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J Am Acad Dermatol. 2018 Dec 21. pii: S0190-9622(18)33104-9. doi: 10.1016/j.jaad.2018.12.031. [Epub ahead of print]

The Uses of Naltrexone in Dermatological Conditions.

Author information

1
Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030. Electronic address: brigette.lee@bcm.edu.
2
Medical University of Southern California, 171 Ashley Ave, Charleston, SC 29425.

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.

KEYWORDS:

Hailey-Hailey disease; dermatology; lichen planopilaris; low dose naltrexone; naltrexone; opioid receptor; opioid receptor antagonist; opioids; pruritus; psoriasis; scleroderma

PMID:
30582992
DOI:
10.1016/j.jaad.2018.12.031

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