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Indian Dermatol Online J. 2019 Aug 28;10(5):567-570. doi: 10.4103/idoj.IDOJ_453_18. eCollection 2019 Sep-Oct.

Low-Dose Naltrexone-Induced Remission in Hailey-Hailey Disease Maintained in Remission with Topical Combination of Ketamine and Diphenhydramine.

Author information

1
Department of Dermatology and Dermatosurgery, Skinnocence: The Skin Clinic and Research Centre, Gurugram, Haryana, India.
2
Department of Dermatology and STD, LHMC and Associated Hospitals, New Delhi, India.
3
Department of Dermatology and STD, HIMS Institute, Safedabad, Uttar Pradesh, India.
4
Department of Dermatology, Mazandaran University of Medical Sciences, Sari, Iran.

Abstract

Recent anecdotal evidence suggests that oral low-dose naltrexone (LDN) is effective for Hailey-Hailey disease (HHD) but suffers the limitation of immediate relapse following cessation of the medication. With lack of safety data on long-term administration of LDN, we explored the utility of a topical diphenhydramine/ketamine (DK) cream in maintaining the remission achieved with LDN. A 42-year-old male with treatment-refractory HHD remitted with 5 mg naltrexone/day but relapsed on stopping the drug. Symptoms abated after restarting LDN. The impact of regular twice-a-day application of a specially formulated DK cream containing diphenhydramine (2% w/w) and ketamine (1% w/w) over the affected areas on maintenance of remission was explored till the next relapse. Our approach enabled dose reduction of naltrexone to 3 mg/day without loss of treatment benefit. After 3-month overlap of naltrexone and DK cream, withdrawal of naltrexone maintained remission with only the topical regime with no adverse effects till 4 months of follow-up. The use of topical agents with anti-inflammatory, antipruritic, antinociceptive, and naltrexone-mimicking properties merits exploration as an option to provide short but significant period of naltrexone-free maintenance of remission to patients with HHD.

KEYWORDS:

Benign familial pemphigus; Hailey–Hailey disease; diphenhydramine; ketamine; low-dose opioid; naltrexone

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