Alopecia and levodopa

Hair Loss: A Well-Known Yet Understudied Symptom in Parkinson's Disease Patients During Dopaminergic Therapy

OBJECTIVE

Hair loss has been reported to occur during dopaminergic therapy in patients with Parkinson's disease. The mechanism by which dopaminergic therapy induces hair loss is not well understood. Dopamine receptors are present in the hair follicle, where they regulate melanin production. However, the role of dopamine receptors in hair growth is still not well understood. This study aimed to evaluate the prevalence of hair loss and identify factors associated with complaints of hair loss in patients with Parkinson's disease.

METHODS

A cross-sectional design involving 495 Parkinson's disease patients was applied to evaluate hair loss status. Patients completed a questionnaire, and scalp/hair examinations were performed. Patients with underlying conditions that could affect hair loss and those prescribed medications known to increase the risk of hair loss were excluded. Finally, 291 patients (58.8%) were included for analysis.

RESULTS

Among the 495 patients, 138 (27.9%) reported hair loss. Interestingly, more than half of the patients who complained of hair loss (79 out of 138) did not utilize treatments such as hair products, massage, dietary modifications, or alopecia medications. Hair inspection by a single investigator revealed objective hair loss in 263 patients (53.1%). An analysis of factors associated with hair loss complaints showed that the intake of dopaminergic medications with a levodopa-equivalent daily dose > 448 mg was associated with complaints of hair loss.

CONCLUSION

Dopaminergic medication is associated with hair loss complaints in Parkinson's disease patients.

Tremor Drugs in the Crosshairs

Background:

Alopecia areata is a rare but debilitating adverse effect of drugs used in the treatment of tremors. Recurrent hair loss after different types of tremor medications has never been described before.

Case Report:

We herein report the case of a 56-year-old tremor patient who we diagnosed with tremor-dominant Parkinson’s disease. Unfortunately, she developed acute alopecia areata following the introduction of firstly levodopa/benserazide, secondly propranolol, and thirdly topiramate.

Discussion:

Our case report highlights alopecia areata as a possible side effect to a variety of drugs commonly used for tremor management. Fortunately, in most reported cases, as well as in our case, the hair loss is reversible.

Levodopa-induced skin disorders in patients with Parkinson disease: a systematic literature review approach

The use of levodopa for treatment of Parkinson's disease is a well-established clinical practice. Data about the true incidence and severity of cutaneous complications associated with the use of levodopa are largely lacking. Aim of this review was to evaluate the quality of evidence referring to the skin disorders caused by levodopa treatment for Parkinson's disease. Thirty of 1084 studies were included; 8 randomized controlled trials and 22 case reports in a total of 2749 patients. Malignant melanoma was the most frequent oral levodopa-related skin disorder followed by allergic cutaneous reactions, alopecia, vitiligo, skin hyperpigmentation, Laugier-Hunziker syndrome, Henoch-Schönlein syndrome, pseudobullous morphea and scleroderma-like illness. Naranjo scores ranged from 2 to 8. Regarding levodopa clinical trials, the most frequent skin complication was peripheral edema, followed by malignant melanoma. Although evidence is not robust, melanoma is the most frequent and possible fatal levodopa-associated skin disorder, while other skin allergic or immunological reactions are less common and reversible. Although levodopa treatment may induce melanogenesis and promote melanomagenesis, existing evidence does not support an association between levodopa therapy and induction or progression of malignant melanoma. The suggested association with melanoma may reflect the well-documented association of Parkinson's disease with melanoma rather than the exposure to the drug. Nevertheless, until a solid conclusion can be drawn, the use of levodopa in the context of malignant melanoma should be considered with caution. Well-designed prospective studies are needed to determine the cause and effect relationship between levodopa and skin disorders.

Madarosis: a marker of many maladies

Madarosis is a terminology that refers to loss of eyebrows or eyelashes. This clinical sign occurs in various diseases ranging from local dermatological disorders to complex systemic diseases. Madarosis can be scarring or non-scarring depending upon the etiology. Appropriate diagnosis is essential for management. Follicular unit transplantation has been found to be a useful method of treating scarring madarosis and the procedure relevant to eyebrow and eyelash reconstruction has been discussed. A useful clinical approach to madarosis has also been included for bedside diagnosis. The literature search was conducted with Pubmed, Medline, and Google scholar using the keywords madarosis, eyebrow loss, and eyelash loss for articles from 1960 to September 2011. Relevant material was also searched in textbooks and used wherever appropriate.

Bilateral subthalamic nucleus stimulation results in reversal of alopecia in Parkinson's disease

Alopecia is a rare but important side effect of anti-parkinsonian medications. Our patient was a 72-year-old man with advanced Parkinson's disease (PD) who received levodopa and anti-cholinergic drugs and whose head had become almost completely bald. As bilateral subthalamic nucleus (STN) stimulation produced improvement in his motor symptoms, his drug dosages were reduced postoperatively. At 8 months after surgery, hair again covered his entire head. Our study presents a new aspect of the benefit of STN stimulation with regard to drug-induced non-motor symptoms in patient with PD.

Hair loss induced by dopamine agonist: case report and review of the literature

We report the case of a female patient with Parkinson's disease who experienced hair loss that appeared after the administration of cabergoline. Her hair re-grew after decreasing the dose of cabergoline, indicating that hair loss was induced by cabergoline. In reviewing the literature, there have been reports of hair loss after administration of various dopaminergic drugs that include levodopa and all types of dopamine receptor agonists. Although the pathophysiological mechanism underlying the hair loss is unclear, hair loss may be possibly overlooked, and should be noted as a possible side effect of the dopaminergic therapy.