Skin picking... what's causing this, and how do we stop it?

[gcvmom]

difficult child 1 used to take Lexapro for his Generalized Anxiety Disorder (GAD). It helped with his needle phobia TREMENDOUSLY.

But...

We had lots of problems with him when stimulants wore off in terms of his over-the-top oppositionality, defiance, mouth, tantrums, yada, yada, yada. Door slamming, slashing a screen, running off down the block in the middle of a rain storm at night because he was mad at me, impulse control issues (online porn), lying, stealing money from us, stealing toys from the sibs, etc., etc.

So the psychiatrist thouuuuuught that Lexapro might be disinhibiting him too much. So we cut it in half to 10mg. Then he got really irritable. So we switched to Celexa, and the irritability got better, but now he's picking at his upper arms. Some days it's worse than others, but he leaves scabs. Then he picks at the scabs. And if there aren't scabs, he says his skin feels itchy (may just be a little dry) and that's why he scratches. So I encourage him to use the Cetaphil lotion we have, but he rarely uses it.

Oh, and as an aside (because I really think this is due to sleep issues with school starting), he's been really grumpy the last two days but once the stimulant is out of his system, he's fine (but still picking).

I'd love to hear from the drug guru's here on what else we might try (short of making him wear long sleeves or mittens). We don't go back to the psychiatrist until October, but I'm thinking I'd like to call to ask for a better solution to try out before our next appointment.

 

[gcvmom]

Oh, and a little p.s. here: Earlier this year the psychiatrist cautioned me that we need to keep an eye on difficult child 1 because of difficult child 2's bipolar and husband's mood issues -- he said he's at risk for developing something more significant because of the family tree.

 

[klmno]

Hmmm....any chance it could be having the opposite effect and making him depressed? I mention that because the first signs of depression that my son exhibited (before therapist, psychiatrist, medications, anything) were disruption of sleep, grumpiness, being emotional AND picking at his arms until they bled and scabbed.

I suppose it could be anxiety, too though. My son bites his nails to the quick when it's anxiety.

Either way, it sounds like it's either an effect of the medication or stress. I guess you had it narrowed down that much though already, huh?

I just read your second post- FWIW, I'm a firm believer that depression/anxiety and bipolar are on a spectrum.

 

[gcvmom]

I guess what I'm wondering is do I cut back on the Daytrana, or do we go back to Lexapro? Or do we stop the Celexa and try something else?

He's skipping lunch again too, most likely because of the Daytrana and the excitement of starting high school (and a brand spanking new school, at that).

 

[klmno]

Oh gosh...I'd call psychiatrist. LOL! But, my gut tells me try cutting back daytrana (but that's having no experience with it). My son didn't do well on either AD's or anti-anxiety medications so I wonder about the celexa too, but it would seem odd for it to cause it. Since it's a long-acting drug (takes longer to get in and out of the system), I'd probably try the other first. How long has he been taking the celexa? If it's only a couple of days it might not even be working yet.

 

[tiredmommy]

Could it be a tic?

 

[smallworld]

Skin picking is a form of anxiety. Think Obsessive Compulsive Disorder (OCD) spectrum. Skin picking can be exacerbated by or even start with stimulants. If it's exacerbated by an SSRI, then the SSRI is having a paradoxical effect.

FWIW, I like to say that my three kids have various flavors of mood disorders. They absolutely don't all have bipolar disorder (and in fact, may not end up having BiPolar (BP) dxes as adults). But they are all ending up on various combos of mood stabilizers, APs and ADs and working toward very good mood stability. So it's worth considering when you talk to the psychiatrist about your difficult child 1.

 

[crazymama30]

Depending on how much stimulant he is on, I would try cutting back. My difficult child gets more anxious on too much stimulant. He chews holes in his clothes (even heavy winter jackets).

If it really is dry skin, what about getting more aggressive about him putting lotion/cream on? Or they make a benadryl cream and even having him take oral benadryl as long as it does not send him over the edge (some kids benadryl can have an opposite effect on them and make them hyper).

With him having Crohn's, could it be related to a mineral/vitamin defeciency? Does he have any absorption issues?

 

[gcvmom]

klmno, he's been on the Celexa since this last Spring.

TM, I don't think it's a tick -- if anything, I think it's anxiety/stress/boredom or some combination.

SW, I am not surprised about the Obsessive Compulsive Disorder (OCD) aspect... he tells me he counts things a lot in his head. I think it's in there to a certain degree.

The fact that his dad is doing so well on a MS and AD tells me that this may be a viable option for difficult child 1 as well, so I've no problem if that's the road we end up travelling with him.

CM, he used to have a zinc deficiency when he was first diagnosis'd, and in fact, his fingers were peeling because of that. But his labs have been great, no inflammation, and he's growing, so I doubt there's any nutritional deficiency (other than he is not eating at school the past two days!)

He was on 30mg Daytrana, but I cut it back to 20mg, and now I'm thinking we need to try just 15mg. I think we'll do that today and see how he does...

Thanks everyone!

 

[Over]

I can't offer any insights on new medications to try, but I can tell you we've been there too. Alexis (7) picked at her arms so bad she's left scars, she would do it at night when I couldn't see to stop her and try to hide it by wiping the blood on her sheets. Her skin didn't seem overly dry. I think hers was anxiety. All of the sudden about a month ago she stopped. I think because she could see the scars and so could the kids at school. Oh by the way... she didn't start the picking until she started on Daytrana!

 

[Josie]

Like Smallworld, I have heard of the skin picking being related to Obsessive Compulsive Disorder (OCD). My daughter does this a little bit around her fingernails.

Last Spring, I did a trial of inositol (natural supplement) to see if it would help her Obsessive Compulsive Disorder (OCD). Then, I ended up taking her to another psychiatrist for more help. This psychiatrist said he had seen the most sucess with inositol in "pickers and pullers" (hair pullers). When he said that, I looked at her hands and she hadn't been picking at them.

Just thought I would mention this because I think you can do inositol without changing anything else. Let me know if you want me to find the links I have about it.

 

[gcvmom]

Thanks, Hope! I'll check out the inositol.

 

[AnnieO]

I do this. Mostly around my cuticles but I also am unable to leave any kind of scab or bump alone, which caused scarring on my back when I was a teen from pimples. I poked and scratched and picked. So it's bad.

The lexapro didn't help me with it. I honestly think it's a nervous habit. I could probably break myself of it - if I ever noticed while I am doing it! I don't notice until it starts to hurt or I start to bleed.

I am hoping the inositol works for you. Hope... Where would you get this? Organics place or...??? I'm thinking it would be worth a try for me too!

 

[gcvmom]

Over... I reduced the Daytrana further today, so we'll see if that helps.

Step, I pick at the dry skin on my heels, and sometimes it's really bad. I think it's stress related, too. I used to pick at my arms when I was a kid, but never tobthe degree that difficult child 1 is doing it

 

[AnnieO]

My cuticles look awful. If I keep my nails painted it's harder to see, but paint doesn't stay on well and then I pick at THAT too!

Jett does this occasionally, usually when he is bored or stressed. It's worst at night when he's in bed and supposed to go to sleep.

 

[susiestar]

I have always picked at the soles of my feet. From childhood. But mostly because they felt like I was always walking on hot goals or broken glass. Sometimes picking helped. The bottom of my feet came off not in little bits of dried skin but in sometimes huge sheets. Sometimes not as huge, but never in little bits. And the skin never seemed dry or calloused. If this happens it is an atypical form of psoriasis (also an inflammatory autoimmune disease).

Lyrica changed all of that for me. Now I actually have skin on my feel long enough to get dry. Using a pumice stone can help reduce picking of feet by getting rid of dead skin.

For what difficult child is doing, Wiz did that. A LOT. He would even go and get a stick or a rock and gouge his skin so he had sores to pick at. Just imagine the dirt he would come in with and finding blood mixed in with it. He got several skin infections.

Lotions did nothing to change it.

Risperdal and a high dose of Luvox helped. SSRI dosing for Obsessive Compulsive Disorder (OCD) is higher than for anxiety and depression.

I don't know if stims make it worse. He did it long before he was on stims and he did it after them until we added risperdal and increased it several times.

Good luck. Keep the triple antibiotic ointment with pain reliever around. If the scabs/sores hurt he will pick more.

 

[Over]

Let me know how he does on the decreased dose of Daytrana. I'm going to be bringing up the skin picking at our next appointment as well as the anxiety. Susie, My difficult child was on Riperdal and was still doing the picking! The doctor is going to have to figure out what's going on because she's getting picked on at school for it, and she's already got enough to deal with.

 

[TerryJ2]

I had to read this because my dad does this, too. He picks at real or imagined scabs on his scalp, back and arms. He's got Alzheimer's and is on an antidepressant, but I don't know which one. I'll tell my sister about inositol. Thank you!
Best of luck, gcvmom.

 

[Josie]

For Obsessive Compulsive Disorder (OCD), a high dose of inositol is required. I was trying to give my daughter 16 g daily in 3 doses. A lot of times, I forgot to give her the lunch dose, so she got less.

Most people that do this, buy the powder and mix it in a drink. I just mixed hers in water and she thought it was ok to drink. It is sweet.

It is much cheaper to buy it online. I bought the first bottle at a vitamin store for about $60. At 16 g daily, the bottle doesn't last long. When I ordered it online, I was able to get 6 - 8 weeks worth for about the same price.

You do have to start out at a smaller dose and work up, to avoid GI problems.

When my daughter took this, her Obsessive Compulsive Disorder (OCD) did seem to get a little better but we were doing intensive CBT/ERP at the same time, so I can't say it was directly tied to the inositol. I was pretty impressed though when I saw she wasn't picking any more at all and the doctor said that inositol worked for that.

 

[gcvmom]

Well, the Daytrana reduction did seem to help last night, but it sure didn't help his ADHD symptoms! He was loud and mouthy and kinda obnoxious. I gave him a 5mg Focalin booster after school and that seemed to tone things down.

Today he forgot to put his patch on, and I'm just not interested in driving it down to school to help him out today... I know that sounds bad. I'm pretty annoyed with him because it looks like he's already lost his student ID card, which will cost $ to replace, and he needs it to get textbooks and to get into the dance tomorrow night that I PAID FOR ALREADY!!! So I told him he'd better either find it or figure out how to get it replaced. And if he doesn't go to the dance because he doesn't have the card, then he has to repay me the money for it.

I was NOT a very pleasant person to be around this morning. husband was amazingly calm about all this, so I took that as my cue to take an extra 1/2 tab of MY medications! After that and my coffee, I'm feeling much better!