The Uses of Naltrexone in Dermatological Conditions

Publication date: Available online 21 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Brigette Lee, Dirk Elston

Abstract

Background

Naltrexone in standard and reduced doses is efficacious in many inflammatory and acantholytic disorders.

Objective

We summarized current data of naltrexone relevant to dermatological practice.

Methods

An English language PubMed literature search was performed using the terms naltrexone, low-dose naltrexone, Hailey-Hailey, psoriasis, lichen planopilaris, alopecia, opioid, opioid receptor, treatment, dermatology, monitoring, side effect, skin, pruritus, cutaneous, acantholytic, and Darier.

Results

Opioid receptors are found throughout the skin and affect cell proliferation, migration and adhesion. Mu opioid receptors have been found in all layers of the epidermis while delta receptors are concentrated at cell junctions and can reduce desmoglein expression. Typical doses of naltrexone result in continuous binding to receptors. Low doses result in intermittent blockade with increased ligand and receptor expression, potentiating their effect.

Limitations

Our review was restricted to the English language literature.

Conclusion

Naltrexone affects inflammation, cell adhesion, and keratinocyte proliferation and migration. While low-dose naltrexone has demonstrated efficacy in treating Hailey-Hailey disease, further dose-ranging studies are needed. Data suggest naltrexone could be helpful in the treatment of pruritus and a variety of inflammatory and acantholytic skin diseases refractory to other treatments. At higher doses, liver function tests should be monitored on a periodic basis.

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