Patients abusing cocaine or methyl-amphetamine may develop skin excoriations and scarring associated with a creeping sensation on and under the skin.


Clinical features:

(1) abuse of cocaine or methamphetamine

(2) sensation of something creeping on or under the skin, which may be interpreted as being a bug

(3) constant picking at the skin which may take on the appearance of a constant, repetitive behavior

(4) scratching results in excoriations and subsequent scars, some of which may become hyperpigmented


Differential diagnosis:

(1) drug withdrawal

(2) neurosis or phobia (acarophobia = fear of mites)

(3) psychosis, delusions or paranoia

(4) injection site reactions


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