Not DS's issue and so not my area of expertise, but just spitballing a few ideas: if she does it a lot while at her desk, maybe she would like some velcro attached to her desk to scratch. DS uses velcro at the desk to help keep his hands to himself. I suppose you could put a strip of velcro on lots of things if it helps, like a backpack strap.

My DS sometimes has issue with scratching bug bites at night, and he wears "hand socks" to bed. He likes how they feel and it helps him not damage his skin in his sleep.

Also try getting her a manicure with nail polish. This helps disassociate the feeling between the hands/fingers and the skin.

Remember the activity blankets they had for babies with fidget type toys on it? Why not fashion something like that for her? I'm sure someone on Etsy could come up with something for you. Maybe even a weighted blanket with zippers, buttons, beads, various textures and such? Like a sensory strip, but a sensory blanket. Especially if it's happening when she's in bed, she needs something else to fidget with that is a mindless distraction.

Have you tried Pharmanac?

I am an adult and the only thing that really worked for my face picking (and other OCD symptoms) is Prozac. I started taking it when I was an adult, so I have no experience taking it as a child.
Perhaps a child psychiatrist can advise you. Fidgets are helpful when you are conscious of your behavior, but I'm often not, and they certainly don't help when you're sleeping.

I'm glad you're taking it seriously, because you can get infections and boils from the small cuts that picking causes. No Fun, it hurts.

I have a DC with this issue. Have you looked into a vitamin supplement called inositol? It's a kind of B vitamin that has shown promise in treating this condition. It made a HUGE difference for my DC.

http://facepick.proboards.com/thread/14/thank-csp-inositol

I"m an adult picker and nail biter and I swear that crocheting is the best thing ever! If she does all these behaviors while watching TV or engaged in some other activity where her body is kind of still, then a hand activity like knitting or crocheting or even embroidery might really help a lot. It's the free floating anxiety that never really allowed me to sit still and not pick at something.

I would actually call a knitting shop and see if there was someone there who might be willing to teach your daughter to knit or crochet. (I actually think crochet is easier). I remember my grandma teaching me all these crafts when I was young and they were really great for soothing myself. She's not too young to learn a hobby like this.

My daughter has the same issue, including the blood stained sheets. I'm reading this with interest.

Japanese erasers? I know several kids that use them for fidgets. And they are "cool" among the elementary set.

With a girl there are so many decent options. How about something like a rainbow loom bracelet (I know those are slightly 2014, but I think still within the realm of what's okay for that age) -- she can pick and pull at that all she wants and it will be barely noticeable. Also a ring that she can twist on her hand, or a bracelet with beads that can twist/spin. Those stress relieving balls that they sell to squeeze also can work -- I think half the ADHD kid have one of those, so there are plenty of kids with them.
They also sell pencil toppers that are cute that one could chew on.
And fidgety girls have twirled their hair forever. I still do it.

I'm a little concerned about the blood on the sheets -- do you think she is picking at them in her sleep? I don't know a lot about sleep conditions, but I would worry that she is not getting the right kind of restful sleep, which can certainly make the anxiety and ADHD worse. My DD has had sleep problems -- I think some kids brains just keep revving all night, and hers might be manifesting with the picking. That seems like it would need medical intervention. (Although we had good luck with giving melatonin before bed, which helped with the repeated night wakings and seemed to lead to more restful sleep.)

One last idea, but do you know if maybe her skin is a little itchy? I have eczema and often its itchy before there is any rash even. I use a cream called Cereve that is fabulous and seems to help the skin heal. Skin picks more easily when it is dry, so it may help to make sure the skin is really healthy and moisturized so that it doesn't pick off so easily.

I recommend jewelry (smooth stones like polished agate in a large size) that she can roll between her fingers. Why not g o to a bead store, have her run her fingers through things t o fin a texture she'd like.

My son has a worry stone in his pock e ts, which might be another thought.

I have tried a ton of different fidgets--therapyshoppe.com has a large assortment. Putty is good when that's a possibility. Most recently, I've tried bracelets, including zippered bracelets, so they're always at hand.

My 8-year old DD has the same diagnoses and has similar issues. She does some picking, but does a lot more chewing and compulsive writing. The only thing I found that worked is Exposure-Response Therapy. It's best to do it with a professional, but I also found I can do it myself like this: Get a timer. Tell her to think about picking, but not to do it, feel the urge and the anxiety, but not to give in to it, See how long she can stay away from picking. Start with the shortest interval she is able to achieve, even if it is just a few seconds. Then gradually work up to longer and longer intervals. Do it in sessions of 15 to 30 minutes daily.

What about a Baltic Amber necklace? They are advertised as safe for chewing, but they don't look like the silicone chew beads. Also, Mederma ointment is great for scars. (It used to be rx only and was used for severe burn scarring. Now it's over-the-counter.) Also, keep up sun protection (spf) the new skin/scarring will burn more easily.

My 8 year old has ADHD, OCD, and anxiety and she picks at her skin so much. She has scars all over her arms and legs and things take forever to heal because of the picking. Now that it's warmer and she is wearing shorts and t-shirts, people are making comments (like, "oh, are those bug bites?" not anything ill intentioned). Her sheets even have blood stains on them. She has some chewable necklaces that I bought when she was chewing holes in clothes (she's stopped that) but isn't crazy about wearing them because she thinks it's too obvious that it's something "special." She does chew on her knuckles but the picking is the bigger issue. What has worked for your kids?