can be done to help you manage them.

What are concerns about infestation? 

You have been given this leaflet as you are concerned that your skin or other parts of your body are infested with some form of living organism or other material. You may have been worrying about this for some time, or you may have only recently started to have these concerns. It is likely that you have already seen several healthcare professionals who have not been able to confirm that you have an infestation.

Understandably, people in this situation often feel extremely frustrated and upset or angry. However, it is important to remember that your healthcare team are there to help you and will do everything they can to try and make things better.

What causes concerns about infestation? 

It can be difficult to quickly find a cause for your symptoms. An infestation may feel like the most logical explanation for the sensations of crawling and biting that you feel. There are however many other possible explanations for these symptoms.

In some people, these sensations could be the result of an underlying health condition such as iron deficiency or thyroid disease. Some medicines can cause these symptoms as a side effect. The use of recreational drugs (such as marijuana, cocaine or amphetamines) can also be relevant.

Your healthcare professional may need to do checks to rule out other causes such as these.

No matter what is causing these symptoms, they can cause serious psychological distress and have a negative impact on many aspects of life. This in turn can lead to poor sleep, anxiety, low self-esteem or feeling low, which can make any physical symptoms feel worse.

Are concerns about infestation hereditary? 

No, there is no evidence that this condition is passed on from parents to their children (genetically). However, some people who are affected are worried that other members of their family, friends or even pets might be affected because of them. It is important that you inform your healthcare team if you are worried about this, so that professional help can be offered, before trying to do something about this yourself.

What are the symptoms associated with concerns about infestation? 

People with this condition commonly describe their skin sensations as itching, crawling, moving, ‘dropping’ or biting. This may be just on the scalp or may be somewhere else on the body. Some people also report seeing black specks, particles, fibres, worms or small insects coming from their skin that others may be unable to see. Some people say that they come from the nose, around the eyes, or from the genitals or gut.

What are the skin changes seen in concerns about infestation? 

When you have this condition, there may or may not be any visible skin changes. Common changes seen include redness, scrapes or scratches, open wounds, increased or decreased areas of skin colour, scarring, and sometimes an eczema-like rash. These changes are often triggered or worsened by scratching, picking at the skin, heating, or by putting chemicals on the skin. We recognise that it may be very difficult, but advise that you resist using such methods, since this typically leads to worsening of the symptoms.

How are concerns about infestation typically investigated? 

It is likely that you will already have had a thorough examination of your skin, but if not, this will take place in the doctor’s clinic. True skin infestations are easily identified with a skin examination, which may involve the use of a tool to look at the skin up close such as a dermatoscope. If you have taken photographs, these will be examined by your healthcare professional. You may also have provided a self-collected specimen from your skin, which may be suitable to be sent to the laboratory for testing. Blood and urine tests are also usually carried out to explore all the potential causes for your distressing skin sensations.

Concerns about infestation can be very worrying and may trigger feelings of stress or anxiety. You may be asked to fill in some questionnaires about this side of things to see if supporting you to manage the associated stress would be helpful.

In some people, despite a thorough assessment and lots of tests, no cause is found. While this may feel very frustrating, healthcare professionals understand that the physical sensations of crawling and biting that you feel are very real, not imagined, and are still treatable.

Understanding the link between mind and skin 

We know that problems affecting the skin have an impact on mental health and mood. It is also clear that conditions affecting the mind can significantly worsen skin conditions or, in some cases, even cause them. There is increasing evidence that multiple systems in the body interact with, and influence each other to cause illness, including the skin, gut, nervous, hormonal and immune systems. It may seem strange if your healthcare team offers you treatment to help improve your psychological wellbeing when you are primarily concerned about your skin, however this is a recommended way of treating this condition that has been shown to be highly effective.

How can concerns about infestation be treated? 

If your healthcare professional finds evidence of a specific infestation, they will proceed to treat it accordingly. When they are unable to find an infestation, it is difficult to justify the use of treatments specifically for insects, bugs, or parasites. Such treatments may have unpleasant side-effects such as skin irritation, which can make symptoms worse.

Your healthcare professional will continue to keep an open mind on what may be causing your symptoms and will re-examine you and review any further specimens you may bring to future clinic appointments.

Sometimes you may be offered a referral to a specialist clinic where there is a range of different specialists (including a psychologist and a psychiatrist) with expertise in working with more complex skin conditions. This does not mean that your symptoms are not real. It simply means that healthcare professionals recognise that living with these symptoms can have a huge impact on your life which may require several different treatment approaches.

In many cases, when no identified cause has been found, people with concerns about infestation will be offered medication such as neuroleptics (also known as antipsychotics). These are used in very low doses, much lower than those used to treat some other conditions, and are generally well tolerated and safe. Research shows that neuroleptics can help with the itching / biting / moving sensations in the skin (or elsewhere in the body). Having started such medication, people usually report a reduction in their symptoms, and an improvement in their mood and quality of life. More importantly, they often report no longer having concerns about infestation.

It is important to note that these medications need to be taken for several weeks before improvements are seen, and they are usually continued for at least one year. They should be taken regularly and as prescribed to work properly and to reduce the risk of side-effects.

It is important to treat every aspect of the problem when people have concerns about infestation. Treatment is therefore offered to help with any feelings of stress, anxiety or depression. You may also be offered an appointment to see a psychologist. They will be able to listen to your concerns and take a full history of the impact that these feelings are having on you.  If needed, they will offer you evidence-based talking therapy to help reduce the distress related to your condition.

Self-care (What can I do?) 

Having concerns about infestation can impact on many areas of daily life. It is common for people in this situation to avoid leaving the house, or socialising / meeting with family or friends, for fear of passing on what is felt to be the infestation. Sleep is often disturbed, and some people may drink more alcohol or turn to recreational drugs to try and make things feel better. It may feel uncomfortable at first, but it helps to get out of the house each day, engage in regular physical activity, maintain regular social contact, eat as healthily as possible, focus on getting good sleep, and avoid too much alcohol or any recreational drugs. Distracting yourself when feeling the physical sensations of infestation will also help, such as by going for a walk, listening to the radio, or phoning a friend or family member.

Sometimes, just talking with a counsellor about worries and anxiety can help you find effective ways to cope with them. The NHS offers talking therapies for free – for more information visit: nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/nhs-talking-therapies/.

Where can I get more information about this condition? 

Please note that the British Association of Dermatologists (BAD) provides web links to additional resources to help people access a range of information about their treatment or skin condition. The views expressed in these external resources may not be shared by the BAD or its members. The BAD has no control of and does not endorse the content of external links.

This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists and Psychodermatology UK. Individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor. 

This leaflet has been assessed for readability by the British Association of Dermatologists’ Patient Information Lay Review Panel

 BRITISH ASSOCIATION OF DERMATOLOGISTS PATIENT INFORMATION LEAFLET

PRODUCED | SEPTEMBER 2022

UPDATED JUNE 2026

NEXT REVIEW DATE | JUNE 2029

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