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Darkening of white hair in Parkinson`s disease
during use of levodopa rich Mucuna pruriens
extract powder
Escurecimento do cabelo branco na doença de Parkinson durante tratamento com extrato
em pó de Mucuna pruriens rico em levodopa
Renato P Munhoz
, Hélio A G Teive
An 85-year-old patient with stable Parkinsons disease
(PD), treated with levodopa/carbidopa 250/25 mg tid. During
a follow-up visit, it was noticed that her temporal white hair
was getting progressively darker (Figure), starting after intro-
duction of Mucuna pruriens extract (MPE) at a dose equiva-
lent to 1000 mg of levodopa/day. Hair and beard darkening
was recognized as a complication of treatment with levodopa
in PD since its earliest introduction.
DOPA/dopamine are in-
termediate metabolites in the production of melanin, there-
fore, this association is not surprising. After the addition of
decarboxylase inhibitors, this phenomenon, probably related
to peripheral eects of levodopa, became strikingly rare.
MD MSc at State of Paraná Parkinson Association, Curitiba PR, Brazil;
MD PhD at Movement Disorders Unit, Neurology Service, Universidade Federal do Paraná (UFPR), Curitiba PR, Brazil.
Correspondence: Renato Puppi Munhoz; Travessa Lange 225; 80240-170 Curitiba PR – Brazil; E-mail:
Conflict of interest: There is no conflict of interest to declare.
Received: 12 September 2012; Received in final form: 20 September 2012; Accepted: 27 September 2012
Figure. (A) The patient at the age of 62 year; (B) Showing hair
darkening after use of Macuna Pruriens extract powder.
1. Reynolds NJ, Crossley J, Ferguson I, Peachey RD. Darkening of white hair in Parkinson’s disease. Clin Exp Dermatol 1989;14:317-318.
... Anecdotally, a woman with white hair has been described that after 3 months of treatment with Mucuna, it turned back to black [50], "like when I was young," she said. This is food for thought: the threads connecting youth, dopamine, sufering, old age, stress, and gray hair [48,49]. ...
... There is a possibility that the inhibition of tyrosinase by α-synuclein [15] might result in earlier onset of hair greying due to decreased melanogenesis in hair follicles. It is also of interest to note that darkening of grey hair in PD patients following L-dopa therapy has been reported [24][25][26]. ...
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.
The Side Effects of Drugs Annuals form a series of volumes in which the adverse effects of drugs and adverse reactions to them are surveyed. The series supplements the contents of Meyler's Side Effects of Drugs: the International Encyclopedia of Adverse Drug Reactions and Interactions. This review of the 2011 publications on drugs that affect autonomic functions or the extrapyramidal system covers drugs that stimulate both alpha- and beta-adrenoceptors (adrenaline, noradrenaline, Ephedra and ephedrine, and pseudoephedrine), drugs that predominantly stimulate α1-adrenoceptors (phenylephrine), drugs that stimulate β1-adrenoceptors (dobutamine), drugs that stimulate β2-adrenoceptors (ritodrine), drugs that stimulate dopamine receptors (dopamine and the dopamine receptor agonist cabergoline), entacapone, and anticholinergic drugs, including orphenadrine. It also includes two special reviews on the dopamine receptor agonists rotigotine and piribedil. Recurrent features include reports of takotsubo cardiomyopathy and compulsive behavior associated with dopamine receptor agonists. There have also been many comparative studies, including noradrenaline versus dopamine and dopamine versus dobutamine to restore blood pressure.
We describe a patient with long-standing Parkinson's disease who noted that his white hair turned grey and darkened 8 months after the addition of carbidopa to his established levodopa (L-dopa) therapy and 4 months after the introduction of bromocriptine.