Low-dose naltrexone: a novel treatment for Hailey-Hailey disease

Abstract

Hailey-Hailey disease (chronic benign familial pemphigus) is a rare inherited dermatosis typically characterized by erosions at intertriginous sites preceded by minor trauma or stress. We report a case of treatment-resistant Hailey-Hailey disease having failed topical and oral steroids, prophylactic aciclovir and doxycycline, and systemic therapies including dapsone, acitretin and ciclosporin. Low-dose naltrexone 4·5 mg once daily was commenced following an incidental benefit in this patient's similarly affected sister. The clinical and psychological response to date has been considerable.

Use of low‐dose naltrexone in the treatment of severe Hailey–Hailey disease: One case report

“…Patients may experience minor adverse effects, such as headache, gastrointestinal tract symptoms, and vivid dreams (Ibrahim et al, 2017). Contraindications for its use include opiate addiction, acute hepatitis, or liver failure (Campbell, McGrath, & Corry, 2018).…”

Hailey-Hailey disease successfully treated with vitamin D oral supplementation

“…Such proteins include desmogleins and desmocollins which assemble together and with other proteins to form the desmosomes. Proposed medical treatments have included topical agents such as vitamin D3 analogs, antibiotics, cadexomer iodine, corticosteroids, tacrolimus, and pimecrolimus, as well as a number of systemic treatments such as doxycycline, methotrexate, cyclosporine, acitretin, thalidomide, alefacept, alitretinoin, afamelanotide, terbinafine, and naltrexone (Campbell, McGrath, & Corry, 2018;Chiaravalloti & Payette, 2014;Engin et al, 2015). However, nevertheless it is well known that defects in ATP2C1 cause abnormal assembly of the desmosomes at level of the skin, the exact mechanism is not yet clearly understood.…”

“…Numerous different treatments have been proposed in literature reflecting the high rate of dissatisfaction to current available therapy options which are not particularly effective also because they may improve inflammation but do not treat the underlying cause (Engin et al, 2015). Proposed medical treatments have included topical agents such as vitamin D3 analogs, antibiotics, cadexomer iodine, corticosteroids, tacrolimus, and pimecrolimus, as well as a number of systemic treatments such as doxycycline, methotrexate, cyclosporine, acitretin, thalidomide, alefacept, alitretinoin, afamelanotide, terbinafine, and naltrexone (Campbell, McGrath, & Corry, 2018;Chiaravalloti & Payette, 2014;Engin et al, 2015). Nb-ultraviolet B therapy, photodynamic therapy, laser therapy (carbon dioxide laser, 595 nm pulsed dye laser and CO2 laser) have also been reported (Chiaravalloti & Payette, 2014;Engin et al, 2015;Farahnik et al, 2017).…”

Reopening the case for case reports

“…In their series, naltrexone produced a significant and sustained clinical response in four family members. 5 Jennings et al describe the treatment of hidradenitis suppurativa (HS) with the glucagon-like peptide-1 agonist liraglutide. 6 HS is associated with elevated body mass index with obesity possibly contributing to HS disease severity.…”

“…6 HS is associated with elevated body mass index with obesity possibly contributing to HS disease severity. 7 The patient 5 The treatment of hidradenitis suppurativa with the glucagon-like peptide-1 agonist liraglutide 6 Describe new adverse effects of therapies Vemurafenib-induced toxic epidermal necrolysis: possible cross-reactivity with other sulfonamide compounds 8 Foreign body reaction triggered by cytotoxic T lymphocyte-associated protein 4 blockade 25 years after dermal filler injection 9 Paradoxical ulcerative colitis during adalimumab treatment of psoriasis 10 Lichenoid drug eruption induced by an infliximab biosimilar 11…”