Oral naltrexone as an adjuvant therapy for refractory atopic dermatitis

Abstract

Background: Topical treatments including tacrolimus ointment have an important role in eczema treatment. However, limited efficacy may result from insufficient frequency or amount in using these agents.Objective: To investigate the frequency of application and amount of topical tacrolimus used during the treatment of eczema in Korean patients Methods: A total of 200 eczema patients were included in this study. The number of application per day during the first and second week was inquired. The amount of tacrolimus ointment used for 2 weeks was also assessed. The standard amount of used tacrolimus was calculated by the fingertip unit (FTU, 1 FTU ¼ 0.5 g for 2% of body surface area).Results: After 2 weeks of treatment, mean number of application was 24.4 times 6 7.5, whereas, the instructed number of application was 28 times. In the number of application, 147 (73.5%) and 122 (61.0%) of patients followed the prescription at the first and second week, respectively. Mean amount of application per 2% of body surface area was 0.54 g 6 0.52. However, only 53 (26.5%) patients applied between 80% and 120% of standard amount. Conclusion: Korean patients with eczema tend to apply topical tacrolimus less frequently and moreover in inappropriate amounts. Therapeutic education and clear instructions regarding not only the frequency but also the amount of application are needed to improve therapeutic outcome during topical treatments.Commercial support: None identified. 957Oral naltrexone as an adjuvant therapy for refractory atopic dermatitis Pruritus is a major symptom in atopic dermatitis, and directly impacts on patients' quality of life. There is a release of inflammatory mediators, including histamine; however, other mediators such as endopeptidases, kinins and neuropeptides may play a role as triggers of pruritus. Naltrexone, an oral -opioid antagonist, is directly involved in the mechanism of pruritus via either central or peripheral nervous system. It is utilized as an antipruritic agent in pruritus related to uremia, cholestasis and lymphoma, and has a potential role in controlling this marked symptom in atopic dermatitis. We performed an open-label clinical trial of eight male patients from the Atopic Dermatitis Outpatient Clinic in the Department of Dermatology of the University of São Paulo Medical School, aged 15-36 years, and diagnosed according to Hanifin and Rajka's criteria. Inclusion criteria comprised severe atopic dermatitis and pruritus, with intense lichenification and prurigo. Exclusion criteria were: hepatic or renal disease, use of opiates in the past two weeks and use of systemic immunosuppressant. Initial oral naltrexone dose was 25 mg/day (2 weeks), followed by 50 mg/day for 12 weeks. Results were assessed by SCORing Atopic Dermatitis (SCORAD). Six out of eight patients showed improvement of the skin lesions, with a 20% decrease in the SCORAD, with emphasis on reducing lichenification and pruritus. Two of eight patients dropped the study prior to the endpoint (one at week 4, due to humor changes, and...