Constant scratching / picking at the skin -- tips on ho...

Constant scratching / picking at the skin -- tips on how to help

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:

http://www.rxlist.com

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.

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 sites such as Buck & Buck.

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 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.