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Naltrexone for the Treatment of Darier and Hailey-Hailey Diseases.

Title
Naltrexone for the Treatment of Darier and Hailey-Hailey Diseases.
Publication Type
Journal Article
Research Type
Human
Reported as
Review
Date
July 01, 2019
Authors
A Jfri, IV Litvinov, E Netchiporouk
Institution
McGill University
Link
Abstract

Darier (DD) and Hailey-Hailey (HHD) diseases are both genodermatoses caused by defective calcium transport and homeostasis. DD is caused by a mutation of the ATPA2A gene and HHD by a mutation of the ATP2C1 gene. Clinically, the former is characterized by itchy, painful macerations with red-brownish papules in a seborrheic distribution; the latter manifests with painful blisters that rupture, leaving erosions in intertriginous areas. Treatment options for both conditions are limited and include topical steroids, systemic steroids, retinoids, antibiotics, topical aminoglycosides, as well as dapsone and immunosuppressive therapies. One additional promising and novel therapeutic option for these diseases is naltrexone.

The use of LDN at 4.5 mg once daily in patients with HHD has shown promise in early observational studies. In contrast to the classic doses of 50-100 mg, LDN does not need any laboratory monitoring and has a favourable safety profile, with common side effects of vivid dreams and headache. Prior to LDN therapy, patients should be carefully screened for recent use and/or prior dependence of opioids. Further studies to assess the efficacy of naltrexone in low-dose or higher doses in these 2 diseases are needed.