“It is foolish to pluck out one’s hair for sorrow, as if grief could be assuaged by baldness.” Marcus Tullius Cicero
“Anyone can be confident with a full head of hair. But a confident bald man – there’s your diamond in the rough.” Larry David
Introduction: When you play golf, they frequently pair you up as a foursome. There seems to two types of people you meet for the first time on a golf course. The quiet-type where you shake hands, exchange names, and then play golf with a limited conversation. The other type is also there to play golf but can be much more talkative and interactive. Both types of golfers work just fine for me.
Recently, I had a tee-time at Mooresville Golf Club, Mooresville, NC, and I was paired up with a delightful couple and another single guy (remember, they like a foursome). I liked them all immediately. Around the 4th hole, I mentioned that I had Parkinson’s and that I considered golf to be part of my therapy. I was asked about treatment and drugs that I take, especially related to dopamine agonists (DA). Why? Because one of my partners that day had been taking a dopamine agonist for restless leg syndrome. He wanted to know if there was a link with using a DA and hair loss (alopecia)? He went further by saying his sister also had used a DA for restless leg syndrome and she had noticeable hair loss; she stopped taking the DA and eventually her hair returned. I told my new golf-friend (yes, he had some substantial baldness), that I would look into the evidence of dopaminergic drugs linked to hair loss, and write about it.
“I have always believed that hair is a very sure index of character.” Katharine Tynan
Evidence Linking use of a Dopamine Agonist with Alopecia (Hair Loss): Performing either a PubMed or a Google Scholar search for “dopamine agonist and hair loss” gives several case reports and a couple of articles (a few are cited below). Tabamo and Di Rocco in 2002 present 2 cases, “We report two women with PD who developed alopecia while being treated with the dopamine agonists pramipexole and ropinirole. The alopecia reversed partially after the drugs were discontinued….” One patient on pramipexole noted substantial hair loss; after switching to ropinirole, her hair growth was eventually restored. The second patient upon increasing dosing of pramipexole noted hair loss. It was described by Tabamo and Di Rocco as follows, “As in the previous case, the hair loss was not accompanied by itching, scaling or other dermatologic abnormalities, but was characterized by hair shedding and
thinning that worsened over the following weeks.” The patient was switched to ropinirole and the hair loss continued. Although the dopamine agonist was working therapeutically, the hair loss was cosmetically unacceptable. She was then switched from ropinirole to carbidopa/levodopa whereby the hair loss stopped; however, a full reversal of hair-growth was not achieved.
The other reports notice similar events with the use of a DA for treating Parkinson’s. Confounding each were unknown effects from additional treatments/drugs, and their own influence on hair loss. Hair follicles have dopamine receptors where they supposedly function in melanin production. Oddly, in some cases, switching from one DA to another reversed the hair loss; however, this was not true of all cases. Finally, the majority of cases of hair loss promoted by a DA for Parkinson’s were described in women.
Tabamo, RE, Di Rocco, A. Alopecia induced by dopamine agonists. Neurology, 2002; 58(5), 829-830. doi: 10.1212/WNL.58.5.829.
Miwa H, Kondo T. Hair loss induced by dopamine agonist: case report and review of the literature. Parkinsonism & Related Disorders. 2003;10(1):51-2. doi: 10.1016/s1353-8020(03)00058-0.
Katz KA, Cotsarelis G, Gupta R, Seykora JT. Telogen effluvium associated with the dopamine agonist pramipexole in a 55-year-old woman with Parkinson’s disease. Journal of the American Academy of Dermatology. 2006;55(5, Supplement):S103-S4. doi: https://doi.org/10.1016/j.jaad.2005.09.039.
Langan EA, Lisztes E, Biro T, Funk W, Kloepper JE, Griffiths CE, Paus R. Dopamine is a novel, direct inducer of catagen in human scalp hair follicles in vitro. Br J Dermatol. 2013;168(3):520-5. doi: 10.1111/bjd.12113. PubMed PMID: 23176199.
“Let us dance in the sun, wearing wild flowers in our hair.” Susan Polis Schutz
A Final Comment and Conclusions: Mechanistically, it appears that DA (and dopamine itself) are inhibitors of hair growth. However, what percent of people being treated for Parkinson’s with dopaminergic drugs will develop alopecia is currently not known. However, if you are experiencing hair loss caused by a DA, definitely contact your Neurologist to discuss treatment options. Importantly, please remember that all drugs used to treat Parkinson’s have known side-effects; furthermore, another related dopaminergic drug may not work as well as the one you are currently taking. To conclude, the alopecia that occurs in some people-with-Parkinson’s being treated with a DA adds another undesirable side-reaction linked to dopamine agonists.
“Worry does not empty tomorrow of its sorrow. It empties today of its strength.” Corrie Ten Boom
Cover Photo Credit: https://www.wilmingtonandbeaches.com/kure-beach/about/weather/