[ilovetheelderly]

There's a res at our LTC who constantly scratches the skin raw it seems. Family or daughter is in denial about diabetes and the doc has tried Claritin to no avail, Atarax 25 mg tried at HS for 2 days only and abrubtly stopped, and now doc is trying Paxil 10 mg.?? Sarna lotion was tried with no help and d/c'd and now kenalog (med with 2 to 3 different med's in it) with no relief in sight.!! When res scratches the marks are red based and circular in shape, really weird! Res is slightly demented and I guess family or doc want to stay conservative as far as behaviors are concerned because behaviors are present already. Anybody, ever seen these problems, help please.

[VivaLasViejas]

Has anyone tried elemental zinc? I've seen this clear up some of the gawdawfulest cases of itchy, rashy skin, including my own case of eczema about 18 years ago. It comes in 220 mg. tablets, and you give it once a day for 6 weeks only (any longer than that, and it can result in copper deficiency).

In addition, Aveeno makes some great products, including oatmeal soap and body wash, that help soothe skin. You should avoid hot water and regular soaps when bathing the resident, as these dry out the skin even more. You may also want to look at what's being used in the resident laundry; it's usually a cheap industrial detergent and is just hell on sensitive skin. If possible, try using Dreft or another very mild detergent made for babies or those with allergies.

As a last resort, I'd call the resident's doctor for a dermatology referral.

Hope these suggestions help.

[adrienurse]

I came across this article earlier today. Maybe it'll help http://www.aafp.org/afp/20030915/1135.html

[katlpnforlife]

just wondering if the resident has had blood work done to rule out any possible liver pathology?

I also have to agree, Avveeno collodial oatmeal works wonders on itch!

[kateRN]

Sounds like this COUld be exzema?? I had a really bad problem with this myself about a year ago. It popped up out of no where- I now think it was due to an allergic reaction to some scented lotions I was using. But anyway, I would scratch myself raw while I slept, unconsciously. Oral stuff didn't help any, but then my doc tried me on Eladil. That stuff is a lifesaver. It took away the itch and allowed the rash to heal. I think that it also could be used for psoriasis. Make sure his fingernails are clipped really short too, to do some damage control.

[ilovetheelderly]

Since I last posted, res started to have an inflammatory event with new lesion-like (red in nature) from Left hand to upper arm and was continually itching. Paxil was d/c'd r/t possible skin reaction which just so happen to be pruritus and rash, can you stand it. This poor res was on Sarna lotion, kenalog, and now desonide mixture from pharmacy after Derm MD continually is probably baffled. Res uses special soap and res family insists its not anything they use for laundry. Thanks for all the information, and all I heard about this Eladil. The article for pruritus is awesome too, thanks for everyone's input. The article also says that some pruritus is ideopathic but we will find relief. Thanks for everyone who posted, I don't know what the MD OR Derm MD will order something quick for the relief. Cool compresses assist also. We've t r ied so many creams it's ridiculous, and with not much relief either. Thanks again everyone. The creams are started for a little while and then they're discontinued and pulled out of the treatment cart so that no one else may use it.

[sixes]

Just a thought
Has a nose swab been taken?
Could be staph C
We have a resident that went through the same thing.
And yes I thought the Doc had lost his mind when he ordered a nose swab for prsistant itching
Guess what it came back positive
Polysporin in the nose times 6 weeks bid and no more scrathing

[ktwlpn]

Originally Posted by ilovetheelderly

Since I last posted, res started to have an inflammatory event with new lesion-like (red in nature) from Left hand to upper arm and was continually itching. Paxil was d/c'd r/t possible skin reaction which just so happen to be pruritus and rash, can you stand it. This poor res was on Sarna lotion, kenalog, and now desonide mixture from pharmacy after Derm MD continually is probably baffled. Res uses special soap and res family insists its not anything they use for laundry. Thanks for all the information, and all I heard about this Eladil. The article for pruritus is awesome too, thanks for everyone's input. The article also says that some pruritus is ideopathic but we will find relief. Thanks for everyone who posted, I don't know what the MD OR Derm MD will order something quick for the relief. Cool compresses assist also. We've t r ied so many creams it's ridiculous, and with not much relief either. Thanks again everyone. The creams are started for a little while and then they're discontinued and pulled out of the treatment cart so that no one else may use it.

Has this resident actually been examined by a dermatologist and had biopsies done? Labs? I have seen some really wierd dermatological diagnosis in the elderly.Seems that many disorders present atypically in this group...Scrapings or biopsies and labs may tell the tale....I have seen an atypical presentation of scabies that sounds similar to this resident-my gal had round reddened raised lesions all over her trunk-after months of treating her and repeated negative skin scrapings a biopsy was positive for scabies.Once she was treated for that and the self inflicted open areas healed she was fine...I also don't understand your comment about the family being "in denail" regarding diabetes...Are her sugars elevated? Can't deny numbers on a lab slip...

[unknown99]

When I worked in the LTC facility, we had a patient with those same exact symptoms.We tried everything also, and nothing worked. The poor lady was just a mess, extremely miserable. Then one day our new medical director seen her. He said he thought it was scabies, and we treated her with Lindane. Don't you know she no longer had the problem after that. It turns out it was scabies that did not follow the usual tract pattern.

[jaimealmostRN]

Originally Posted by katlpnforlife

just wondering if the resident has had blood work done to rule out any possible liver pathology?

I also have to agree, Avveeno collodial oatmeal works wonders on itch!

This is what I was thinking. Does this resident have liver problems, cirrhosis? I'd def. rule that out. If he does have liver issues, Questran works really well to stop those bile acids on the skin.