Low Dose Naltrexone in Dermatology

March 2019 | Volume 18 | Issue 3 | Original Article | 235 | Copyright © March 2019


Joanna Jaros BAa and Peter Lio MDb

aUniversity of Illinois College of Medicine, Chicago, IL bDermatology and Pediatrics, Northwestern University Feinberg, School of Medicine, Chicago, IL

More studies are needed to elucidate the role of LDN as a therapeutic agent in dermatologic conditions. Given that oral and topical naltrexone has been shown to improve pruritus in patients with AD, this is certainly an exciting question and challenge.22 The question of LDN’s efficacy in clearing skin lesions also remains unanswered. Until more evidence becomes available, we must continue engaging in balanced dialogues with our patients to weigh the risks and benefits of off-label treatments such as LDN.

DISCLOSURE

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have no financial information to disclose.

REFERENCES

  1. Smith JP, Stock H, Bingaman S, et al. Low-dose naltrexone therapy improves active Crohn's disease. Am J Gastroenterol. 2007;102(4):820-828.
  2. Mischoulon D, Hylek L, Yeung AS, et al. Randomized, proof-of-concept trial of low dose naltrexone for patients with breakthrough symptoms of major depressive disorder on antidepressants. J Affect Disord. 2017;208:6-14.
  3. Li Z, You Y, Griffin N, et al. Low-dose naltrexone (LDN): A promising treatment in immune-related diseases and cancer therapy. Int Immunopharmacol. 2018;61:178-184.
  4. Younger J, Parkitny L, McLain D. The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain. Clin Rheumatol. 2014;33(4):451-459.
  5. Patten DK, Schultz BG, Berlau DJ. The safety and efficacy of low-dose naltrexone in the management of chronic pain and inflammation in multiple sclerosis, fibromyalgia, crohn's disease, and other chronic pain disorders. Pharmacotherapy. 2018;38(3):382-389.
  6. Strazzulla LC, Avila L, Lo Sicco K, et al. Novel Treatment Using Low-Dose Naltrexone for Lichen Planopilaris. J Drugs Dermatol. 2017;16(11):1140-1142.
  7. Frech T, Novak K, Revelo MP, et al. Low-dose naltrexone for pruritus in systemic sclerosis. Int J Rheumatol. 2011;2011:804296.
  8. Albers LN, Arbiser JL, Feldman RJ. Treatment of Hailey-Hailey disease with low-dose naltrexone. JAMA Dermatol. 2017;153(10):1018-1020.
  9. Muller G, Grieshaber R, Talley JF, et al. Compounded Low-dose Naltrexone for the Treatment of Guttate Psoriasis: A Case Report. Int J Pharm Compd. 2018;22(4):270-278.
  10. Resnick RB, Volavka J, Freedman AM, et al. Studies of EN-1639A (naltrexone): a new narcotic antagonist. Am J Psychiatry. 1974;131(6):646-650.
  11. Verebey K, Mule SJ. Naltrexone pharmacology, pharmacokinetics, and metabolism: current status. Am J Drug Alcohol Abuse. 1975;2(3-4):357-363.
  12. Hutchinson MR, Zhang Y, Brown K, et al. Non-stereoselective reversal of neuropathic pain by naloxone and naltrexone: involvement of toll-like receptor 4 (TLR4). Eur J Neurosci. 2008;28(1):20-29.
  13. Campbell. Novel Treatment Using Low-Dose Naltrexone for Lichen Planopilaris.
  14. McLaughlin PJ, Zagon IS. Duration of opioid receptor blockade determines biotherapeutic response. Biochem Pharmacol. 2015;97(3):236-246.
  15. Smith JP, Field D, Bingaman SI, et al. Safety and tolerability of low-dose naltrexone therapy in children with moderate to severe Crohn's disease: a pilot study. J Clin Gastroenterol. 2013;47(4):339-345.
  16. Zagon. T lymphocyte proliferation is suppressed by the opioid growth factor ([Met(5)]-enkephalin)-opioid growth factor receptor axis: implication for the treatment of autoimmune diseases. 2011.
  17. Ibrahim O, Hogan SR, Vij A, et al. Low-Dose Naltrexone Treatment of Familial Benign Pemphigus (Hailey-Hailey Disease). JAMA Dermatol. 2017;153(10):1015-1017.
  18. Tsakok T, Woolf R, Smith CH, et al. Atopic dermatitis: the skin barrier and beyond. Br J Dermatol. 2018.
  19. Bigliardi-Qi M, Lipp B, Sumanovski LT, et al. Changes of epidermal mu-opiate receptor expression and nerve endings in chronic atopic dermatitis. Dermatology (Basel, Switzerland). 2005;210(2):91-99.
  20. Bigliardi PL, Stammer H, Jost G, et al. Treatment of pruritus with topically applied opiate receptor antagonist. J Am Acad Dermatol. 2007;56(6):979-988.
  21. Dodou K, Armstrong A, Kelly I, et al. Ex vivo studies for the passive transdermal delivery of low-dose naltrexone from a cream; detection of naltrexone and its active metabolite, 6beta-naltrexol, using a novel LC Q-ToF MS assay. Pharm Dev Technol. 2015;20(6):694-701.
  22. Phan NQ, Bernhard JD, Luger TA, et al. Antipruritic treatment with systemic mu-opioid receptor antagonists: a review. J Am Acad Dermatol. 2010;63(4):680-688.
  23. Metze D, Reimann S, Beissert S, et al. Efficacy and safety of naltrexone, an oral opiate receptor antagonist, in the treatment of pruritus in internal and dermatological diseases. J Am Acad Dermatol. 1999;41(4):533-539.
  24. Brune A, Metze D, Luger TA, et al. [Antipruritic therapy with the oral opioid receptor antagonist naltrexone. Open, non-placebo controlled administration in 133 patients]. Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete. 2004;55(12):1130-1136.
  25. Monroe EW. Efficacy and safety of nalmefene in patients with severe pruritus caused by chronic urticaria and atopic dermatitis. J Am Acad Dermatol. 1989;21(1):135-136.
  26. Brunner PM, Leung DYM, Guttman-Yassky E. Immunologic, microbial, and epithelial interactions in atopic dermatitis. Ann Allergy Asthma Immunol. 2018;120(1):34-41.
  27. Vierow V, Forster C, Vogelgsang R, et al. Cerebral Networks Linked to Itch-related Sensations Induced by Histamine and Capsaicin. Acta Dermato-venereologica. 2015;95(6):645-652.

AUTHOR CORRESPONDENCE

Peter Lio MD peterlio@gmail.com