10.5826/dpc.1303a157
text/xml
2160-9381
2983
en
Shari Lipner
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Xanthonychia Due to Staining From Carbidopa-Levodopa
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-07-31
2022-11-15
2023-07-31
2023-08-24
e2023157
Dermatol Pract Concept
Shari Lipner
2023/07/31
10.5826/dpc.1303a157
e2023157
Weill Cornell Medicine, New York, USA
2160-9381
en
e2023157
Anang JBM. Levodopa-Carbidopa-Related Rash in Parkinson's Disease: A Case Series. Can J Neurol Sci. 2018;45(5):588-589. doi:10.1017/cjn.2018.58
Xanthonychia Due to Staining From Carbidopa-Levodopa
https://dpcj.org/index.php/dpc/article/download/2983/2228
                              Xanthonychia Due to Staining
                               From Carbidopa-Levodopa
                                        Jonathan Kyle Hwang1, Shari R Lipner1


1 Weill Cornell Medicine, New York, USA



Citation: Hwang, JK, Lipner SR. Xanthonychia Due to Staining from Carbidopa-Levodopa. Dermatol Pract Concept.
2023;13(3):e2023157. DOI: https://doi.org/10.5826/dpc.1303a157
Accepted: January 17, 2023; Published: July 2023
Copyright: ©2023 Hwang et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: Author JKH has no conflicts of interest. Author SRL has served as a consultant for Hoth Therapeutics, Ortho-
Dermatologics, Belle Torus Corporation and Moberg Pharmaceuticals.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Shari R. Lipner MD, PhD, 1305 York Avenue, New York, NY 10021, (646) 962-3376, shl9032@med.cornell.edu




Case Presentation                                                        The differential diagnosis for yellow discoloration of the
                                                                         nails includes onychomycosis, nail psoriasis, nail lichen
An 84-year-old female with a history of Parkinson disease                planus, and yellow nail syndrome [1]. Our case stresses the
presented with yellow discoloration of her fingernails for a             importance of considering exogenous causes in diagnosing
few months. She had been taking carbidopa-levodopa for                   xanthonychia. The carbidopa-levodopa pills our patient
her Parkinson disease for many years, crushing the tablets               was prescribed contain D&C yellow no. 10 aluminum lake,
into smaller pieces before ingesting. Physical examination               which give the pills a yellow appearance and has been pre-
was significant for a contracted left hand, xanthonychia                 viously associated with maculopapular rashes of the trunk
of all 10 fingernails, and crumbling of the left fingernails             and arms [2]. As carbidopa-levodopa can cause xanthony-
(Figure 1). A clipping of the fingernails was performed to               chia, patients should be counseled to wear gloves if they are
rule out onychomycosis and psoriasis as etiologies.                      chewing and handling the medication.



Teaching Point                                                           References
                                                                          1. Vignes S, Baran R. Yellow nail syndrome: a review. Orphanet
In this case, the yellow nail discoloration was due to exoge-
                                                                             J Rare Dis. 2017;12(1):42. DOI: 10.1186/s13023-017-0594-4.
nous pigment from crushing and handling of her carbidopa-
                                                                             PMID: 28241848. PMCID: PMC5327582.
levodopa medication. The yellow dye from the pill mixes                   2. Anang JBM. Levodopa-Carbidopa-Related Rash in Parkinson's
with saliva and drips onto the patient’s fingernails, which                  Disease: A Case Series. Can J Neurol Sci. 2018;45(5):588-589.
was demonstrated to the authors during the clinic visit.                     DOI:10.1017/cjn.2018.58 PMID: 30033887.




Image Letter | Dermatol Pract Concept. 2023;13(3):e2023157                                                                              1
    Figure 1. Xanthonychia of fingernails due to staining from carbidopa-levodopa.




2                                                                            Image Letter | Dermatol Pract Concept. 2023;13(3):e2023157
