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The feeling that bugs are constantly crawling on one's skin may or may not be due to the actual presence of insects or parasites on the skin.

Common causes of skin infestation include lice, scabies, chiggers, bed bugs, and ticks.

Lice may be found in the scalp, the body and the pubic area. They cause extreme itching, and scratching may lead to skin lesions and infections. It is easy to diagnose, since nits (eggs) can be found in the hair shafts, while lice can be found in the scalp or skin. The hands and feet are not affected.

Scabies is a skin condition caused by mites that burrow under the top layers of the skin to lay their eggs. Intense itching occurs only a few weeks after they have laid their eggs. They create bumps on the skin that look like pimples, and wavy, thread-like lines that follow the pattern of their burrowing activities. The skin of the hands (between the fingers), the back of the knees, and the inside of the elbows are usually affected.

Chiggers are mites that come from tall grass, wooded areas and weeds. The larvae crawl into the skin and hold on to the hair shafts. They bite into the skin, causing itchiness and leaving red bumps, and fall off after a couple of days.

Bed bugs are parasites that usually attack at night, particularly on the skin of the abdomen, buttocks, and ankles. Their bites produce rashes with intense itching, and bite sites may bleed. The bugs, which are usually found in places that are unclean or crowded, also emit a peculiar odor.

Various types of ticks can crawl on the skin and bite, causing itching and sometimes, serious illness. Ticks may come from pets, grasses, bushes or trees. They usually fall off the skin after a few days to couple of weeks.

The diagnosis of skin infestations is usually made from identification of the offending organism, which may be seen with the naked eye or through a microscope. Symptoms usually improve with treatment and elimination of the bugs.

In some cases, however, dermatologists are not able to identify the cause of why some patients feel there are bugs crawling on their skin, which can cause itching and discomfort, leading them to scratch constantly. Sometimes, scratching can lead to skin inflammation and infection, but skin biopsies do not reveal any organism or bug causing the problem. This baffling condition has been sometimes called a delusional parasitosis or infestation, wherein a patient believes that he is suffering from a real skin infestation, although there is no evidence found.

In contrast to this psychiatric condition, a physical or dermatological condition called Morgellons Disease has been identified by some doctors, which has symptoms that are similar to delusional parasitosis. In this condition, which is sometimes called an "unexplained dermopathy," the patient feels that there is something crawling on the skin, which may also bite and sting. No evidence is found, except for thread-like fibers seeming to appear under the skin.

Unlike those skin conditions where bugs could be definitely identified and treated accordingly, delusional parasitosis and Morgellons disease have no specific treatments. However, psychiatric evaluation and support are recommended.

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