Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-04T19:26:37.246Z Has data issue: false hasContentIssue false

Chapter 17 - Cutaneous Manifestations of Parkinson’s Disease

Published online by Cambridge University Press:  05 March 2022

Néstor Gálvez-Jiménez
Affiliation:
Florida International University
Amos D. Korczyn
Affiliation:
Tel-Aviv University
Ramón Lugo-Sanchez
Affiliation:
Cleveland Clinic
Get access

Summary

In neurological clinical practice, Parkinson’s disease (PD) is commonly associated with a variety of dermatological disorders, such as seborrheic dermatitis, rosacea, bullous pemphigoid, skin cancer and melanoma, as well as sweating dysfunction. The recognition, diagnosis, and therapeutic approaches of these characteristic skin disorders affecting PD patients are important for the clinician and may even be life-saving, considering the relatively higher incidence of malignant skin tumors in PD patients.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ravn, AH, Thyssen, JP, Egeberg, A. Skin disorders in Parkinson’s disease: potential biomarkers and risk factors. Clin Cosmet Investig Dermatol 2017; 10: 8792.Google Scholar
Peyri, J, Lleonart, M, Grupo espanol del Estudio S. Clinical and therapeutic profile and quality of life of patients with seborrheic dermatitis. Actas Dermosifiliogr 2007; 98(7): 476482.Google Scholar
Tanner, C, Albers, K, Goldman, S, et al. Seborrheic dermatitis and risk of future Parkinson’s disease (PD) (S42.001). Neurology 2012; 78(Suppl 1): S42.001S42.CrossRefGoogle Scholar
Martignoni, E, Godi, L, Pacchetti, C, et al. Is seborrhea a sign of autonomic impairment in Parkinson’s disease? J Neural Transm 1997; 104(11–12): 12951304.CrossRefGoogle ScholarPubMed
Antonini, A, Barone, P, Marconi, R, et al. The progression of non-motor symptoms in Parkinson’s disease and their contribution to motor disability and quality of life. J Neurol 2012; 259(12): 26212631.Google Scholar
Antunes, I, Purim, KSM, Grande, LL, et al. Dermatoses in parkinsonism: the importance of multidisciplinary follow-up. Rev Assoc Med Bras (1992) 2019; 65(6): 791795.Google Scholar
Skorvanek, M, Bhatia, KP. skin, The and Parkinson’s disease: review of clinical, diagnostic, and therapeutic issues. Mov Disord Clin Pract 2017; 4(1): 2131.CrossRefGoogle ScholarPubMed
Fischer, M, Gemende, I, Marsch, WC, Fischer, PA. Skin function and skin disorders in Parkinson’s disease. J Neural Transm 2001; 108(2): 205213.Google Scholar
Arsic Arsenijevic, VS, Milobratovic, D, Barac, AM, et al. A laboratory-based study on patients with Parkinson’s disease and seborrheic dermatitis: the presence and density of Malassezia yeasts, their different species and enzymes production. BMC Dermatology 2014; 14(1): 5.CrossRefGoogle Scholar
Burton, JL, Shuster, S. Effect of L-dopa on seborrhoea of parkinsonism. Lancet 1970; 2(7662): 1920.CrossRefGoogle ScholarPubMed
Kohn, SR, Pochi, PE, Strauss, JS, et al. Sebaceous gland secretion in Parkinson’s disease during L-dopa treatment. J Invest Dermatol 1973; 60(3): 134136.Google Scholar
Reider, N, Fritsch, PO. Other eczematous eruptions. In: Bolognia JL SJ, Cerroni L, (eds.). Dermatology, 4th ed. Elsevier; 2018, 228–41.Google Scholar
Gregory, R, Miller, S. Parkinson’s disease and the skin. Pract Neurol 2015; 15(4): 246249.Google Scholar
Gary, G. Optimizing treatment approaches in seborrheic dermatitis. J Clin Aesthet Dermatol 2013; 6(2): 4449.Google Scholar
Vera, N, Patel, NU, Seminario-Vidal L. Rosacea comorbidities. Dermatol Clin 2018; 36(2): 115122.Google Scholar
Egeberg, A, Hansen, PR, Gislason, GH, Thyssen, JP. Exploring the association between rosacea and Parkinson disease: a Danish nationwide cohort study. JAMA Neurol 2016; 73(5): 529534.CrossRefGoogle ScholarPubMed
Mathieu, RJ, Guido, N, Ibler, E, et al. Rosacea and subsequent diagnosis for Parkinson’s disease: a large, urban, single center, US patient population retrospective study. J Eur Acad Dermatol Venereol 2018; 32(4): e141e144.CrossRefGoogle ScholarPubMed
He, A, Sweren, RJ, Kwatra, SG. Association between rosacea and Parkinson disease. JAMA Neurol 2016; 73(9): 11581159.Google Scholar
Egeberg, A, Thyssen, JP. Association between rosacea and Parkinson disease-reply. JAMA Neurol 2016; 73(9): 11591160.Google Scholar
Powell, FC, Raghallaigh, SN. Rosacea and related disorders. In: Bolognia JL SJ, Cerroni L, (eds.). Dermatology, 4th ed. Elsevier; 2018, 604–614e1.Google Scholar
Segal, R, Mimouni, D, Feuerman, H, Pagovitz, O, David, M. Dermoscopy as a diagnostic tool in demodicidosis. Int J Dermatol 2010; 49(9): 10181023.CrossRefGoogle ScholarPubMed
Wood, H. Parkinson disease: new evidence for a pathogenic link between rosacea and Parkinson disease. Nat Rev Neurol 2016; 12(5): 250251.Google Scholar
Inzelberg, R, Flash, S, Friedman, E, Azizi, E. Cutaneous malignant melanoma and Parkinson disease: common pathways? Ann Neurol 2016; 80(6): 811820.CrossRefGoogle ScholarPubMed
Liu, R, Gao, X, Lu, Y, Chen, H. Meta-analysis of the relationship between Parkinson disease and melanoma. Neurology 2011; 76(23): 20022009.Google Scholar
Gao, X, Simon, KC, Han, J, Schwarzschild, MA, Ascherio, A. Genetic determinants of hair color and Parkinson’s disease risk. Ann Neurol 2009; 65(1): 7682.Google Scholar
Herrero Hernandez, E. Pigmentation genes link Parkinson’s disease to melanoma, opening a window on both etiologies. Med Hypotheses 2009; 72(3): 280284.Google Scholar
Alexoudi, A, Alexoudi, I, Gatzonis, S. Parkinson’s disease pathogenesis, evolution and alternative pathways: a review. Rev Neurol 2018; 174(10): 699704.CrossRefGoogle ScholarPubMed
Alexoudi, A, Alexoudi, I, Gatzonis, S. Association between rosacea and Parkinson disease. JAMA Neurol 2016; 73(9): 1159.Google Scholar
Tsukita, K, Sakamaki-Tsukita, H, Tanaka, K, Suenaga, T, Takahashi, R. Value of in vivo alpha- synuclein deposits in Parkinson’s disease: a systematic review and meta-analysis. Mov Disord 2019; 34(10): 1452–1463.Google Scholar
Taieb, A, Ortonne, JP, Ruzicka, T, et al. Superiority of ivermectin 1% cream over metronidazole 0.75% cream in treating inflammatory lesions of rosacea: a randomized, investigator-blinded trial. Br J Dermatol 2015; 172(4): 11031110.Google Scholar
Bloem, BR, Kalf, JG, van de Kerkhof, PC, Zwarts, MJ. Debilitating consequences of drooling. J Neurol 2009; 256(8): 13821383.CrossRefGoogle ScholarPubMed
Swinn, L, Schrag, A, Viswanathan, R, et al. Sweating dysfunction in Parkinson’s disease. Mov Disord 2003; 18(12): 14591463.Google Scholar
De Pablo-Fernandez, E, Tur, C, Revesz, T, et al. Association of autonomic dysfunction with disease progression and survival in Parkinson disease. JAMA Neurol 2017; 74(8): 970976.Google Scholar
Hirayama, M. Sweating dysfunctions in Parkinson’s disease. J Neurol 2006; 253(Suppl 7): VII4247.Google Scholar
Mano, Y, Nakamuro, T, Takayanagi, T, Mayer, RF. Sweat function in Parkinson’s disease. J Neurol 1994; 241(10): 573576.Google Scholar
Sage, JI, Mark, MH. Drenching sweats as an off phenomenon in Parkinson’s disease: treatment and relation to plasma levodopa profile. Ann Neurol 1995; 37(1): 120122.CrossRefGoogle ScholarPubMed
Spica, V, Pekmezovic, T, Svetel, M, Kostic, VS. Prevalence of non-motor symptoms in young-onset versus late-onset Parkinson’s disease. J Neurol. 2013; 260(1): 131137.Google Scholar
Pont-Sunyer, C, Hotter, A, Gaig, C, et al. The onset of nonmotor symptoms in Parkinson’s disease (the ONSET PD study). Mov Disord 2015; 30(2): 229237.CrossRefGoogle ScholarPubMed
Schestatsky, P, Valls-Sole, J, Ehlers, JA, Rieder, CR, Gomes, I. Hyperhidrosis in Parkinson’s disease. Mov Disord 2006; 21(10): 17441748.Google Scholar
Yang, C, Qiu, Y, Wu, X, et al. Analysis of contact position for subthalamic nucleus deep brain stimulation-induced hyperhidrosis. Parkinson’s Dis 2019; 2019: 8180123.Google Scholar
Ramirez-Zamora, A, Smith, H, Youn, Y, et al. Hyperhidrosis associated with subthalamic deep brain stimulation in Parkinson’s disease: insights into central autonomic functional anatomy. J Neurol Sci 2016; 366: 5964.CrossRefGoogle ScholarPubMed
Sanghera, MK, Ward, C, Stewart, RM, et al. Alleviation of drenching sweats following subthalamic deep brain stimulation in a patient with Parkinson’s disease – a case report. J Neurol Sci. 2009; 285(1–2): 246249.Google Scholar
Naumann, M, Dressler, D, Hallett, M, et al. Evidence-based review and assessment of botulinum neurotoxin for the treatment of secretory disorders. Toxicon 2013; 67: 141152.Google Scholar
Gibbs, MB, English, JC, 3rd, Zirwas, MJ. Livedo reticularis: an update. J Am Acad Dermatol 2005; 52(6): 10091019.Google Scholar
Grelak, RP, Clark, R, Stump, JM, Vernier, VG. Amantadine-dopamine interaction: possible mode of action in Parkinsonism. Science 1970; 169(3941): 203204.Google Scholar
Sladden, MJ, Nicolaou, N, Johnston, GA, Hutchinson, PE. Livedo reticularis induced by amantadine. Br J Dermatol 2003; 149(3): 656658.Google Scholar
Quaresma, MV, Gomes, AC, Serruya, A, et al. Amantadine-induced livedo reticularis – Case report. An Bras Dermatol 2015; 90(5): 745747.Google Scholar
Rana, AQ, Masroor, MS. Patient perception of Levido reticularis due to amantadine. Int J Neurosci 2012; 122(7): 363366.Google Scholar
Shealy, CN, Weeth, JB, Mercier, D. Livedo reticularis in patients with parkinsonism receiving amantadine. JAMA 1970; 212(9): 15221523.CrossRefGoogle ScholarPubMed
Silver, DE, Sahs, AL. Livedo reticularis in Parkinson’s disease patients treated with amantadine hydrochloride. Neurology 1972; 22(7): 665669.Google Scholar
Vollum, DI, Parkes, JD, Doyle, D. Livedo reticularis during amantadine treatment. Br Med J 1971; 2(5762): 627628.Google Scholar
Shulman, LM, Minagar, A, Sharma, K, Weiner, WJ. Amantadine-induced peripheral neuropathy. Neurology 1999; 53(8): 18621865.Google Scholar
Benitez, A, Edens, H, Fishman, J, Moran, K, Asgharnejad, M. Rotigotine transdermal system: developing continuous dopaminergic delivery to treat Parkinson’s disease and restless legs syndrome. Ann N Y Acad Sci 2014; 1329: 4566.Google Scholar
Sprenger, FS, Seppi, K, Poewe, W. Drug safety evaluation of rotigotine. Expert Opin Drug Saf 2012; 11(3): 503512.Google Scholar
Sanford, M, Scott, LJ. Rotigotine transdermal patch: a review of its use in the treatment of Parkinson’s disease. CNS Drugs 2011; 25(8): 699719.Google Scholar
Carbone, F, Djamshidian, A, Seppi, K, Poewe, W. Apomorphine for Parkinson’s disease: efficacy and safety of current and new formulations. CNS Drugs 2019; 33(9): 905918.Google Scholar
Trenkwalder, C, Chaudhuri, KR, Garcia Ruiz, PJ, et al. Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson’s disease – clinical practice recommendations. Parkinsonism Relat Disord 2015; 21(9): 10231030.CrossRefGoogle Scholar
Deleu, D, Hanssens, Y, Northway, MG. Subcutaneous apomorphine: an evidence-based review of its use in Parkinson’s disease. Drugs Aging 2004; 21(11): 687709.CrossRefGoogle ScholarPubMed
Wojtecki, L, Sudmeyer, M, Schnitzler, A. Multiple subcutaneous abscesses and necroses due to apomorphine pump treatment. Parkinsonism Relat Disord 2012; 18(8): 1002.Google Scholar
Acland, KM, Churchyard, A, Fletcher, CL, et al. Panniculitis in association with apomorphine infusion. Br J Dermatol 1998; 138(3): 480482.Google Scholar
Poltawski, L, Edwards, H, Todd, A, et al. Ultrasound treatment of cutaneous side-effects of infused apomorphine: a randomized controlled pilot study. Mov Disord 2009; 24(1): 115118.CrossRefGoogle ScholarPubMed
Fernandez, HH, Standaert, DG, Hauser, RA, et al. Levodopa-carbidopa intestinal gel in advanced Parkinson’s disease: final 12-month, open-label results. Mov Disord 2015; 30(4): 500509.Google Scholar
Olanow, CW, Kieburtz, K, Odin, P, et al. Continuous intrajejunal infusion of levodopa-carbidopa intestinal gel for patients with advanced Parkinson’s disease: a randomised, controlled, double-blind, double-dummy study. Lancet Neurol 2014; 13(2): 141149.Google Scholar
Devos, D, French, DSG. Patient profile, indications, efficacy and safety of duodenal levodopa infusion in advanced Parkinson’s disease. Mov Disord 2009; 24(7): 9931000.Google Scholar
Antonini, A, Fung, VS, Boyd, JT, et al. Effect of levodopa-carbidopa intestinal gel on dyskinesia in advanced Parkinson’s disease patients. Mov Disord 2016; 31(4): 530537.Google Scholar
Saddi, MV, Sarchioto, M, Serra, G, et al. Percutaneous endoscopic transgastric jejunostomy (PEG-J) tube placement for levodopa-carbidopa intrajejunal gel therapy in the interventional radiology suite: a long-term follow-up. Mov Disord Clin Pract 2018; 5(2): 191194.Google Scholar
Lucendo, AJ, Friginal-Ruiz, AB. Percutaneous endoscopic gastrostomy: an update on its indications, management, complications, and care. Rev Esp Enferm Dig 2014; 106(8): 529539.Google Scholar
Buongiorno, M, Antonelli, F, Camara, A, et al. Long-term response to continuous duodenal infusion of levodopa/carbidopa gel in patients with advanced Parkinson disease: the Barcelona registry. Parkinsonism Relat Disord 2015; 21(8): 871876.Google Scholar
Sensi, M, Cossu, G, Mancini, F, et al. Which patients discontinue? Issues on levodopa/carbidopa intestinal gel treatment: Italian multicentre survey of 905 patients with long-term follow-up. Parkinsonism Relat Disord 2017; 38: 9092.Google Scholar
Jitkritsadakul, O, Bhidayasiri, R, Kalia, SK, et al. Systematic review of hardware-related complications of deep brain stimulation: do new indications pose an increased risk? Brain Stimul 2017; 10(5): 967976.Google Scholar
Park, YS, Kang, JH, Kim, HY, et al. A combination procedure with double C-shaped skin incision and dual-floor burr hole method to prevent skin erosion on the scalp and reduce postoperative skin complications in deep brain stimulation. Stereotact Funct Neurosurg 2011; 89(3): 178184.Google Scholar
Falowski, SM, Ooi, YC, Bakay, RA. Long-term evaluation of changes in operative technique and hardware-related complications with deep brain stimulation. Neuromodulation 2015; 18(8): 670677.Google Scholar
Solmaz, B, Tatarli, N, Ceylan, D, et al. A sine-wave-shaped skin incision for inserting deep-brain stimulators. Acta Neurochir 2014; 156(8): 15231525.Google Scholar
Schmidt, E, Zillikens, D. Pemphigoid diseases. Lancet 2013; 381(9863): 320332.CrossRefGoogle ScholarPubMed
Chou, PS, Chou, TC, Chang, CH, Yu, S, Lee, CH. Chronic eczematous dermatitis in patients with neurodegenerative diseases may be an early marker of bullous pemphigoid. Med Hypotheses 2017; 103: 8689.Google Scholar
Chen, YJ, Wu, CY, Lin, MW, et al. Comorbidity profiles among patients with bullous pemphigoid: a nationwide population-based study. Br J Dermatol 2011; 165(3): 593599.Google Scholar
Langan, SM, Groves, RW, West, J. The relationship between neurological disease and bullous pemphigoid: a population-based case-control study. J Invest Dermatol 2011; 131(3): 631636.Google Scholar
Brick, KE, Weaver, CH, Savica, R, et al. A population-based study of the association between bullous pemphigoid and neurologic disorders. J Am Acad Dermatol 2014; 71(6): 11911197.Google Scholar
Foureur, N, Descamps, V, Lebrun-Vignes, B, et al. Bullous pemphigoid in a leg affected with hemiparesia: a possible relation of neurological diseases with bullous pemphigoid? Eur J Dermatol 2001; 11(3): 230233.Google Scholar
Bastuji-Garin, S, Joly, P, Lemordant, P, et al. Risk factors for bullous pemphigoid in the elderly: a prospective case-control study. J Invest Dermatol 2011; 131(3): 637643.Google Scholar
Casas-de-la-Asuncion, E, Ruano-Ruiz, J, Rodriguez-Martin, AM, Velez Garcia-Nieto, A, Moreno-Gimenez, JC. Association between bullous pemphigoid and neurologic diseases: a case-control study. Actas Dermosifiliogr 2014; 105(9): 860865.Google Scholar
Cai, SC, Allen, JC, Lim, YL, et al. Mortality of bullous pemphigoid in Singapore: risk factors and causes of death in 359 patients seen at the National Skin Centre. Br J Dermatol 2014; 170(6): 13191326.Google Scholar
Bernard, P, Borradori, L. Pemphigoid group. In: Bolognia JL, Schaffer JV, Cerroni L, (eds.). Dermatology, 4th ed. Elsevier; 2018, 510526.e2.Google Scholar
Schadt, CR, Jackson, SM. Glucocorticoids. In: Bolognia JL, Schaffer JV, Cerroni L, (eds.). Dermatology, 4th ed. Elsevier; 2018, 21862199.Google Scholar
Behlim, T, Sharma, YK, Chaudhari, ND, Dash, K. Dyshidrosiform pemphigoid with Parkinsonism in a nonagenarian Maharashtrian female. Indian Dermatol Online J 2014; 5(4): 482–284.Google Scholar
Chen, J, Li, L, Chen, J, et al. Sera of elderly bullous pemphigoid patients with associated neurological diseases recognize bullous pemphigoid antigens in the human brain. Gerontology 2011; 57(3): 211216.Google Scholar
Leung, CL, Zheng, M, Prater, SM, Liem, RK. The BPAG1 locus: alternative splicing produces multiple isoforms with distinct cytoskeletal linker domains, including predominant isoforms in neurons and muscles. J Cell Biol 2001; 154(4): 691697.Google Scholar
Bose, A, Petsko, GA, Eliezer, D. Parkinson’s disease and melanoma: co-occurrence and mechanisms. J Parkinsons Dis 2018; 8(3): 385398.Google Scholar
Inzelberg, R, Israeli-Korn, SD. The particular relationship between Parkinson’s disease and malignancy: a focus on skin cancers. J Neural Transm 2009; 116(11): 15031507.Google Scholar
Zhang, P, Liu, B. Association between Parkinson’s disease and risk of cancer: a PRISMA-compliant meta-analysis. ACS Chem Neurosci 2019; 10(10): 44304439.Google Scholar
Huang, P, Yang, XD, Chen, SD, Xiao, Q. The association between Parkinson’s disease and melanoma: a systematic review and meta-analysis. Transl Neurodegener 2015; 4: 21.Google Scholar
Kareus, SA, Figueroa, KP, Cannon-Albright, LA, Pulst, SM. Shared predispositions of parkinsonism and cancer: a population-based pedigree-linked study. Arch Neurol 2012; 69(12): 15721577.Google Scholar
Gao, X, Simon, KC, Han, J, Schwarzschild, MA, Ascherio, A. Family history of melanoma and Parkinson disease risk. Neurology 2009; 73(16): 12861291.Google Scholar
Olsen, JH, Jorgensen, TL, Rugbjerg, K, Friis, S. Parkinson disease and malignant melanoma in first-degree relatives of patients with early-onset melanoma. Epidemiology 2011; 22(1): 109112.Google Scholar
Walter, U, Heilmann, E, Voss, J, et al. Frequency and profile of Parkinson’s disease prodromi in patients with malignant melanoma. J Neurol Neurosurg Psychiatry 2016; 87(3): 302310.Google Scholar
Rugbjerg, K, Friis, S, Lassen, CF, Ritz, B, Olsen, JH. Malignant melanoma, breast cancer and other cancers in patients with Parkinson’s disease. Int J Cancer 2012; 131(8): 19041911.Google Scholar
Lerman, S, Amichai, B, Weinstein, G, Shalev, V, Chodick, G. Parkinson’s disease, melanoma, and keratinocyte carcinoma: a population-based study. Neuroepidemiology 2018; 50(3–4): 168173.CrossRefGoogle ScholarPubMed
Inzelberg, R, Jankovic, J. Are Parkinson disease patients protected from some but not all cancers? Neurology 2007; 69(15): 15421550.CrossRefGoogle Scholar
Olsen, JH, Friis, S, Frederiksen, K, et al. Atypical cancer pattern in patients with Parkinson’s disease. Br J Cancer 2005; 92(1): 201205.Google Scholar
Inzelberg, R, Samuels, Y, Azizi, E, et al. Parkinson disease (PARK) genes are somatically mutated in cutaneous melanoma. Neurol Genet 2016; 2(3).Google Scholar
Hu, HH, Kannengiesser, C, Lesage, S, et al. PARKIN inactivation links Parkinson’s disease to melanoma. J Natl Cancer Inst 2016; 108(3).Google Scholar
Siiskonen, SJ, Zhang, M, Li, WQ, et al. A genome-wide association study of cutaneous squamous cell carcinoma among European descendants. Cancer epidemiology, biomarkers and prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2016; 25(4): 714720.Google Scholar
Inzelberg, R, Hassin-Baer, S, Jankovic, J. Genetic movement disorders in patients of Jewish ancestry. JAMA Neurol 2014; 71(12): 15671572.Google Scholar
Saunders-Pullman, R, Barrett, MJ, Stanley, KM, et al. LRRK2 G2019S mutations are associated with an increased cancer risk in Parkinson disease. Mov Disord 2010; 25(15): 25362541.Google Scholar
Agalliu, I, San Luciano, M, Mirelman, A, et al. Higher frequency of certain cancers in LRRK2 G2019S mutation carriers with Parkinson disease: a pooled analysis. JAMA Neurol 2015; 72(1): 5865.Google Scholar
Inzelberg, R, Cohen, OS, Aharon-Peretz, J, et al. The LRRK2 G2019S mutation is associated with Parkinson disease and concomitant non-skin cancers. Neurology 2012; 78(11): 781786.Google Scholar
Agalliu, I, Ortega, RA, Luciano, MS, et al. Cancer outcomes among Parkinson’s disease patients with leucine rich repeat kinase 2 mutations, idiopathic Parkinson’s disease patients, and nonaffected controls. Mov Disord 2019; 34(9): 13921398.Google Scholar
European-Commission-Medicines-Compendium. 2017. Levodopa-Carbidopa. www.medicines.org.uk/emc/medicine/9650 [last accessed January 14, 2020].Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×