Treatment of psoriasis vulgaris using low-dose naltrexone

Abstract

Psoriasis is a common, immune-mediated skin disease affecting 3.1% of the US population.1 Psoriasis negatively impacts health-related quality of life and is associated with multiple physical and mental health comorbidities2 in addition to symptoms such as pain, itching, and bleeding. Psoriasis also imparts substantial burden on the national economy, including high health care resource use and direct and indirect costs and contributes to work impairment, presenteeism, and employment status changes because of symptoms.3 A variety of treatments have been developed over the last several decades for the treatment of psoriasis. Exogenous therapies include topical corticosteroids, vitamin D derivatives, retinoids, and ultraviolet (UV) therapy. Systemic therapies include disease-modifying antirheumatic drugs, such as methotrexate or cyclosporine, and biologic medications such as adalimumab, ustekinumab, and secukinumab. Unfortunately, although psoriasis treatments are becoming increasingly safe and efficacious, they may not always be successful, affordable, or tolerable. Naltrexone, a μ-opioid receptor antagonist commonly used for opioid overdose,4 is typically well tolerated with minimal side effects, and does not have the potential for abuse or physical dependence.5 Low-dose naltrexone has not yet been formally studied in the treatment of psoriasis; however, it may have anti-inflammatory and immunoregulatory properties because of its blockade of macrophage-released tumor necrosis factor (TNF).6 In this report, we present the successful treatment of moderate plaque psoriasis with low-dose naltrexone over a period of 6 months.