Skin Conditions and Movement Disorders: Hiding in Plain Sight

Abstract

Skin manifestations are well-recognized non-motor symptoms of Parkinson's disease (PD) and other hypokinetic and hyperkinetic movement disorders. Skin conditions are usually well visible during routine clinical examination and their recognition may play a major role in diagnostic work-up. In this educational review we: (1) briefly outline skin conditions related to Parkinson's disease, including therapy-related skin complications and their management; (2) discuss the role of skin biopsies in early diagnosis of PD and differential diagnosis of parkinsonian syndromes; and focus more on areas which have not been reviewed in the literature before, including (3) skin conditions related to atypical parkinsonism, and (4) skin conditions related to hyperkinetic movement disorders. In case of rare hyperkinetic movement disorders, specific dermatological manifestations, like presence of angiokeratomas, telangiectasias, Mongolian spots, lipomas, ichthyosis, progeroid skin changes and others may point to a very specific group of disorders and help guide further investigations.

Keywords: atypical parkinsonism; hyperkinetic; movement disorders; skin; skin biopsy.

FIG 1

Skin changes in Parkinson's disease. (A) Seborrheic dermatitis, (B) Rosacea, (C) Bullous pemphigoid.

FIG 2

Skin changes in hyperkinetic movement disorders. (A) Freckle‐like pigmentary changes and (B) Skin xerosis on left elbow in a patient with biallelic ERCC4 variants causing Xeroderma pigmentosum type F presenting also with generalized chorea, ataxia and mild cognitive problems, (C) Cutaneous telangiectasias (arrow) in a patient with biallelic ATM variants, (D) Incontinentio pigmenti, (E) Hypomelanosis of Ito (hypomelanotic streak on the left leg—black arrows), (F) Mongolian spots in a child with GM1‐gangliosidosis, (G) Angiokeratoma (adapted with permissions from Cuestas et al. 2019 ⁹⁷ ), (H) Hypertrichosis in a child with biallelic SURF1 variants, (I) Erythema marginatum, (J) Malar rash in lupus erythematosus.

FIG 3

Skin changes in hyperkinetic movement disorders. (A) Classical pellagra dermatitis over sun‐exposed area of the lower limb with a clear cut‐off at the margins of clothing (adapted with permissions from Madhyastha et al. 2020), (B) Ichthyosis, (C) self‐injurious behavior—artificial skin changes, (D) Self‐injurious behavior—lip biting in antiNMDAR encephalitis, (E) Chilblain lesions in Aicardi‐Gutieres syndrome (adapted with premissions from Videira et al. 2020) (F) Mastocytosis, (G) Tendon xanthomas in Cerebrotendinous xanthomatosis (courtesy of Dr. Paldaufova, Dr. Serdahely, Dept. of Neurology, Skalica, Slovakia), (H) Periorbital xanthelasma in Erdheim‐Chester disease (adapted with permissions from Chasset et al. 2016), (I) Abdominal skin ulcerations in Behçet disease (adapted with permissions from Scherrer et al. 2017).