Hi,
FIL has been picking his face and creating sores. It started 6 months ago when he fell and had a small scrape on his forehead, but he picked it until it was a very large sore. He eventually left that one alone and it healed but he has dozens of small sores all over his face from picking.
Here is what we have tried so far:
Reasoning with him about how we don’t want him to get an infection and end up in the hospital (doesn’t really work at his stage of dementia)
Distraction and redirection, but it only helps a few minutes.
Fidget toys, Rubik’s cube, and anything to keep his hands busy, he loses interest quickly
Giving home photos and coins to handle and look at, but that gets frustrating because of his poor eyesight.
Giving him lotion to put on his face when we see him doing it. Surprisingly, this has been the best deterrent- he doesn’t pick when he feels the lotion on there, but he finds a different spot to pick. Plus it requires vigilance to reapply the lotion dozens a times a day.
The doctor tried Depakote, but that made it worse and is trying Zoloft now in case it is due to anxiety or depression. No real difference.
He knows he shouldn’t do it, he stops if he sees me walk in a room. He picks wherever he thinks DH and I can’t see him, even pulling a blanket up to his eyes. I think he thinks we don’t know what he is doing. He now picks areas like behind his ears and scalp where it is not as obvious.
He gets defensive if we correct him, he will say he is just rubbing. He says he feels stubble, but we feel the area and there is no stubble there. His skin tends to be dry which is why we came up with the lotion idea.
Instead of correcting him now, we just tell him his skin looks dry and put some lotion on his face. We talk about our skin being dry and put lotion on our face and hands too, lol.
It is worse when he is stressed or bored, but he doesn’t want to do much beside watch TV and he is nearly blind.
I try to get him to pet the dog which occupies him for a bit.
It’s worse at night when we can’t keep an eye
There is no way he will wear those mitts. DH won’t even consider that one.
Have any of you dealt with this? Any other ideas?
Sometimes, I wonder if we should just leave him be as long as he’s not getting an infection. The sores are pimple size to pea size.
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
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!
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! 💜🕊💜
Good Luck
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.
This all started about 6 months ago so it’s definitely not a lifelong habit. His neurologist believes it is his dementia progressing and she sees OCD behaviors come up quite often in severe patients, it doesn’t always manifest as skin picking.
My FIL has macular degeneration, it is terrible. It is driving him crazy that he can’t see well. He has an eye doctor next week, praying they have suggestions
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.
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.
Also, from one website it appears this should only be done carefully:
"The treatment typically involves the application of a topical anesthetic until the area is numb. Then, the capsaicin is applied by a therapist wearing rubber gloves and a face mask. The capsaicin remains on the skin until the patient starts to feel the "heat," at which point it is promptly removed."
(https://www.uspharmacist.com/article/capsaicin-risks-and-benefits#:~:text=Capsaicin%20is%20a%20chemical%20compound,nerve%20endings%20in%20the%20skin.)
This is rather scary too - how many would know what to use if this was used at home?:
"Capsaicin could be washed off the skin using soap or other detergents or rubbed off with oily compounds such as vegetable oil, petroleum jelly, or polyethylene glycol. Plain water, vinegar, and topical antacid suspensions are ineffective in removing capsaicin."
I would highly recommend any time some new drug, whether taken orally or applied on the skin, should be done on a test basis. Very often cleaning products say to test it on a area that won't be seen, just in case it causes damage to the material. The same should apply to anything we apply to our skin!! It's harder to test oral meds, as we can only observe and watch for any abnormalities.
Not all side-effects are the same for everyone. Heparin is a drug that has been long in use and has known side-effects, primarily lowering platelet count too low. In my case, platelets went sky high and even then they didn't figure it out until I ended up with a hematoma! This was all happening IN a hospital, with hematologist coming to my room to discuss the high platelet count, and me thinking YOU are the hematologist, I'm not allowed to eat, so anything going into me and affecting me, YOU docs are behind it, figure it out! Those shots were SO painful I was hoping they'd stop. nearly killed me with them! After hematoma, no more Heparin!
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...
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.
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?
I will look into tegraderm, thanks
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.
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.
We use Eucerin which I think is good for eczema. I also have a prescription lotion that we used on my MIL when she had cancer and the chemo made her face peel. I may ask the dr if that is safe to use on him.
He does not tolerate us helping him with shaving, washing, touching his face, or clipping his nails. I think these are things he still does for himself that allow him to feel normal and dignified. He is quite clean and well dressed. We are hesitant to take that away from him. It was much easier to do these things for my MIL with cancer and mom with ALS. They welcomed the hand and foot rubs, putting on lotion, hair brushing, sponge baths. They were so sick I think it was a relief to them. But for him it is humiliating and condescending and it upsets him so much - which makes him pick more.
I agree about meds. He has come off a lot of unnecessary meds (with dr approval) living with us and has been better off for it. He was almost a zombie before that. I would rather he not take Zoloft, it’s not helping anyway. Melatonin has done wonders for him and completely stopped his sun downing.
I like the idea of the dot bandaids.
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.
The neurologist said it is a behavior she has found almost impossible to stop, the best thing is keep treating and bandaging. I asked her about therapy but she said that for dementia it really doesn’t work because they do not know why they do it and much of the time they are not aware that they are doing it. She gave the thumbs up for trying CBD oil tho
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.
Did anything change shortly before this started? Added meds, food, different laundry detergent, soap, shampoo?
Just a thought.
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.