Implications of Skin Disorders in Parkinson Disease for Neurologists, Dermatologists

Through heightened awareness and education on skin disorders in Parkinson disease (PD), neurologists and dermatologists can better recognize skin-related manifestations of PD and direct patients to the optimal source of care for these issues, said Nicki Niemann, MD, neurologist at the Muhammad Ali Parkinson Center and an assistant professor of neurology at Barrow Neurological Institute.

Transcript

AJMC^®: Hello, I'm Matthew Gavidia. Today on the MJH Life Sciences™ Medical World News, The American Journal of Managed Care^® is pleased to welcome Dr Nicki Niemann, neurologist at the Muhammad Ali Parkinson Center and an assistant professor of neurology at Barrow Neurological Institute. Dr Niemann additionally served as a co-author of a review article titled “Parkinson disease and skin.”

In the review, it was noted that the presence of particular skin disorders may predate onset of motor symptoms in PD. Can you further discuss this trend, especially when it comes to potential diagnostic implications?

Niemann: I think I may have alluded to that a little bit before. To the best of my knowledge, and according to the best available evidence, the primary skin disorders that seem to come up sometime before PD is recognized would be sweating changes or changes in sweat pattern and seborrheic dermatitis–probably, as I mentioned before, because both are influenced by dysfunction of the autonomic nervous system.

Then the other conditions that seem to occur later on would be things like melanoma and bullous pemphigoid. I think the main takeaway is that neurologists should be aware that that patients with PD can have symptoms that don't neatly fall into a box with neurological symptoms and signs, and need to be able to make an association between something like PD and a specific skin disorder—not necessarily so they can treat it, but at least a way that they can direct the patient to a provider that would be able to help such as a dermatologist.

On the other hand, it's equally important that a dermatologist understands that certain conditions—in this case, bullous pemphigoid comes to mind—certain conditions in dermatology can have a very high rate of neurological comorbidities. They may already have been recognized, but in other cases, neurological comorbidities may be present, but unrecognized. And I think this would be something that should be discovered or uncovered just by the record of review systems. Although sometimes, it can be tricky to do in a busy clinical practice.

AJMC^®: How can neurologists and dermatologists better assess skin-related manifestations of PD?

Niemann: Yeah, I think the great and obvious thing about skin is that it's almost impossible not to be inspected during a routine visit when we’re with the patient. It doesn't matter if that's with the internist, surgeon, or the neurologist, but going back to the prior discussion, I think more education about skin disorders in PD is what is needed to help raise awareness, and will kind of help us see what is in plain sight. If we start to look for these things, I think we'll pick up on them better, and we'll start to make an association with PD, which might not previously have been the case.

AJMC^®: Lastly, do you have any other concluding thoughts?

Niemann: Yeah, well, first of all, thank you for inviting me to speak with you about our article. I hope this discussion helps raise awareness about skin disorders in PD, and I’d also like to mention that even though we didn't really discuss it at length, because it wasn't the topic of primary focus of the paper, I think skin is going to play a central role going forward in PD—not just in diagnostics, like I've mentioned before, but also potentially therapeutics.

We know that skin can be used to generate stem cells. Stem cells can be used both to test drugs, but can also be used directly as novel stem cell-based therapies. We're not quite there yet, but I think there's a lot of promise and a lot of exciting science going on.

AJMC^®: To learn more, visit our website at AJMC.com. I’m Matthew Gavidia, thanks for joining us!