Father-in-law with dementia skin picking. Any advice?

Update on my FIL...

We have used the Liquid Bandage on his sores now for 2 weeks, so far so good.

It has toned down the picking a lot, at least the areas I can see. His face is clear now. He did manage to start an area at the back of his neck behind his collar.

He still picks/rubs at the areas I put the liquid bandage on but the skin underneath is healing.

He really hates the stuff, I don’t blame him, but it is a deterrent and I have noticed he is stopping himself so maybe over time he will quit the habit altogether.

One thing I dread is, I know my hubby will need to check the rest of his body for sores. My FIL is a very private person and it will be so awkward for him and my husband

Most dementia patients will develop a compulsive obsession behavior. It is impossible to break. It will continue until something else happens, or some other behavior replaces it. Just remember Alzheimer’s Disease never gets better, just worse.

On another note, tah dah...I was my dear, sweet mother's caregiver....and she, too, was nearly blind. She developed Mac Degen in her 70's, and over time, it got worse, of course.
She slowly became less able to do things that all of us take for granted, like, walking, finding her water glass, etc....I learned to become her eyes, yes, I was her "seeing-eye" daughter. And I goofed in the early days, but became very adept at seeing for her.
Later, in her 90's, my hubs insisted on her getting her eyes examined....she was living with us by then. And it was discovered that she had serious cataracts as well as the Mac Degen! Well, at 93, my brave, frail mom underwent cataract surgery, and recovered.....and she did get a little more help with her sight! She still had central blindness, but she could actually see a little out the sides! It did help, and a day or two before she passed at almost 95, she asked me, "Is it snowing out there?" I was amazed! Yes, I told her, it is definitely a snow event going on....but she saw it! Anyway, the cataract surgery helped, even tho Mac Degen really ruined her sight....she still could see, a little.
When is the last time, Lilfarmer67, that your FIL had his eyes checked? Cataracts are devastating to one who already has Mac Degen. Just to remove one obstacle to sight may make a real difference!

Lilfarmer67...
My heart goes out to you. It sounds as tho you are doing as much as you possibly can.
These types of "bad" habits can begin in anyone, even cats and dogs. All it takes is an irritant or an itch....reminds me of the oyster....an irritant gets under its shell, and over time, tissue keeps covering the irritant and forms a beautiful pearl. Wouldn't that be great if our bad habits produced beautiful results? I wish they did.
I will hold you and your FIL and family in prayer....lifting you before our Lord Jesus Christ, and let's see what God wills in this matter. It's very trying to be a caregiver, and the end is usually very heartbreaking.
Make sure, please, that you and FIL and family are saved by Christ our Lord...because eternity is forever, and you certainly don't want to go to hell....we All default to hell, unless we repent and trust in the saving work of God! I tell you this in love, and I definitely want to see all of you in Heaven one fine day. Shalom! 💜🕊💜

My husband of 53 years has Frontotemporal Demenia with Anger issues. His meds were changed and the generic for Zyprexa not only helped his moods, and anger but as an added bonus he stopped being a picker ! He has lots of scars from continually picking in the past though.
Good Luck

Mostly informational, but a few suggestions:

https://www.theadvocate.com/baton_rouge/entertainment_life/health_fitness/article_d3c5034c-91d2-11e8-bfd4-0f91075018f9.html

Another article did say at some point it can become an OCD situation, aka bad habit that started out simply from boredom, anxiety, etc. Funny, it mentions one of our usual offerings - UTI. It can't hurt to have a full checkup, but more often than not it is a nervous habit, caused by who knows what, depression, anxiety, boredom, any number of reasons it started, but at this point it is a nervous habit.

With dementia, therapy sessions aren't going to work and none of our haranguing will change it either (noted by several that it is denied and/or done "in secret."

This one is interesting:

https://www.alzheimerslab.com/skin-picking-in-alzheimers-patients/

It says the picking isn't caused by Alzheimer's, but is commonly found in those who suffer from it. There are some recommended natural treatments (not remedies per se, just ways to help heal faster.) There are some suggestions for averting the behavior, but seems like you've either tried most or are hampered by his failing eyesight. You say the spots are not very large, so perhaps it's best to keep him hydrated, apply lotion often and try some of the natural remedies to speed healing of the picked areas.

It's bad enough to have dementia, but losing eyesight is awful. I often say I could deal with limb loss, hearing loss, losing mobility, there are ways to "deal" with these, but not the eyesight. People with vision loss can learn to cope, but adding in dementia, I can't even imagine. It is one reason I kept mom's Mac Degeneration treatments going until she had a stroke. She had dementia AND hearing loss, so keeping her sight as long as possible was important.

ANXIETY. I’m a caregiver for a woman who does the exact same thing. She starts sores on her body. It’s awful. She’s on Seroquel and it seems to help.

Imho, picking is oftentimes a bad habit, whether it be from dry skin or akin to a tic.

There are some skin conditions that can contribute to this. One is called fungal acne, even though it is not acne.

https://www.mdacne.com/article/fungal-acne-causes-and-treatments-according-to-dermatologists

Good idea to see a dermatologist to make sure there isn't some underlying physical cause. If it's psychological, you might try putting bandaids on the fingers so that he can't pick.

Remember, as we age, our skin thins out and therefore dries out. Dad scratched at his arms and you could see they were dry; lotion didn't help much. His dermatologist suggested capsaicin lotion - the med techs couldn't get it off him fast enough - evidently allergic to and I'd not put it on the face. He would wear gloves off an on during the day. He was lotioned up several times a day.

As someone who picks at my skins imperfections, I also understand it is due to stress and since COVID my scalp has taken a beating. Sometimes I come to realize I'm scratching and have caused a skin tear.

Try not to stress to much over your FIL - it's probably also stressing him out more. Try and keep his wounds clean; keep up hydrating lotions and maybe an antibiotic ointment if the wound looks angry; check for allergens. Who knows maybe you'd have the same luck with CBD oil as 97yrold mom had.

Good luck.

Follow up question - has anyone tried liquid bandages or do you think that would make him pick more?

Since you mentionned trying to keep his hands occupied, here is a suggestion that works wonders for my mom , a robotic cat ( https://joyforall.com/ ) . She was not a cat person at all, but she just adores this cat. He could keep it on his knees and the purring ( with a soft vibration) and mouvements and sounds of the cat may help also distract and calm him.
I believe that at one point we have to keep our expectations at a comfort and health level, manage infection ...and let go of anything that is not a health risk...

I am sorry to put myself into this, but I am having the same problem with my husband. I am also doing pretty much the same things you are. Putting cream such as A! or some kind of cream, makes him feel that I care enough to put medicine ( he thinks it is medicine) on it and he stops for a while. After that I don't address it and he forgets about it for a while. Then we do it again.. when needed.

Maybe ask Dr. for Ativan. It was very helpful for patients when I worked for hospice.

Once the picking starts, it becomes like poison ivy. There is momentary relief when he scratches and picks and then it gets even itchier than before. If you can get a sore healed, that area may stop “itching.” Have you tried bacitracin and bandages?

Bacitracin is the best healing ointment and is an ingredient in many of the well-advertised anti-itch ointments. A tube is less inexpensive than the others. I usually have to ask the pharmacist where it is located. If used at night and kept covered, you can even see improvement when you wake. Like poison ivy, the wounds rage at night and itch even more.

How about a latch-hook rug? Knitting? Other activities that involve slight concentration that match his skill set or/and your needs - playing cards, matching socks, scrubbing something. Even touching swatches of different fabrics (soft blankets, satin fabrics, terry) helped my grandma when she had this problem. I believe this is a common problem with the elderly. Ine of my children did this also, as a toddler.

Lyme can cause skin problems. Possibly a reason to feel like picking is a good idea. My opinion is anyone who lives, or visited, any area with lyme ticks should get a lyme test if symptoms develop, including dementia.

My stepmom with dementia would pick relentlessly. Mostly her face and ears. It was really bad. When we said anything, she would deny it. My dad, also with dementia, would yell at her which caused her to pick other areas like her arms and legs. That way he wouldn't be able to see her doing it (i.e. up her sleeve). Her doctor put her on a low dose antibiotic to prevent infection - she was also getting UTI's. She passed in September but she was picking even on her death bed up to the day she died. She even picked when she was in and out of conceiceness. I think in a (strange) way, it comforts them somehow.

First I would try some anti itch shampoo for sensitive skin.
Is he getting showered often enough?

As my father aged we added olive oil to his diet. You could try coconut oil. Their poor skin is so terribly dry.

Eucerin makes a thick anti itch cream. Try a bandage like tegaderm which is very hard to pick off.

The issue may be more part of dementia than true itchiness.

Trying melatonin will not hurt him or something mild for anxiety. Lower the doses on his zoloft and depakote?

Skin picking is a well-known disorder and people of all ages suffer from it. It falls under the category of body-focused repetitive stress disorders and Google is your friend here. But it’s very difficult for people to stop once it’s become a habit.

You might try inexpensive white cotton “inspection gloves” which are comfortable but make it impossible to pick. Having something to do with the hands helps, like coloring books. Pay attention to triggers...some people pick when watching tv.

The impulses driving the behavior are deep and subconscious. People often don’t realize they are doing it until you “catch” them and then may deny it out of embarrassment. It’s an intractable problem.

He probably picks his skin because it feels itchy. Lotions will help. Try adding a bit more fats and fatty foods to his diet as well. Switch from soap to bath washes with oils in them so his skin gets less dried out during bathing. Might also try anti-itch medications like anti-histamines. Try bandages on open wounds to discourage scratching/picking. Keep his nails very short and very clean to avoid infections. Be aware that impetigo is a skin infection that is easily spread by touching infected wounds and then other places of body. Distraction will work for a awhile - try playing music he likes, television, brushing the dog, ask him to sort laundry...

The lotion should be thicker, a night moisturizer, or even vaseline. He needs to stay well hydrated. Skin care is very important. You can even use a variety of face washes, an astringent, etc. Maybe an exfoliant scrub and a facial clay mask. One thing I do for my mom is spa-care! I warm up a washcloth and wash her face after we do the eye drops. I apply creams.
I have a chronic skin condition and facial hair that requires a lot of work on my part. I'm already 72 and wonder how long can I keep this up. The sores are always flaking and irritating. If there is any possible underlying condition, he needs a dermatologist's assessment.
To encourage your dad to keep his nails short, get him some professional nail nippers (not only the clippers). Joke with him that he will be taking violin lessons soon and needs to keep his nails short for that (*I am a violinist). When I clip my mom's nails with the professional nippers, I always first apply vaseline to keep the nails soft and skin protected. He probably "thinks" he is doing a great job himself, but maybe you can find a calendar from a nail salon and circle the dates (e.g., every 2 wks) that he must trim his nails. Keeping his nails short is crucial for the face picking.
Another thing: My dermatologist gave me some "dot" bandaids to put over my chronic face sores. For a year, I wore dot bandaids in several locations on my face constantly. People and doctors kept saying "don't pick", but my take on it was that my body was telling me to get those flaking scabs off my face to relieve the pressure underneath. I also dabbed acne mediicine that has salycilate and peroxide. You can use acne preparations and regimens which may heal his skin. In the bath, I have a grapefruit body wash that is supposed to heal the skin. Olay makes body washes to heal the skin. There are many products that are over the counter that could substitute for him and relieve the sensations he is feeling on his face.Obviously he can't go out and shop for these (provide a catalog?). You could even use the face Nair, or have someone do a facial wax to remove hair. I have a battery-operated lipstick-sized hair remover (As Seen On TV) that would be a gadget for him to use instead of his fingers. I'd go this route, rather than medicate his behavior away. As a former RN working in nursing homes, it was the way doctors controlled residents' behavior: drug them into oblivion. Nobody questioned that.

My 96 yr old Dad picks and applying Virginia Coconut Oil on him twice a day seem to solve the problem.

I would try not to give meds unless it's an emergency because all meds have side effects which can cause more meds.

You might try playing some of his favorite music.

My Dad loves a foot and back massage.

You might try getting him a jumbo coloring book to color or go On Line and see if you can find a big number hand held Black Jack Game, also try playing some of his favorite tunes and if he's hard of hearing he can wear ear buds same with watching TV, since he's hard of seeing, try using a big lap top to show a favorite movies on.

My Dad still plays cards on his good days.

I pretended it was a razor burn or ingrown hair. Then put a dressing on it, the person picked at the dressing, not the skin. Pick the battles.

how about just getting a mental therapist for me. Maybe by some exercise balls to keep his hands busy. It's a reason why he's doing it. You just have to ask him for one. It's more to it than just him picking it. you need to get to the core of it. I feel a therapist would help and go walking get some exercise. sometimes if he's not married maybe going to the park and sitting and conversing with the ladies will deter him from making it worse. He probably just need a friend.

This question comes up from time to time. You can read through these posts to find that if nothing else, you are not alone in searching for answers.

https://www.agingcare.com/search?term=Picking

My DH aunt, 94 with dementia was a determined picker. Her ears got the worst of it. I had finally just given up and while it didn’t get better or worse it was easier on all of us when I just decided I had to accept it.
Then we tried one drop a day, under the tongue CBD oil. It seemed to work.
It’s antidotal of course, not scientific but hard for me to believe it was placebo only with her mental cognition. I didn’t start it with the picking in mind. I was not giving it for anything in particular, just as a tonic and that was the result.
When the pricey little bottle ran out I didn’t replace it thinking I would see what would happen. She started picking again. Now she has a bright red spot on her upper ear rim that she keeps bleeding. She hadn’t picked in at least a year, maybe longer.

I will replace the CBD oil.
The person I got the first bottle from switched to what she thinks is even better but I would have to order online and haven’t yet but I will if for no other reason than to see if she stops again.
BTW, I discussed with her geriatric doc who had no problem with it.
Another thing I discovered accidentally is that she loves the easy peel fruit. The Little Cuties. She will peel and eat three at a time. Tangelos, satsumas, tangerines. She’s been doing that for several months now. It’s a pretty good activity to keep her hands busy and a healthy snack but hasn’t stopped the picking.
I know it’s stressful for you and I did just block it from my mind after I had tried everything I could think of. lotions. Bandaids. Scolding. Once I showed her in the mirror and she started crying. She said she didn’t want to do that to herself. I realized then she couldn’t control it and I stopped mentioning it at all.

So I was pleasantly surprised when I realized she had stopped after starting the CBD oil.

oh and she does have some seasonal allergies and she takes allergy meds but it didn’t affect her picking.

Good luck with your FIL.

I was wondering if this could be an allergy.

Did anything change shortly before this started? Added meds, food, different laundry detergent, soap, shampoo?

Just a thought.

Perhaps Ask his doc to wean him off the Zoloft and then try Ativan. That’s what my mom was put on her last couple of months. She would pick her arms and under her chin.
Pls. keep his nails trimmed as short as possible and dab a bit of ointment along his nail tips so lessens bacterial build up. What moms NH used was generic Neosporin.

Can you try putting lightweight cotton gloves on him at night, so if he does wake and scratch he cannot easily do as much damage to the skin? If his wrists are small you might have to put a hair scrunchee type of elastic to hold the gloves on. I imagine he’ll fight wearing them during the day, but at least having gloves on while sleeping will help.