«

»

Constant Scratching / Picking at the Skin

Many Alzheimer’s patients scratch themselves bloody — my mother did that.  Sometimes it’s an obsessive/compulsive behavior that’s almost impossible to stop. Other times, though, there is another cause. Among the many tips I’ve seen for trying to help the patient:

>> FIND THE CAUSE

First, evaluate the Alzheimer’s patient thoroughly to see whether something may be causing itching.
– Perhaps the patient has developed an allergy to the bath soap s/he uses.  Try different soaps, or perhaps substitute shampoo, instead of soap, to cleanse the skin.  Liquid soaps may be very harsh to delicate skin, so avoid those.
– S/he may also have developed a reaction to a laundry detergent or fabric softener.  Try different ones, preferably without scents or perfumes.
– If a woman’s face itches, it may be due to the makeup she wears.  Try switching to a non-allergenic makeup, or see if she’ll stop wearing makeup altogether.
– Also consider whether face creams or cleansers, perhaps a man’s shaving cream or lotion, might be causing the problem.
– The culprit could be bed bugs, lice, or scabies, all of which are on the rise all across the country; or (if you have pets) fleas.

The problem could be dehydration.  Be sure your Alzheimer’s loved one drinks plenty of fluids, preferably 2 liters of water a day.

Many of the drugs prescribed for dementia patients – for behavioral problems, sleep aids, slowing down memory loss, and depression – can cause severe itching as a side effect.  Other drugs commonly prescribed for older people, for blood pressure, prostate issues and many others, also can cause intense itching.  Look up the potential side effects of each medicine your loved one is taking.  This side effect may be listed either as itching or urticaria. You may find it listed under “Integumentary System.”  One of the best sites for researching side effects is RxList.

If you identify a medicine that can cause this side effect, talk to the doctor about the possibility of discontinuing it for a while, to see if it’s the culprit, and/or switching to a different drug.

An Alzheimer’s patient may develop obsessive-compulsive disorder (OCD) symptoms, although it is fairly rare.  Certain selective serotonin reuptake inhibitors (SSRIs), such as escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline, have been found to be helpful for treating OCD patients, and OCD symptoms in frontotemporal dementia (FTD) patients.  Talk with the doctor about the advisability of trying one of these drugs.

>> SOOTHE THE ITCHING

Keep any scabs soft with ointment, such as Mupirocin. (Dry scabs invite more scratching.)  Treat open sores with an antibiotic such as neosporin.  Sometimes Alzheimer’s patients will leave bandaids alone, so cover healing scabs with bandaids.  (NOTE:  keep an eye out for allergic reactions to bandaids with latex in them!  Allergic reactions can develop very quickly, and itch like crazy.  All bandage boxes are required to have warning labels if the bandages contain latex, but the warnings can sometimes be very hard to find.  Keep looking until you find something that indicates latex is not in the bandage.)

Tea Tree Oil can help scabs heal and stop the itching.  But be careful when first starting to use this product — it can sometimes be painful.  Watch for signs that the skin is turning red.

Some caregivers have reported success with Pure Aloe Vera Gel.  Be sure to get pure gel, without any lotions or other ingredients.  (If you try using sap from an aloe plant, be forewarned that the sap may stain linens.  Some caregivers have warned that it can also stain the skin a yellow-brown color.)

If the itching is caused by the Exelon patch, remember to put the patch on a different place every day.  Don’t “re-use” the same place for 12 days.  Clean the site well and moisturize the area.  If the itching/light rash persist, some doctors recommend applying Flonase to the skin after removing the patch.  A light coating of a cortisone ointment may also help, but be sure to talk with the doctor before trying this.  Cortisone is absorbed, and it might interfere with some other medicine the patient is taking.  Consult a doctor if the rash persists or spreads, or if the patient develops a rash in any place other than the site where the patch was applied.

Older patients often have very fragile skin.  Frequent bathing may not be advisable.  Switch from a bath to a shower, warm water rather than hot, and only twice a week.  If that doesn’t help, try sponge baths with a no-rinse product.

Keep the skin moisturized. Slather on lotion (people have recommended Eucerin, Aveeno or Cetaphil or other non-allergenic lotions) after each shower while the skin is still moist. Also put lotion on before the Alzheimer’s patient goes to bed. (Accompany this with a massage of the back and shoulders, to make the patient feel loved and pampered.)  Some doctors prescribe a Kenalog/Lubriderm lotion, to soothe the itching and keep the skin soft.

Over-the-counter cortisone cream may ease the itching, but use it only for small areas and only for short periods of time.  If it helps in the short-term but does not break the itching cycle, consult the doctor to see whether continued use is advisable.

Just as tylenol relieves minor pain, it will also reduce the sensation of itching. This can be helpful to break a cycle of itch/scratch or help to determine if there is an actual itch sensation that is causing the scratching. (Be sure to ask the doctor whether it’s okay to give the patient tylenol.)

Make an appointment with a good dermatologist if there’s any rash or redness or any other skin changes.

>> STOP THE SCRATCHING

If no cause for itching can be identified, and nothing you try seems to soothe it, then try other methods to stop the scratching:

Keep the patient occupied; and when s/he is just sitting, keep the hands busy.  Give the person something to hold – small, soft objects to “finger and fiddle” with.  This lessens the picking and gives the skin time to heal.  Some patients like a doll or plush animal.  “Stress balls” come in different colors and shapes, and won’t do any harm if the patient decides to throw it.  “Worry beads” may also work well.

Keep fingernails cut short.  For a woman, get her acrylic nails done, and tell the manicurist to make them very short and very thick – that can make it a bit more difficult for her to “gain purchase” under a scab or loose piece of skin.

See if you can get the patient to wear soft cotton gloves.  Tell a woman they are part of a “spa” treatment – if she thinks she’s being pampered, she may be more cooperative.

If the patient scratches his arms, dress him in long-sleeved shirts, or use “wristies” — elbow length sleeves with elastic at the top and bottom.  The patient may still pick, but at the fabric rather than his skin.  These are sold at websites such as Buck & Buck.

If all else fails, “posey mitts” can be used to give the skin time to heal.  These are sold by many companies … google to find the best bargain.  However, posey mitts are considered to be “constraints”, and may be frustrating and distressful for your loved one.  Only use them as a last resort; and try using just one, on the loved one’s dominant hand, and only during times when your loved one is agitated enough to pick or scratch his/her skin.

27 comments

1 ping

  1. DaveIFM says:

    I was Googling for Alzheimer’s Compendium and up popped this article. Just seconds ago I was watching my wife picking away at age-thingies on her arms. they are little bumps.One had been scratched raw.

    Guess I better start paying attention and rubbing on some moisturizing cream. She has mild diabetes and I am supposed to be helping with moisturizing cream on her feat. I wonder if lotion works as well as creams?

    1. AlzCarer says:

      Dave, my husband’s skin is getting very fragile, especially on his heels, where he may be starting to develop pressure sores. The dermatologist recommended Eucerin Dry Skin Therapy Plus Intensive Repair Body Creme. I had to look around a bit to find it — and in the process discovered that Eucerin offers many different skin care products, for different types of skin problems — but the Intensive Repair Body Creme does seem to get a lot of good reviews. The derm also recommended Neutrogena T/Sal Therapeutic Shampoo, not just for his hair but for his entire body.

      Do ask your wife’s dermatologist whether these products would be appropriate for a diabetic patient, though. It is my understanding that they contain an alpha-hydroxy compound to help slough away dead skin. That’s good for pressure sores — but I don’t know if it’s good for skin problems associated with diabetics.

      Sears apparently offers the Eucerin creme in its stores. Online, several Amazon.com vendors sell the creme. So does Drugstore.com, which has many good customer reviews, appears to be very cost-competitive, and is where I just purchased both the Eucerin creme and the Neutrogena shampoo.

  2. Janie says:

    My husband has been scratching his head for months. Have tried all of the shampoos, creams etc. The doctor can’t find any reason for it. Husband says it doesn’t itch but he keeps doing it. He has now scratched a couple of bald spots into his nice thick hair. I tried to get him to wear a hat, that worked for awhile but now he won’t wear it. I have decided to just live with it, he seems to find some kind of comfort in it.

  3. Dena says:

    Janie—I’m on the same page as you—have decided to just live with it. My 98 year old aunt has mild dementia, no outside interests, can’t focus on reading or follow television—-so she sits in her favorite chair and scratches her head for hours at a time. She’s worn a bald spot in her hair and it’s getting bigger. Her hair dresser hides the damage every week, but she tears up her hair style by the time I’ve got her back home. There’s no medical reason, she refuses any and all medication, I suspect she’s incredibly bored, but I can’t do anything about it. She’s never had what one would call an “interior” life or real hobbies and it’s too late now. So instead of getting frustrated and telling her to stop scratching 92 times a day I’ve decided to shut up and let her scratch. I’m telling her other nieces and nephews the same thing: leave it alone. You’re correct that it seems to be comforting behavior.

    1. AlzCarer says:

      Dena, I know this is driving you nuts … but those sores can get infected and cause some serious problems. Have you tried keeping your aunt’s hands busy? worry beads, a stuffed animal or baby doll (which she might find very comforting), an activity apron (there are many different designs available at stores that offer products for dementia patients), etc?

      Also, be sure to keep her fingernails cut very short and filed, and clean them regularly. That will help minimize infections.

  4. Debbie says:

    My mother rubs her head constantly & my New Years resolution is to leave her alone about it. I tried hats, even a pink hard hat but her hand goes up there any way & starts rubbing away. She does it with the phone when she’s talking to my sisters, looks at me when I ask her to stop & does it anyway. I just try to explain to the hair dresser when she gets her hair cut that it isn’t from an itchy scalp. I tried cortisone creams but if I’m not watching she will use a huge tube of it every day. It is driving me crazy watching her so I think that now I am the one needing medication to calm me down! I tried to redirect her hands to something to fiddle with but she will have the object in her hand & go for her scalp at the same time.

    1. AlzCarer says:

      Good luck with your resolution … ! Debbie, are you really sure it doesn’t itch? Because if it does, the poor woman may really be suffering. I know my scalp will itch like crazy if I don’t wash my hair often enough (every other day) with a shampoo designed to help itchy scalps. Try googling for “itchy scalp” to find the many things that can cause this symptom. Note also that many of the meds we give our loved ones can causing itching as a side effect. If you haven’t talked to her doctor about this problem, I’d suggest you do that — and maybe ask for a referral to a dermatologist. And you do want to make sure she doesn’t scratch herself to the point she gets an infection…

  5. Debbie says:

    I have had her to doctors & they can’t find a reason for the itching. I tried every shampoo & remedy imaginable. When she had the hats on, she rubbed so much that the hats were bloody. Out of every hour she spends about 56 minutes rubbing her head….I don’t have the strength in my own arms to leave it up there for more than 10 minutes at a time so I don’t know how she does it! I worry about it because besides infection she still has the soft spot on the front of her head that normally closes in infants. Hers never closed.

    1. AlzCarer says:

      What a mess. Have you checked out all the meds she takes, to see if they cause itching as a side effect? Skin disorders are pretty common side effects of the meds typically given to elderly dementia patients. My favorite website for looking up meds is RxList.com .

      Sometimes — not terribly often, but sometimes — our loved ones have obsessive-compulsive disorder (OCD) and may respond to a med for that, such as certain SSRIs (escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline) or the TCA clomipramine. See, e.g., the WFSBP Guidelines and the Medscape review.

      Or it may be a sign of anxiety. SSRIs are also the first line of defense against chronic anxiety, but other drugs may be helpful, too, such as lorazepam (Ativan) or oxazepam (Serax).

  6. Debbie says:

    My mother told me that it comforted her to dig in her head & that it shouldn’t bother me so I left her alone about it. She was reading books, watching game shows & talk shows on tv. Now since I stopped telling her to stop it as progressed to the point that she no longer watches tv other than a quick glance, doesn’t read at all and just sits in the chair with her head down, eyes closed, grimacing and digging away at the head…her whole waking time is focused soley on her head. I would think if it were due to medication she would be doing it all over not just at the very top strip about 4 inches long by 1 inch wide. The only time that varies is if she tries to do it on the sly if company is here, then her hand moves to the side of her head like she is trying to “rest her hand on her head” but the fingers are constantly going. I have to leave the room because I can’t stand to see it.

    1. AlzCarer says:

      Hi, Debbie. It sounds more like your mother’s scratching is associated with anxiety or agitation. It also sounds deeply-rooted enough that suggestions under “stop the scratching”, toward the end of the article, may not be enough to break the cycle … although gloves, if she’ll keep them on, and at least keeping her fingernails clipped short, may help protect her poor scalp.

      Have you talked with her doctor about the possibility of giving her an SSRI? They not only may help if there’s an OCD component to her behavior, but are also the first line treatment for chronic anxiety.

  7. Robbie McCartin says:

    I just wanted to add to this, so you had more more information. My mother is going to be 86 next month and she began scratching and picking at her head more and more as the months have gone by. I have tried giving her things to keep her hands busy, but soon her fingers are back in her hair. Her hair is clean. She says it doesn’t itch. It seems to be a symptom of this disease? I have no idea why, but my father had a different type of dementia- he had lost oxygen to his brain. He did not get this fidgety head scratching symptom. It is distressing for caregivers. I think short nails, scalp care,offering options to keep hands busy… are the best choices. I would not put restraint mitts on my mom unless she had an infection.She does do it ALL the time. Just another case to add. She takes Paxil and Aricept.

    1. AlzCarer says:

      Hi, Robbie. Thanks for your input. I’d agree that restraint mitts should only be used in extreme circumstances.

  8. Silvia Latimer says:

    Thank you so much for the advise. My mother has moderate dementia and diabetes. She scrateches her head constantly. We have eneded up at ER with infections where she scratches. WE have tried everything. Her doctor has switched her depression meds from Citalopram to paroxetine to see if it helps inhibit the urge to scratch. I feel supported knowing that many other people are experiencing teh same problem. Not that I wish this to nayone, but their cases and your advise help me reconsider what I am doing. I will certainly try a couiple of the ideas you give us. Thank you again!

  9. Dewey Bright says:

    My wife has dementia which is why I am on here. She has not yet had any of the scratching issues, but I just had a comment. What about using rubber surgical gloves for these folks. They could still scratch [sort of] but this would eliminate the infection issue. Thanks for your website; I will be checking it religiously as time goes on. My wife is 69 and was diagnosed almost 6 yrs ago.

    1. AlzCarer says:

      Excellent idea!

      I have been having back problems that limit the time I can spend on the computer, so I haven’t written much recently. I do hope to get back to it soon. Meanwhile, if you have specific questions/concerns, please let me know.

  10. Pam Kollar says:

    My husband has been picking at his face, ears, neck, upper back and shoulders. When I tell him to stop he says he is just feeling his skin. There are scabs, red swollen spots all over his shoulders especially. When I show him the areas in the mirror he has no idea how his skin got like that. I have been putting bandaids ALL over the areas. I get one area healed up and another is bloody. It is nice to know I am not alone and that this can happen to people with Alzheimer’s. I will have to change the body soap and increase the application of lotions and creams. An infection is my greatest concern, but at least I now know it happens to others. He takes very few meds but I will check the side effects just to make sure it is not a medication issue. Thank for this website.

    1. AlzCarer says:

      Pam, this is such a difficult problem to deal with, sigh. Bless his heart. Well, and yours, too — I know it hurts your heart. Often, we cannot find an underlying reason for the behavior, and have to just try to minimize the damage. Keep his fingernails trimmed as short as possible. And … whenever he starts the “feeling” and picking, put something in his hands to preoccupy him — see if you can’t keep his hands busy, with an activity apron, or maybe a plush toy if he’s fairly far along in the progression (many of our loved ones take great comfort in toy animals), or something like worry beads. Or distract him with a toy or game or activity.

  11. stacey says:

    I’m taking care of a 90 year old woman now she sucking her fingers and picking her arm I put cream everyday and I give her candy when she sucks her fingers her case worker knows what else should we do.

    1. AlzCarer says:

      Hi, Stacey. Keep her fingernails trimmed very short, and have her wear long-sleeved tops (blouses, sweatshirts, robes, etc) with sleeves that are difficult to roll up. I’ve never tried a “security sleeve” such as Posey makes, but that might work. Also, do whatever you can to keep her hands busy — she may simply be bored and fidgeting. She might like to have a doll or a stuffed animal to play with, worry beads, a twisty toy such as Tangle Therapy, Playable Art-Ball, or a Rubik’s Twist (Rubik’s Snake), or a “sensory activity apron” or “activity pillow”. Google — you can find these in many places such as medical supply houses, AlzStore.com, Amazon.com, etc.

  12. Robin Lynn Wildes says:

    It is good to know that we are not alone. My 89 year old grandmother started this picking thing a few months ago. It was just around her neckline, and has now moved to her arms and her face…and her head where she had surgery a year ago. She isn’t interested in anything, and believes that her skin is DRY and that the picking is dead skim or scabs but she does it for hours at a time. We have tried creams, detergent, keeping her fingernails short…none of it works. I believe it started when we started her medicine, Donepezil, so I will have my uncle check with her doctor and maybe we can adjust the dosage. My prayers are with all of you who are going through this.

    1. AlzCarer says:

      Hi, Robin. Instead of adjusting the dosage, you could also ask the doctor about switching to one of the other cholinesterase inhibitors — Razadyne or Exelon, or even nonprescription huperzine A. A patient who develops adverse side effects from one of these drugs may do much better on another. See:

      Alzheimer’s Drugs — Fact and Fiction

  13. Dianne Golledge says:

    My 86 yr old mother who was diagnosed with early stage Alzheimers 12 months ago is a picker/scratcher too :( it has been going on for about 5 months now. Her bad areas on on the top half of each arm and as far as she can reach around her back. She will sit there and slide her left hand up the right sleeve & slide the right hand up the left sleeve and just pick. Her arms and back are scarred and bloody & look horrendous. I keep the areas covered with band aids and put surgical pads down each arm kept in place with surgical tape. It is costing a fortune in band aids etc but I find nothing else works. If I give her something to occupy herself she will fiddle with it for a bit the just put it down and go back to scratching. I had her to her general GP last week and he has sent her for blood tests suggesting that in rare cases low iron levels can cause itchiness, haven’t got the results yet but otherwise said it was now probably just habit. She is due back at her geriatrician next month so I will see what she says. While it breaks my heart to see mum like this it is somewhat comforting to know we are not the only ones going through it, thank you all for your tips.

  14. Diane D says:

    My Aunt has severe scratching. She picks until she bleeds. I notice when we are not staying with her, when we come back she has again gone up and down both arms, with making more bloody openings of her skin. Do you think Aricept, or Namenda is the cause? It seems she started this about the time she was put on these two medications. Her personal hygiene has changed, I never see her bathe, and will wear the same outfit for days. Also, with forgetting who came to visit, can’t come up with family names etc. what stage is this considered? Thank you for your help!

    1. AlzCarer says:

      Hi, Diane.

      Pruritus (itching) and urticaria (hives) are frequent side effects of Aricept. You might want to talk with her doctor about switching her to one of the other cholinesterase inhibitors, which are much less likely to cause skin problems. Razadyne (galantamine) appears best of the three prescription drugs from this particular perspective.

      Namenda is unlikely to be the culprit.

      However … I want to be sure I understand your comment about timing. Does she scratch only when you’re not around? Because if so, that doesn’t sound so much like a side effect of a drug, as it does something like picking at her skin due to anxiety or boredom.

      You may want to start keeping a daily journal of her symptoms/behaviors, as well as anything that could affect them — changes in drugs/dosages (including OTC), stresses, illnesses, storms, strange visitors, etc. This disease can be such a roller coaster that your memory of what happened when won’t be reliable all by itself.

      The best description I’ve found of the seven stages of Alzheimer’s is at:

      http://www.alzinfo.org/clinical-stages-of-alzheimers

  15. Marilyn M says:

    I find that Sarna Lotion is a good quick relief with larger areas that itch. It is made from menthol and camphor, so it is “smelly” when first put on but the remaining odor is quite pleasant. DO keep up with moisturizing and try to find the “culprit” that is instigating the itch.

    In a pinch and less costly than Sarna is Vicks Vaporub. It has menthol, camphor and eucalyptus. It is quite “aromatic”, but the smell might be soothing to the mind if it was used earlier in life with a loving hand. (My mind goes back to colds where the VIcks was plastered onto my chest, the gurgling of the steamer in my room and my parents taking turns reading to me.) Also, it is good for a muscle rub.

    Best hugs to those of you who are helping aging parents in their time of need.

    1. AlzCarer says:

      Thanks for the ideas, Marilyn.

  1. Constant scratching / picking at the skin « The Alzheimer's Caregiver says:

    [...] We’ve moved … [...]

Leave a Reply

Your email address will not be published.