Skin Problems and Care in Parkinson’s

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Parkinson’s disease is usually thought of as a movement disorder, but there are many other symptoms that are not related to movement.  Depression, loss of sense of smell, anxiety, constipation, changes in voice…these symptoms often come to mind with Parkinson’s.  Skin is the largest organ of the body, and yes, Parkinson’s affects skin, too.  It is frequently under-diagnosed or untreated, time with the Parkinson’s neurologist is limited and focus is often on the more troublesome movement problems.  Skin problems can be more than just annoying, and they need to be considered and treated, too.

One of the most troublesome skin issues seen early in the development of Parkinson’s is seborrhea.  Greasy skin and limp, oily hair with dandruff  have been associated with Parkinson’s for many decades now. Areas around the nose and forehead are most affected.  The exact mechanism  which causes seborrhea to develop is not yet understood, but undoubtedly relates to the loss of dopamine on the functions of glands located in the skin.

Chronic problems with seborrhea can lead to dermatitis.  Skin and hair need to be washed frequently and anti-dandruff shampoos may be helpful.  But if dermatitis develops in spite of cleanliness, topical steroids may need to be tried.  Seborrheic dermatitis can also develop around the eyes, causing small patches that form little flakes of skin that can get into the eyelashes and the eyes.  Washing carefully with dandruff shampoos and letting it run gently over tightly closed eyes can often help.  Interestingly, when dopamine replacement is implemented, seborrhea often improves.  It seems to be more active when the disease itself is active.

Sialorrhea, or excessive saliva is a common Parkinson’s symptom.  Sometimes it has been thought that due to the difficulty with swallowing people with Parkinson’s often  have,  excessive saliva accumulates in the mouth from not swallowing often enough. There have been several studies that have found excessive amounts of saliva do appear to be produced in some subjects, so swallowing is not the only issue.

Skin around the lips and mouth can become irritated from excessive saliva, especially if drooling occurs.. The friction of constant wiping  can make it even worse. If not taken care of, the skin can begin to break down and cause even more discomfort.   Lip balms and creams to protect the skin can help.  Medications such as anticholenergics may be used to help dry up the secretions and botulinum toxin injections in salivary glands have helped some patients.

Drenching sweats, or hyperhidrosis, are another majorly discomfiting and embarrassing  problem for people with Parkinson’s. Night sweats which soak all the bed clothes are especially difficult to endure.  The excessive sweating involves mainly the head, including the face, and the trunk while the palms of the hands remain amazingly dry.  Hyperhidrosis  usually occurs if the dose of dopamine is either too high or too low.  If the sweating occurs during off-periods, increasing the dopamine dose can help.  Beta blockers, such as propranolol, are sometimes useful.

Problems with sensations of tingling or pain in the skin are also a common Parkinson’s complaint and are also probably due to the loss of dopamine.  Skin lesions, both cancerous and non- cancerous appear to occur a bit more frequently in the Parkinson’s population than in the general population.  Some studies have found a slight correlation and other studies find the rates about the same.  It is difficult to tell if Parkinson’s and skin lesions are connected, because as people age, both become more prevalent.  Possibly, because people with Parkinson’s often have other sensations in their skin, lesions may not be noticed as quickly.  And additionally, since the skin of people with Parkinson’s  is very sensitive, it may have a stronger reaction to exposure to sun.

A further concern is the implication of levodopa treatment in developing malignant melanoma.  Current guidelines for physicians often state that if a patient has undiagnosed or suspicious skin lesions, dopamine should not be used.  The reason being that both dopamine and melanin share biochemical pathways in their synthesis.  But studies have shown that there is not necessarily a correlation, that the occurrences of  melanoma in Parkinson’s patients may simply be coincidental.

Skin patches for treatment of Parkinson’s offer a more continuous and even delivery of medication without taking so many pills.  While for the most part, it was well liked by people with Parkinson’s, it did have drawbacks of skin irritation.  Although it was recommended that the site of application be changed every day, sometimes the skin reactions lasted too long on  sensitive and fragile skin and caused too much discomfort.  The FDA withdrew their approval, and the patch was re-formulated and has again received FDA approval.  If the patch is used, careful attention must be paid to the skin in the areas of application.

In later stages of Parkinson’s, people may be much more sedentary than in the earlier stages. Off-time, stiffness and immobility as well as difficulty turning in bed can be challenging.  Sitting or lying down for long periods together with the friction of bedclothes can cause pressure sores to develop and ead to the breakdown of sensitive skin.  Add to this, the moisture of either night sweats or urinary incontinence, and the bacteria, and skin damage is inevitable.  In as little as two days, ulcers can develop.  Because immobility and rigidity are usually at the root of these problems, keeping the person with Parkinson’s mobile is the best treatment: making sure that dopamine and other medication is timely and properly regulated.  While it sounds simple, it is very difficult and complex and not easy to effect.  Caregivers, from caring physicians, nurses, spouses and family members all have to be carefully trained.

Fungal infections in incontinent patients are also a high risk.  Fungal infections look like red patches that are moist and itchy.  They can spread across the skin very rapidly.  Treatment consists of an anitfungal cream, such as mycostatin.  Special care must be taken with folds in the skin, to keep them clean and dry.

Parkinson’s affects the skin in many ways.  Sensory perceptions of hot and cold, pain and touch are diminished from nerve loss in the skin..  MicroRNAs (MiRNA) are non-coding RNA that help regulate cell cycles, differentiation and growthare also involved in skin.  In Par4kinson’s, these regulators have been found in an altered state.  Just exactly how the dopamine system affects them and how they affect wound healing is yet to be discovered.  .Together with the other non-motor, autonomic system changes, the skin presents an area for more research and better understanding of how Parkinson’s impacts the whole person.

 

 

 

Beitz, J.M; Skin and Wound Issues in Patients with Parkinson’s Disease: An Overview of common Disorders; Ostomy Wound Manage. 2013;59(6):26–36.

Pan, T; Li, X; Jankovic, J.; The Association between Parkinson’s Disease and Melanoma. Int. J. Cancer; 2011;128(10):2251-2260

Fisher, M., Gemende, I., Marsch, W., Fisher, P.A.: Skin Function and Skind Disorders in Parkinson’s Disease. J. Neur. Trans. 2001:108(2):205-213

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