Getting rid of bugs under your skin depends entirely on what’s actually there. The most common culprit is scabies, a microscopic mite that burrows into the top layer of skin and causes intense itching. Other possibilities include hookworm larvae, botfly larvae, or, in some cases, no parasite at all but a very real sensation caused by a neurological or psychological condition. Each situation calls for a different approach, so identifying the problem correctly is the first step toward solving it.
Scabies: The Most Common Cause
Scabies mites are too small to see with the naked eye. They tunnel into the outer layer of your skin, lay eggs, and trigger an allergic reaction that causes relentless itching, especially at night. You’ll typically notice thin, irregular lines on the skin (burrow tracks) along with small red bumps, most often between the fingers, on the wrists, elbows, waistline, or buttocks.
A doctor can confirm scabies by scraping a small sample of skin from the edge of a visible lesion and examining it under a microscope. The scraping is done with a blade dipped in mineral oil so the collected material, including any mites or eggs, sticks to the surface for examination. Some clinicians use a handheld magnifying device called a dermoscope to spot mites directly on the skin without scraping.
Treating Scabies
The most effective treatment is permethrin 5% cream. You apply it to your entire body from the neck down, leave it on for 8 to 14 hours, then wash it off. A single application often works, but two treatments spaced about a week apart may be needed to kill any mites that hatched after the first round. A 2025 clinical trial published in The BMJ found that permethrin cream cured about 91.5% of confirmed scabies cases after two applications on days 0 and 10, compared to 76.6% for oral medication.
Oral ivermectin is the main alternative, taken as two doses 7 to 14 days apart. It works well when cream application is impractical, such as in large outbreaks or for people who have difficulty applying cream over their whole body. However, the same trial showed it was statistically less effective than permethrin cream for clearing the infestation by day 28. Ivermectin’s safety hasn’t been established for young children or pregnant women.
Permethrin cream is safe for adults and children two months and older. Common side effects include mild itching, redness, numbness, or tingling at the application site. These usually resolve on their own. Itching can actually persist for a few weeks after successful treatment because your body is still reacting to dead mites and their waste. This doesn’t necessarily mean the treatment failed.
Cleaning Your Home After Scabies
Mites can survive off the body for a short time, so you need to decontaminate your environment alongside treatment. Wash all sheets, pillowcases, blankets, towels, and clothing used in the last three days in water above 50°C (122°F) for at least 10 minutes. If your washing machine doesn’t get that hot, run items through a tumble dryer on the highest heat setting for a minimum of 20 minutes. Items that can’t be washed, like stuffed animals or pillows, can be sealed in a plastic bag for 72 hours. Scabies mites die within a few days without a human host.
Hookworm Larvae (Cutaneous Larva Migrans)
If you’ve walked barefoot on warm, sandy soil, especially in tropical or subtropical regions, hookworm larvae can penetrate the skin of your feet and begin migrating. You’ll see a raised, reddish, winding track that creeps forward a few centimeters per day, accompanied by intense itching. The larvae can’t complete their life cycle in humans, so they stay in the upper layers of skin and eventually die on their own, but this can take weeks or months of miserable itching.
Treatment speeds things up dramatically. Oral antiparasitic medication is the standard approach, typically prescribed for one to several days depending on severity. Some cases relapse and require a second round. Topical antiparasitic creams have also been used successfully, particularly in children. Without treatment, the larvae usually die within a few weeks to months, but secondary bacterial infections from scratching are a real risk in the meantime.
Botfly Larvae (Myiasis)
Botfly larvae are a different problem entirely. These are visible, growing maggots that develop inside a bump under the skin, usually after a mosquito deposits botfly eggs during a bite. You’ll notice a raised lump with a small central opening (a breathing hole for the larva), and you may feel movement inside. This is most common after travel to Central or South America.
Do not try to squeeze the larva out. Botfly larvae have rows of tiny hooks and spines anchoring them deep in the tissue, and crushing them during removal can leave fragments behind that trigger a serious inflammatory reaction.
The simplest approach is suffocation. Covering the breathing hole with petroleum jelly, heavy oil, or even a strip of raw bacon forces the larva to surface for air. It typically emerges within 3 to 24 hours. The key is using something thick enough to block airflow but not so rigid (like nail polish) that it kills the larva in place. A dead larva that doesn’t emerge requires surgical removal.
For clinical extraction, a doctor numbs the area and either carefully widens the opening to pull the larva out with forceps or injects fluid beneath the larva to push it upward. Every part of the larva must come out intact to avoid a foreign-body reaction in the tissue.
When No Parasite Is Found
Sometimes the sensation of bugs crawling under or on the skin is vivid and distressing, but medical exams and skin scrapings find no parasite. This is a recognized medical condition called delusional infestation (also historically called Morgellons disease in cases involving fibers). It’s not about being “crazy.” It’s a specific neurological pattern where the brain generates real sensory experiences of infestation.
A CDC investigation into cases of self-reported fiber emergence from skin found no parasites, no infectious agents, and no common underlying medical condition among study participants. Most fibers collected from patients’ skin turned out to be cellulose, likely from cotton clothing or bedding. Skin lesions were consistent with scratching or insect bites rather than burrowing organisms.
About half of people with delusional infestation bring physical specimens to their doctor, collecting skin flakes, threads, or debris as “evidence” of infestation. This is so common it has a clinical name: the specimen sign. If this describes your experience, it’s worth considering the possibility seriously, because effective treatment exists.
A 2022 systematic review found that several medications produce high rates of complete remission. Certain antidepressants resolved symptoms entirely in over 80% of patients studied. Other psychiatric medications achieved complete remission in 40% to 79% of cases, with most remaining patients experiencing significant partial improvement. The condition responds well to treatment when patients are willing to try it, and improvement is often noticeable within weeks.
Recognizing Secondary Infections
Whatever the cause, the biggest complication from bugs under the skin is infection from scratching. Broken skin allows bacteria in, and what started as a parasitic problem can become a bacterial one. Watch for increasing redness spreading outward from a lesion, warmth or swelling around the area, pus or cloudy fluid draining from a sore, or fever. Scratching scabies lesions can introduce streptococcal bacteria, which in rare cases leads to kidney complications. Tick bites are especially prone to infection if the mouthparts break off and remain in the skin, causing localized ulceration.
Keeping your nails short, applying cool compresses to itchy areas, and using anti-itch creams can reduce scratching while you wait for treatment to take full effect. If a sore becomes hot, swollen, or starts oozing, that’s a bacterial infection developing and needs its own treatment.