Ask the MD: Skin Changes and Parkinson’s
Monday, 17th October 2022

One of the less common and lesser-known symptoms of Parkinson’s disease (PD) is changes in the skin. Possible skin symptoms include rashes, which can come from PD itself, medications to treat the disease, or Parkinson’s symptoms, such as drooling. Living with PD also raises the risk of skin cancer. Here, learn about Parkinson’s-related skin conditions and treatment options.

Seborrheic dermatitis

Seborrheic dermatitis causes red, flaky, scaly, oily, and sometimes itchy patches on the skin. These patches most often appear on the scalp and forehead, near eyebrows, in the creases between the nose and mouth, behind the ears, and on other parts of the face and body. They are not an infection, and they are not contagious.

Researchers aren’t exactly sure why seborrheic dermatitis happens. It may be an inflammatory reaction to an overgrowth of a normal yeast that lives on the skin. It involves skin glands (the sebaceous glands) that make a waxy, oily substance (sebum) to protect and moisturize skin. In Parkinson’s, seborrheic dermatitis also may be due, in part, to changes in the nerves that control skin and temperature regulation (the autonomic nervous system).

Seborrheic dermatitis doesn’t happen in everyone with PD. It’s more common in men and those with oily skin. It may be worsened by cold, dry air; stress; and lotions or cleansers with alcohol, which can dry and irritate skin.

If you or your loved one has seborrheic dermatitis, consider these tips:

  • Loosen scales and patches with mineral oil before cleansing.
  • Rinse your hair and beard with anti-fungal or anti-dandruff shampoo twice a week. (Look for ingredients like ketoconazole, selenium sulfide, sulfur, salicylic acid, and others.)
  • Cleanse and moisturize your face daily with products free from alcohol, perfume or dye.
  • If prescribed by your doctor, apply a topical anti-fungal or anti-inflammatory cream as directed.

These are general recommendations. Speak with your Parkinson’s doctor about the best treatments for you.

Treatment-related skin changes

All medications and surgical treatments have potential side effects. Sometimes, these include skin changes. While these don’t happen in everyone, it’s important to know about the possibility so you can watch for changes and speak with your doctor as soon as they happen.

Parkinson’s treatments that may cause skin changes include:

Amantadine: In some people, this drug causes a reddish-purple or bluish rash in a lacy or fishnet-type pattern. This is called livedo reticularis. It typically happens on the legs. It may be caused by changes in the blood vessels below the skin. The rash is not usually painful or itchy. Stopping medication makes it go away. But don’t stop this (or any other) medication before speaking with your doctor.

Entacapone (Comtan): This medication doesn’t cause skin changes but can darken the color of sweat (as well as urine and saliva). This is harmless, but worth knowing to avoid unnecessary worry.

Patches, such as rotigotine (Neupro) or rivastigmine (Exelon): Patches can, in some people, irritate the skin or cause an allergic reaction. And this can lead to burning, itching or stinging, as well as a rash or other skin changes. Removing the patch should resolve symptoms, but always speak with your physician. (You may also want to take a picture of the rash to share with them.) Sometimes, your doctor may recommend a prescription cream to heal rash. To limit the chance of a reaction, rotate where on the skin you place patches. Don’t use the same site more than once every two weeks. Wash the skin with soap and water after removing a patch, using baby or mineral oil to remove any remaining adhesive.

Infusions: These include levodopa/carbidopa gel infused through a tube into the intestine (Duopa) and levodopa/carbidopa liquid or amantadine infusions under the skin. (The latter two are under development in the United States.) Because of the way they are delivered, infusion therapies can cause skin redness, swelling, infection or nodules. Side effects may be limited by keeping the skin clean and dry and, for under-the-skin treatments, regularly alternating the site in which you administer medication.

Deep brain stimulation (DBS): DBS involves the implantation of wires into the brain and under the skin to deliver electrical stimulation that eases motor symptoms. (Learn more.) Occasionally, the skin over these wires can break down, increasing risk for infection. This complication, called skin erosion, may require surgery and antibiotics.

Read more about Parkinson’s medications.

Skin irritation from drooling
Some people with Parkinson’s, especially in later years, experience drooling. (Read more.) When significant, drool can irritate the skin and cause a rash around the mouth, chin or neck.

Treatments may include:

  • Sugar-free hard candy or gum to encourage swallowing
  • Prescription medications or injections to decrease saliva
  • Handkerchief or soft cloth to gently pat skin dry as often as possible; a bandana or bib around the neck to absorb moisture
    Daily facial rinse with warm water
  • Petroleum ointment application to protect clean, dry skin and promote healing
  • Avoidance of scented cleansers, lotions, laundry detergents and other products that touch skin
  • Skin cancer

People with Parkinson’s have an increased risk of the skin cancer melanoma. You can take steps to protect your skin and limit your risk. Learn more.

Your Parkinson’s doctor can likely diagnose and treat many of these skin changes. But if symptoms are especially significant or not responding to treatment, and for a yearly skin exam to watch for cancer, see a skin specialist (a dermatologist).