Objective: We report four patients with PD treated several years with irregular and progressively higher doses of pramipexole who presented with extensive chronic bilateral lower limb edema and/or skin reactions.

Background: Skin reaction and lower extremities edema associated with a high dose of pramipexole is not commonly seen in clinical practice. Recently was published a review regarding skin complications in PD (1) however, pramipexole as cause of skin alterations has not been described before.

Methods: This is a descriptive observational study reporting three cases of skin reactions in PD patients treated with pramipexole. We documented graphically during one year the recovering of the most severe case.

Results: Pramipexole is a non-ergot dopamine agonist that is frequently used as a single therapy or in combination for the management of PD and primary restless legs syndrome (2). Distal edema is a recognized complication described previously. It occurs with a frequency that ranges from 5.6% to 50% in differents reports, but skin involvement with or without edema is not clearly recognized. (3) (4). Several etiologies have been proposed but the pathophysiology remains unclear (5).

Conclusions: Although distal edema is a recognized complication of dopamine agonist (DA) treatment, and has been previously described (7)(8), severe chronic peripheral edema with severe skin reaction after years of treatment with higher doses of pramipexole has not been reported. Physicians need to be aware of this complication in order to avoid unnecessary testing and delayed treatment. This project was accepted for poster presentation in the PSG Annual Meeting & Symposium 2017 and rescheduled for May 5 – May 6, 2018 in Jersey City, NJ

References: 1. Skorvanek M, Bhatia K; The Skin and Parkinson’s Disease: Review of Clinical, Diagnostic and Therapeutic Issues. Movement Disorders Clinical Practice. January/Feebruary 2017 Vol 4, Issue 1 21-31. 2. Antonini A, Barone P, Ceravolo R; Role of Pramipexole in the Management of Parkinson’s Disease. CNS Drugs 2010, 24 829-841. 3. Silindir M, Ozer A/ The benefits of pramipexole selection in the treatment of Parkinson’s disease. Neurol Sci (2014) 35; 1505-1511. 4. Zavala, J.; Munhoz, R.; Teive H., Pramipexole related chronic lower limb oedema in a patient with Parkinson’s disease. Case Reports / Journal of Clinical Neuroscience 19 (2012) 1298–1299. 5. Kleiner-Fisman G, Fisman DN: Risk factors for the development of pedal edema in patients using pramipexole. Arch Neurol 2007; 64:820–824. 6. Biglan KM, Holloway Jr RG, McDermott MP, et al. Risk factors for somnolence,edema, and hallucinations in early Parkinson Disease. Neurology 2007; 69’ 187-95. 7. Cicero E, Nicoletti A, Mostile G, et all. A case of severe lef oedema in a patiente with Parkinson’s disease treated with pramipexole Postgrad Med J, 2016 onlie first published on March 3, 2016 as 10.1136/postgradmedj-2016-133990. 8. Tan, E.; Ondo, W. Clinical Characteristics of Pramipexole Induced Peripheral Edema Arch Neurol. 2000; 57: 729-732.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-characterization-of-pramipexole-induced-edema-and-skin-reaction-in-parkinsons-disease-pd-after-one-year-of-follow-up/