Could my strange skin sensation at 39 be neurological?

Question

Hello doctor,

I am a 39-year-old male experiencing a persistent sensation for almost two months that feels like something, similar to an insect, is crawling across my face, head, and legs. This crawling and itching sensation is especially noticeable at night and has become quite distressing. There are no visible signs of insects or skin lesions. I consulted a dermatologist who prescribed Cortex tablets, but they have not helped. I have a history of alcohol consumption and smoking. Interestingly, I had a similar episode around the same time last year, but it was much milder. Given the recurrence and worsening of symptoms, I am concerned that this may not be just a dermatological issue. I would like to understand whether this could be related to a neurological or systemic issue and what steps I should take to ensure an accurate diagnosis and effective treatment.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for reaching out.

Based on the symptoms you have described, a crawling or tingling sensation on your skin, particularly at night, with no visible insects or skin rash, and the lack of response to dermatological treatment (Cortex- Betamethasone or Dexamethasone), the condition you are likely experiencing is called formication, a type of paresthesia. This can feel like insects moving on or under the skin and is not necessarily related to a dermatological issue.

Possible causes:

Neurological conditions such as peripheral neuropathy or early multiple sclerosis.
Substance use or withdrawal, especially alcohol or stimulants.
Psychological factors, including stress, anxiety, or somatic symptom disorder.
Vitamin deficiencies, particularly Vitamin B12.
Side effects of medications.
Delusional parasitosis (rare) - A fixed belief of infestation without evidence.

This condition is more often linked to neurological or systemic factors rather than skin diseases.

Recommended next steps:

A. Neurological evaluation: Consult a neurologist to rule out peripheral or central nervous system causes.

B. Blood investigations: Include tests for:

Vitamin B12 levels.
Liver and kidney function.
Thyroid profile.
Blood glucose levels.

C. Lifestyle changes: Reduce or stop alcohol and smoking, as they can aggravate neurological symptoms.

D. Medication review: Since corticosteroids (like Cortex) are ineffective for non-dermatological issues, reviewing your medications with your doctor is essential.

E. Psychiatric assessment: If no physical cause is identified, a consultation with a mental health professional can help rule out psychological or psychosomatic contributors.

Given the persistence and recurrence of your symptoms, it is important to pursue a comprehensive workup. A neurologist or internal medicine specialist would be the right starting point for further evaluation and appropriate management.

I hope this information has been helpful.

Regards.