Literature Review: Naltrexone: New Use for an Old Drug

Strazzula, L.C., et al. Novel treatment using low-dose naltrexone for lichen planopilaris. Journal of Drugs in Dermatol. 2017; 16:1140-1142.

Recently, the drug naltrexone (an opiate antagonist that is used to help treat those who are dependent on alcohol and opiates) has resurfaced in the dermatology literature. It was presented in the Archives of Dermatology to treat Hailey-Hailey disease (a rare autoimmune blistering disorder) and in the November 2017 issue of the Journal of Drugs in Dermatology, it was suggested as a treatment for lichen planopilaris (LPP), a variant of lichen planus that affects the scalp causing scarring hair loss. Its mechanism as an opioid antagonist (with greatest affinity for mu receptors) has been postulated to also have an effect in treating autoimmune diseases. Dr. Jerry Shapiro at NYU described four case reports using low dose naltrexone (3mg po daily) as an adjunctive therapy for recalcitrant lichen planopilaris. Two patients were male, two were female, and all had been on oral doxycycline and topical clobetasol solution prior to the addition of low dose naltrexone. In all four cases, the patients reported an improvement in symptoms within 1-2 months of starting the drug. They remained on it alone or in combination with oral pioglitazone (p-par gamma agonist) 15mg daily. Side effects may include vivid dreams, nightmares, headache, or increased anxiety, but all four patients tolerated the medication well without any reported side effects.

Comment: Perhaps the greatest difficulty in treating LPP is the chronicity and tenacity of inflammation even after years of therapy. There is still no drug that is FDA approved LPP. The use of an old drug for a new purpose with minimal side effects is quite exciting. My local pharmacy has been able to compound 3mg naltrexone in a Loxoral (inactive capsule filler) base.