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Low-dose naltrexone may be effective in Hailey-Hailey disease

A low-dose of naltrexone demonstrated safety and efficacy in a small cohort of patients with Hailey-Hailey disease, according to recent findings.

The researchers noted that this disease has proven difficult to manage with a cross-section of interventions, including corticosteroids, immunomodulators, retinoids, and laser therapies.

The study included three patients with recalcitrant Hailey-Hailey disease confirmed by biopsy and treated on an outpatient basis at the Cleveland Clinic between January 2016 and January 2017. The naltrexone dose ranged from 1.5 mg to 3 mg per day. Clinicians monitored patients every 2 to 3 months for clinical factors such as healing of erosions, improvement in erythema, and alleviation of pain, along with adverse events and quality of life.

Results indicated at least an 80% improvement in extent of disease in all three patients. A 90% clearance was reported in one participant. Substantial quality of life improvements also were reported in all three patients, with no adverse events. One patient reported improvement in depressive symptoms.

“Low-dose naltrexone may represent a low-cost and low-risk alternative or adjunct in the treatment of [Hailey-Hailey disease],” the researchers concluded.

In an accompanying editorial, Erik J. Stratman, MD, of the Marshfield Clinic in Marshfield, Wisconsin, wrote that patient word of mouth through online support groups may have fueled the decision to use naltrexone in Hailey-Hailey disease. He suggested that patients arriving in the office with printed webpages and other information often sparks doctor-patient discussions about rare or unusual diseases.

“There are many medications that work in skin diseases for reasons we don’t fully understand,” he wrote. “While this is my most frequent opening line when trying to convince my new patients with delusions of parasitosis to be open-minded about a trial of oral antipsychotic medications, it is apropos to this discussion, too. As much as we may wish to claim that it is our highly trained translational minds that make these mental thought models and connections to new drug therapies (sometimes, that’s true), in our field we sometimes find that drugs approved or used for one condition serendipitously improve or alter another unrelated condition.”

Stratman noted that repurposing already-approved medications can be a streamlined process, as those drugs have previously demonstrated satisfactory pharmacologic and safety profiles.

“Treating Hailey-Hailey disease may turn out to be a legitimate repurpose for low-dose naltrexone,” he wrote, adding that the drug’s initial use was for substance use dependence. “While the exact mechanism is unclear in Hailey-Hailey disease and larger, better controlled studies will be needed before drawing firm conclusions about this therapy. For those of us who treat patients with severe Hailey-Hailey disease, or perhaps even its acantholytic cousins, Darier disease or symptomatic recalcitrant Grover disease, naltrexone may emerge as a promising new option.” – by Rob Volansky

Disclosure: The researchers report no relevant financial disclosures. Stratman reports no relevant financial disclosures.