Prurigo excoriée treated with low dose naltrexone

Abstract

A 53-year-old woman presented with a 25-year history of acne excoriée and prurigo excoriée. Her symptoms began in 1988 coinciding with her husband’s death from a brain tumour when she was 27. The pruritus affected her quality of life and disturbed her sleep. She had scarring on her face and body resulting from persistent scratching. The pruritus proved refractory to treatment despite a multi-modal treatment approach including multiple topicals, phototherapy and systemic agents such as isotretinoin, antibiotics, anxiolytic agents and neuromodulators. She was extremely frustrated that various treatments had been ineffective at controlling the itch-scratch cycle. She was commenced on low dose naltrexone (LDN), 3 mg nocte, and she became itch free within a few weeks. She reports that the LDN has had a beneficial impact on her quality of life.

Chronische noduläre Prurigo: Update zu Pathogenese und Management

“…Pruritus ist eine häufige unerwünschte Wirkung von Opioiden, und der µ-Opioidrezeptor wird hauptsächlich mit opioidinduziertem Pruritus in Verbindung gebracht [121]. Ein Fallbericht zeigte, dass Naltrexon, ein µ-Opioid-Antagonist, den Pruritus bei einem Patienten mit Prurigo excoriate reduzierte [122]. Andererseits konnte gezeigt werden, dass der κ-Opioidrezeptor Pruritus lindert [123], und Difelikefalin, ein κ-Opioidrezeptor-Agonist, hat eine gute Wirksamkeit gezeigt und wurde für die Behandlung von urämischem Pruritus zugelassen [124, 125].…”

Chronic Nodular Prurigo: An Update on the Pathogenesis and Treatment

“…Pruritus is a common adverse effect following opioid use and μ opioid receptor was primarily involved in opioid-induced pruritus [ 121 ]. A case report showed naltrexone, a μ opioid antagonist, attenuated pruritus in a patient with prurigo excoriate [ 122 ]. On the other hand, the κ opioid receptor has been found to attenuate itch [ 123 ] and difelikefalin, a κ opioid receptor agonist, demonstrated good efficacy and has been approved for the treatment of uremic pruritus [ 124 , 125 ].…”