QDoes naltrexone have a role in dermatology?
Naltrexone is an opioid receptor antagonist which has been shown to be successful in treating inflammatory and pruritic skin disorders. Many opioid receptors are found throughout the epidermis which affect inflammation, proliferation, migration and adhesion at the cellular level. At low doses (2-5 mg daily) naltrexone provides a transient blockade of receptors and increases endogenous production of opioids and opioid receptors. Standard and low doses have been studied in a variety of dermatologic conditions with varying levels of success.
I have not yet used standard dose naltrexone—which has been studied for prurigo and pruritus—because I have had good levels of success with low dose naltrexone (LDN) which generally has a lower side effect profile and there is no need for periodic lab monitoring. I have had success using LDN to limit flares of Hailey-Hailey disease and as an adjuvant to patients with difficult to control atopic dermatitis, prurigo nodularis, and idiopathic pruritus who cannot be controlled with standard therapies alone or who decline to take immunosuppressive treatments.
Naltrexone is not currently my first line treatment for any specific disorder but I have found it to be a safe, effective and inexpensive adjuvant therapy that can be used for virtually any inflammatory skin condition. Since LDN works but upregulating opioid production and opioid receptors, it takes time for the treatment to work and to find the right dose for each patient. The role of naltrexone will continue to grow in dermatology as more prospective studies are conducted and as low dose formulations become available commercially.