What treatment and management recommendations do you have for amphetamine-induced skin picking disorder without insight?

Assuming the stimulant is prescribed for ADHD, I recommend dose reduction or switching to a different medication, or, rarely, I recommend the patient consider a "stimulant holiday" for at least 1-2 months. I explain that most of my patients notice improvement with adjustments or breaks from their stimulant ADHD medications. I find that methylphenidate-based preparations (Concerta, Ritalin) seem to be less problematic than amphetamine-based preparations (Vyvanse, Adderall). I recommend switching to a non-stimulant option when possible, such as atomoxetine, bupropion, guanfacine, or clonidine. Guanfacine and clonidine can be added to a stimulant regimen.

NAC or Namenda can be helpful in some cases, especially when prescribed concurrently wit...

A practical adjuvant for pickers/neuroexcoriators of any etiology is the use of hydrocolloid dressings. Currently available in an array of sizes as ‘acne spot patches’ and ‘blister bandaids’, these thin dressings can be applied to clean skin at the first sign of picking or on an established wound and left in place for up to a week, even when showering. If the patient has a history of infection or staph colonization, have them spray the site with stabilized hypochlorous, then pat dry when changing the dressing. Continue until the wound is healed.

N acetylcysteine is inexpensive, and the dose can be titrated. Ethical considerations of placing an active drug abuser on an expensive, injectable biologic.

Primary focus: withdrawal/cessation of meth.

I don't have experience in this area. I am interested in the answers.

Remeron has evidence for meth abuse... Namenda has evidence for the monotherapy of skin excoriation disorder...

Coffin et al., PMID 31825466

Grant et al., PMID 36856701

I don’t have any experience in this area, and I am learning from the discussions.

Thanks!