People with Parkinson’s often experience changes to their skin, particularly increased oiliness and red, itchy, flaky skin known as seborrheic dermatitis.. Changes in the amount of sweat may also be noticed, with either too much or too little perspiration.
Some skin problems may be relatively minor whilst others can be distressing, although they are rarely serious. Such problems may occur at any time in the course of the condition.
Image by ©JonnyAcheson2019
Common skin problems and treatment
The most common change is increased oiliness, particularly around the forehead, nose and scalp, where the sebaceous (oil secreting) glands are concentrated. Parkinson’s can cause an excess secretion from these glands of an oily substance called sebum which keeps skin supple and provides protection, but in excess results in the skin looking greasy and shiny.
Treatment: If your skin is too oily, wash with a mild soap and cleanse it twice daily in warm water, then rinse in cold water. If you use make-up and moisturisers, water-based gels are preferable to oil-based creams. A pharmacist or your doctor will be able to advise on suitable products.
If skin becomes extremely oily it may also be red, flaky and itchy - this is known as seborrheic dermatitis (‘dermatitis’ means that the skin is inflamed). Skin may also become flaky, crusty or may peel. This mainly affects the scalp, face (particularly around the nose, the eyebrows and eyelids), ears (inside and out), chest and folds in the skin such as under the arms, breasts and groin.
This is a common condition but people with Parkinson’s have an increased risk of developing it. There is no direct connection between the severity of Parkinson's and the degree of oiliness.
It is thought that a type of yeast found on the skin (Malassezia) may cause this condition. Certain foods are also thought to play a role, although there is so far no evidence linking the problem to foods rich in yeast. Any foods which seem to cause or make things worse should be avoided.
Seborrheic dermatitis is more likely to occur in men, probably as a result of increased sebum secretion connected to male sex hormones. The problem may get worse if you are stressed or tired.
Treatment: Various products are available to treat seborrheic dermatitis by eliminating yeast on the skin. Antifungal treatments may help by treating the yeast on the skin. Anti-inflammatory steroid creams or ointments may also help. You should avoid cosmetics containing alcohol as well as soaps and shaving products that irritate your skin. Non-greasy, special moisturising creams (emollients) and soap substitutes are recommended. Special lotions and shampoos are available from pharmacists for dandruff or flaky skin. It is best to check with your doctor if you use such products for a period of time. The problem may return if you stop using special lotions or shampoos. The following recommendations may help.
For the scalp and beard:
- Loosen any crusts or scales on the scalp by rubbing on olive or mineral oil several hours before washing your hair. You can also use a de-scaling agent containing coal tar or salicylic acid.
- Wash your hair and your beard, if you have one, with a medicated shampoo, or one containing coal tar or salicylic acid, which you can buy over the counter. Alternatively, your doctor can prescribe special shampoos.
- Shampoos containing 5% tea tree oil are thought to be effective when used daily.
- If you have severe itching on your scalp, your doctor can prescribe a steroid-based cream or ointment to be used for a short period.
For the face and body:
- A cream containing ketoconazole can be prescribed by your doctor. You can use this until the skin has improved.
- A mild steroid cream, which may contain an antifungal agent, can also be used to reduce inflammation and soreness. If symptoms have not cleared up within six months you should see your doctor or a dermatologist (skin expert) for advice.
- If your eyelids are affected, clean them daily with cotton buds moistened with baby shampoo. If this does not help, see your doctor or a dermatologist for advice.
- Medicated eardrops can be used to treat the ear canal.
Some people with Parkinson’s have problems with their autonomic nervous system (ANS), which controls sweating. This can result in sweating too little (hypohidrosis) leaving the skin very dry or sweating too much (hyperhidrosis).
Perspiration helps regulate the body’s temperature, keeping your body temperature steady in hot weather, during a fever, or if you exercise) so if you sweat very little or not at all when it is hot or you are energetic you should speak to your doctor as this puts you at risk of overheating.
It is also worth mentioning that people with Parkinson’s tend to have a reduced sense of smell so may not notice their body odours.
Often, people with Parkinson's find sweat production to be reduced in the extremities, such as hands and feet. As a compensatory mechanism other parts of the body may sweat more than they normally would.
You are more likely to sweat excessively if you are ‘off’ or during ‘wearing off’, although this can also happen if you are ‘on’ and medication is working well, particularly if you have dyskinesias (uncontrolled movement). Many people also experience drenching night sweats.
Changes in sweating may be caused by Parkinson’s medications. Anticholinergic medications (e.g.trihexyphenidyl, procyclidine) are occasionally used to treat tremor in Parkinson’s. Other anticholinergic medications (e.g oxybutynin, tolterodine, solifenacin) are sometimes used to treat bladder problems. These anticholinergic medications can block the secretion of sweat, resulting in a rise in body temperature. So during hot weather this type of medication may need to be reduced, or avoided totally in older people. On the other hand, levodopa can lead to excessive sweating and some people experience drenching sweats during the ‘wearing off’ stage, just before the next dose of medication is due. Levodopa dosage should therefore be adjusted to minimise this excessive sweating, although this can of course mean that other Parkinson’s symptoms may be less well controlled. In this situation, your doctor adjust your Parkinson’s medication to try to reduce fluctuations and wearing off symptoms.
Some people with Parkinson's feel cold and may shiver and wear winter clothes even in the summer months. The exact cause of this is unclear, but it may well be due to problems with the autonomic (or automatic) nerves that control body temperature. If you feel the cold badly or if you feel cold even in warm weather, you should discuss this with your doctor.
Treating excessive sweating:
If you perspire too much, then take frequent showers, wear loose fitting cotton clothes, leather footwear and be sure to drink plenty to replace the fluids lost in perspiration. Avoid things that trigger sweating, such as crowded rooms, alcohol or spicy food. Antiperspirants are advised only for those who perspire a lot as they can block the essential perspiration of those who perspire very little. (Note: there is a difference between antiperspirants and deodorants. Antiperspirants containing aluminium chloride reduce the release of sweat, deodorants mask any unpleasant smell. In fact, sweat itself does not have an odour - it is only sweaty clothes that are not changed that smell.)
If you experience night sweats use light, cotton bedding. Whilst satin sheets may be recommended to make turning in bed easier, satin can increase sweat. You may find it helps to sleep in a separate bed so as to avoid disturbing your partner if you have one. Always keep a glass of water beside your bed to replace lost fluids.
If you find the underarm of your clothes becomes stained you can buy special underarm shields which absorb excess moisture and protect clothing. White clothing tends to show sweat marks less than dark colours.
If lifestyle measures are not helpful you should discuss the possibility of botulin toxin injections. These can reduce sweating but need to be repeated.
Treating sweating too little:
If you don’t sweat much or not at all, it is important to avoid getting too hot as the body relies on perspiration to keep it cool and avoid overheating. Always consult your doctor before exposure to extreme heat sources such as infra-red saunas or steam saunas. Stay in the shade in hot weather, wear light clothes and remember not to exert yourself too much. Keep skin moisturised with an emollient ointment or cream.
Content last reviewed: October 2018
We would like to thank Dr Rob Skelly (Royal Derby Hospital, UK) for his help in reviewing this information.
Our thanks to Parkinson’s UK for permission to use the following source: