Amantadine-induced livedo reticularis - Case report

Quaresma, Maria Victória; Gomes, Ana Carolina Dias; Serruya, Aline; Vendramini, Dâmia Leal; Braga, Lara; Buçard, Alice Mota

doi:10.1590/abd1806-4841.20153394

Cited by 13 publications

(6 citation statements)

References 8 publications

(22 reference statements)

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“…The skin biopsies are often unspecific, with the normal epidermis and dermis showing no evidence of vasculitis. 10,11 Most of the reported cases have normal laboratory features, including antiphospholipid antibodies and lupus anticoagulant research. There are few cases associating amantadine with LR, and some authors suggest that the prolonged use of the medication may be associated with severe livedo, leg ulcers, and peripheral neuropathy, as a result of altered blood supply to the skin and peripheral nerves.…”

Section: Discussionmentioning

confidence: 99%

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Livedo Racemosa: Clinical, Laboratory, and Histopathological Findings in 33 Patients

Pincelli

Echavarría

Criado

et al. 2020

The International Journal of Lower Extremity Wounds

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Livedo racemosa is a cutaneous finding characterized by a persistent, erythematous, or violaceous discoloration of the skin, in a broken, branched, discontinuous, and irregular pattern. A retrospective review of 33 cases with clinical diagnosis of livedo racemosa over the past 6 years was evaluated in the dermatology department of a tertiary care hospital. We found predominance in Caucasian women (78.8%); age ranged from 8 to 81 years, with a mean age of 36 years. Livedo racemosa was described as generalized in 12 patients (36.4%), although the main localization was on lower limbs (42%). After laboratory testing and histopathological examinations, 12 patients (36.4%) were classified with idiopathic livedo racemosa; secondary diseases were diagnosis in 21 patients (63.6%), including Sneddon’s syndrome, cutaneous polyarteritis nodosa, systemic lupus erythematosus, and others. Medical history of thrombotic events was described in 8 (24.2%) patients, and also 8 (24.2%) patients had abnormal results for 2 or more thrombophilia laboratory tests. Skin biopsy showed no histological abnormalities in 11 cases (33.3%), thrombosis of dermal blood vessels in 10 (30.3%), intimal/subintimal thickening in 7 (21.2%), and vasculitis in 5 (15.2%). In conclusion, livedo racemosa is a clinical feature that might be correlated to vascular disorders, such as thrombotic and/or hypercoagulable states, autoimmune diseases, and neoplastic diseases, or it can be secondary to specific medications. It is essential to establish a correct approach in cases of livedo racemosa, which includes anamnesis, physical examination, laboratory test, histological examination, and complementary examination according to clinical findings, in order to diagnosis underlying causes.

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Section: Discussionmentioning

confidence: 99%

“…The livedo reticularis is a common adverse event described in patients using amantadine for the treatment of Parkinson’s disease and has a higher prevalence in females and involves mainly the lower limbs and trunk. 10 The reported incidence ranges from 2% up to 90%. The reason why amantadine stimulates the formation of LR is still unknown.…”

Section: Discussionmentioning

confidence: 99%

Livedo Racemosa: Clinical, Laboratory, and Histopathological Findings in 33 Patients

Pincelli

Echavarría

Criado

et al. 2020

The International Journal of Lower Extremity Wounds

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“…Amantadine LR is a rare complication seen with amantadine treatment that has been reported only in case reports or small case series. [82][83][84] It is characterized by patchy mottling of the skin and can be described as following a "fishnet pattern." 85 It is caused by increased prominence of the venous beds in the skin, arising from impediments to arterial flow, venous dilation, or obstruction of venous flow.…”

Section: Therapy-related Skin Disordersmentioning

confidence: 99%

The Skin and Parkinson's Disease: Review of Clinical, Diagnostic, and Therapeutic Issues

Škorvánek

Bhatia

2016

Movement Disord Clin Pract

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Background: Parkinson's disease (PD) and the skin are related in a number of ways, including clinical abnormalities of the disease itself and skin-related side effects of dopaminergic medication, pumps, and surgical therapies. Recent advances in understanding the role of a-synuclein suggest skin biopsies as a potential diagnostic or even a premotor marker of PD. Methods: The PubMed database was searched for publications up to October 2015, and the current evidence on skin-related issues in PD was comprehensively summarized. Results: The evidence was summarized on the prevalence, etiology, and management of seborrheic dermatitis, sweating dysfunctions, bullous pemphigoid, and malignant melanoma, as well as therapy-related skin disorders, especially those observed in amantadine, rotigotine, apomorphine, and levodopa/carbidopa intestinal gel therapies and deep-brain stimulation. Skin biopsies evaluating the presence of a-synuclein, the density and morphology of cutaneous nerves, and skin fibroblast functions also are discussed. Conclusions: Skin disorders are a common manifestation of PD. However, the exact pathophysiology and prevalence of these disorders are not well understood, and more systematic research is needed in this regard. Peripheral tissue biopsies as a diagnostic marker of PD are an exciting avenue in future PD research, although multiple caveats and pending issues need to be solved before they can be used in routine clinical practice.Parkinson's disease (PD) is a progressive neurodegenerative disease characterized by the presence of multiple motor and nonmotor symptoms. Skin disorders, such as seborrheic dermatitis (SD) and hyperhidrosis, are well recognized and frequent -but often overlooked-nonmotor symptoms of PD; they have been associated with PD for nearly a century, since the first reports of seborrheic facies in PD by Krestin.1 Given the interest in biomarkers that precede the motor features of PD, it is worth noting that skin affection may precede the onset of typical motor symptoms by years. 2 Other skin disorders, such as malignant melanoma and bullous pemphigoid (BP), are significantly more prevalent in PD patients compared with the general population. 3,4 Recent advances in the understanding of the role of a-synuclein (SNCA) in the pathophysiology of PD, its prion-like mechanism of spreading, and findings of typical Lewy body pathology in the peripheral nervous system, suggest skin biopsies as a potential diagnostic marker of PD. Unlike the peripheral melanins produced in skin melanocytes, neuromelanin is produced in specific populations of catecholaminergic neurons in the brain. It is believed that neuromelanin interacts with transition metals, especially iron, and mediates intracellular oxidative mechanisms. This function seems to be compromised in PD, thus rendering pigmented neurons vulnerable to oxidative damage. 5 The skin can be affected by antiparkinsonian medication as well. Specific drug-delivery methods, such as skin patches, subcutaneous application of apomorphine, l...

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“…Erythematous-cyanotic welldefined spots, which are also known as complete or closed, are clinically found. These spots delimit internal skin areas with the normal aspect or pale in color (1).…”

Section: Introductionmentioning

confidence: 99%

Livedo reticularis following drug interaction of sertraline and amantadine in a patient with obsessive-compulsive disorder and depression: A brief report

Panahi

Rasnani

Zare

et al. 2022

APTJ

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Livedo reticularis (LR) is a cutaneous vascular pattern that presents with reticular patch morphology. LR is a manifestation of a wide range of diseases, from idiopathic to systemic. We reported the clinical image of a patient with obsessive-compulsive disorder (OCD) and LR associated with amantadine use. On examination, mild postural tremor was left-handed and had a kinetic tremor. Rest tremor and re-emerge tremor were detected in addition to mild rigidity and bradykinesia in the patient; we proposed probable drug-induced Parkinsonism. We should notice skin lesions after amantadine use and consider LR after the prescription of it. Also, co-administration of SSRIs and amantadine may increasethe probability of LR.

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Amantadine-induced livedo reticularis - Case report

Cited by 13 publications

References 8 publications

Livedo Racemosa: Clinical, Laboratory, and Histopathological Findings in 33 Patients

Livedo Racemosa: Clinical, Laboratory, and Histopathological Findings in 33 Patients

The Skin and Parkinson's Disease: Review of Clinical, Diagnostic, and Therapeutic Issues

Livedo reticularis following drug interaction of sertraline and amantadine in a patient with obsessive-compulsive disorder and depression: A brief report

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