How to get facial sore to heal in elderly patient with dementia and diabetes?

[LilyRose]

My uncle, 83, has schizophrenia, diabetes and additional dementia that may be Alzheimer's. He lives in a nursing home. He has an open sore about a quarter of an inch across high on the side of his nose very close to his left eye. Staff keep it clean and put Neosporin on it, but it doesn't heal because he picks at it. He has had the sore for several years. 1)Do you have any ideas what the original cause of the sore might be? (He had cataract surgery on his left eye and a consequent infection in the area of his left iris, but that was eight years ago.) 2)Do you have any ideas of things staff could use or do to facilitate the sore healing? 3)Is it safe to leave things as they are? 4)If a specialist were involved, what type of specialist would be most appropriate? His eye occasionally gets infected, probably from the picking, which we feel he now does as much out of habit as from skin discomfort. We had a difficult time finding a good place for this nice man who has been mentally ill since adolescence. He seems happy where he is now and is fairly healthy except for the diabetes. We think it would be cruel to restrain him. (Staff tried dressings, which he picked off. They tried gloves, which he took off. They tried sunglasses, which he took off.) We welcome your input and suggestions. Thank you.

[Alan Rockoff, MD]

When a patient picks at a spot, it's nearly impossible to get it to heal, regardless of the treatment.  Even people not burdened by dementia have trouble stopping themselves from picking.  I would advise a consultation with a skin doctor to be sure the ulcer is no in fact a basal cell skin cancer, which might warrant treatment because of the proximity to the eye.  If it's just a traumatic ulcer, then if there might be a way to block the spot with a dressing of some sort so it can't be picked.

Best.

Dr. Rockoff