Low Dose Naltrexone in Dermatology
“Most research is showing that low-dose naltrexone (LDN) can be helpful in inflammatory and autoimmune conditions of the body. LDN is very well tolerated by most patients, with the most common adverse reaction being drowsiness and vivid dreams. LDN must be compounded, as it is not commercially available.”
Low-Dose Naltrexone Treatment of Familial Benign Pemphigus (Hailey-Hailey Disease)
Objective: To assess low-dose naltrexone hydrochloride (LDN) in the treatment of recalcitrant Hailey-Hailey Disease (HDD).
Design: A case series following 3 patients with biopsy-confirmed HDD for one year. One patient was a woman in her 40s, and the other two were men in their 60s. Clinical response, adverse events, and subjective quality of life was tracked every 2 to 3 months.
Treatment: Patients were treated with 1.5 to 3.0 mg of naltrexone hydrochloride daily.
Results: Each patient exhibited at least 80% improvement in extent of disease, and one patient showed 90% clearance. All patients experienced improved quality of life, and no adverse events were reported.
Conclusion: LDN may be a low-cost, low-risk treatment option for patients with HDD.
Dose is best started in opioid Naïve patients at 1.5mg at HS for a week, then 3mg at HS for week and then 4.5mg at HS thereafter.
Treatment of pruritus with topically applied opiate receptor antagonist
Objective: To determine the efficacy of topical naltrexone in the treatment of severe pruritus.
Design: A randomized, placebo-controlled, double-blind crossover trial with 40 patients who had localized or generalized atopic dermatitis with severe pruritus. The study utilized a 2 week wash-in period, and then 1 to 2 weeks of treatment each for naltrexone and placebo (however long it to for patients to experience 3 pruritus bouts).
Treatment: 1% naltrexone cream or matching placebo was applied at the onset of pruritus. Patients recorded pruritus symptom severity in a diary periodically for four hours after onset.
Results: Naltrexone cream significantly improved pruritus symptoms better than placebo cream (-243mm naltrexone vs. -190mm placebo VAS). The time to achieve 50% pruritus intensity reduction was 74 minutes for placebo and only 46 minutes for naltrexone.
Conclusion: Opioid receptors play a relevant albeit poorly elucidated role in chronic pruritus. This study suggests that antagonizing MOR in the skin can improve pruritus symptoms better than placebo.
Novel Treatment Using Low-Dose Naltrexone for Lichen Planopilaris
Objective: To describe the effect of taking low-dose naltrexone (LDN) on lichen planopilaris (LPP).
Design: A retrospective medical record review including four LPP patients.
Treatment: The patients were treated with 3 mg of naltrexone per day.
Results: The chart review found that the four LPP patients taking 3 mg naltrexone daily received benefit from the medication, including reduction of pruritus, inflammation of the scalp, and disease progression.
Conclusion: This is the first case report of LDN being used to treat LPP. LDN could be a safe and cost-effective treatment option for this condition.