Low-dose naltrexone: a novel adjunctive treatment in symptomatic alopecias?

Tortelly, Violeta Duarte; Mattos, Taynara De; Fernandes, Larissa Starling de Albuquerque; Nunes, Bruno Eduardo Morais; Melo, Daniel Fermandes

doi:10.5070/d3258045142

Cited by 4 publications

(9 citation statements)

References 5 publications

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“…In a placebo-controlled randomized trial of low-dose naltrexone in LPP, reported side effects included sleep problems, anxiety, and headache, however the difference between naltrexone and control groups was not statistically significant [13]. Morning dosing of naltrexone has been suggested as a method of mitigating vivid dreams and sleep disturbances [12]. In the absence of signs or symptoms, no specific lab monitoring is required for low-dose naltrexone [7].…”

Section: Discussionmentioning

confidence: 99%

“…A case series of four patients with LPP and FFA treated with oral low-dose naltrexone at 3 mg daily reported a reduction of pruritus, clinical evidence of scalp inflammation, and disease progression [2]. Lowdose naltrexone has also been reported as beneficial in relieving symptoms of trichodynia [12]. Based on encouraging data from anecdotal reports and the above case series, we prospectively investigated whether low-dose naltrexone improves patient-reported symptoms, clinical markers of disease activity, and measurement of hair loss progression.…”

Section: Introductionmentioning

confidence: 99%

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Oral Low-Dose Naltrexone in the Treatment of Frontal Fibrosing Alopecia and Lichen Planopilaris: An Uncontrolled Open-Label Prospective Study

Hamel¹,

Chen²,

O’Connell³

et al. 2023

Cureus

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BackgroundFrontal fibrosing alopecia (FFA) and lichen planopilaris (LPP) is scarring alopecias with limited evidence supporting their treatment options. We investigated the use of low-dose naltrexone (3 mg oral daily) as adjunctive therapy in the treatment of FFA and LPP. MethodsA single-center, uncontrolled open-label prospective study was performed, with 26 patients who took lowdose naltrexone for one year included in the per-protocol analysis. Both patient-reported (pruritus and burning/pain) and physician-assessed (erythema, scale, and scalp involvement) outcomes were analyzed. ResultsThere were decreases in erythema and scale for the overall longitudinal outcomes using linear mixed effects model analysis. However, only erythema had a significant decrease at 12 months compared with baseline. Mean erythema decreased by 0.93 at 12 months compared with baseline on a 0-3-point scale (p<0.0001, 95% mean CI [-1.32, -0.53]). There was no statistically significant difference comparing 12 months to baseline for the other outcomes including pruritus, burning/pain, and scalp involvement. Limitations include the possibility of spontaneous stabilization, concurrent medications, a small sample size with limited racial diversity, and mild subjective symptoms at baseline. ConclusionOur study supports further investigation of oral low-dose naltrexone as adjunctive therapy in the treatment of FFA and LPP if there is prominent erythema, and possibly scale.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Oral Low-Dose Naltrexone in the Treatment of Frontal Fibrosing Alopecia and Lichen Planopilaris: An Uncontrolled Open-Label Prospective Study

Hamel¹,

Chen²,

O’Connell³

et al. 2023

Cureus

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“…17 Low dose naltrexone (1-5 mg/day) may have antiinflammatory effects, 24 and has been used to treat alopecia areata and lichen planopilaris disease progression. 25,26 Due to its reduction of scalp pruritus in other immune-mediated scalp diseases, it is a potential candidate for further study in the management of scalp DM. While the aforementioned case report is promising, it is difficult to make any definitive comment given the limited data.…”

Section: Low-dose Naltrexonementioning

confidence: 99%

“…Due to its reduction of scalp pruritus in other immune‐mediated scalp diseases, it is a potential candidate for further study in the management of scalp DM. While the aforementioned case report is promising, it is difficult to make any definitive comment given the limited data 17,25,26 …”

Section: Emerging Therapiesmentioning

confidence: 99%

A narrative review of therapies for scalp dermatomyositis

Kolla

Liu

Shaw

et al. 2021

Dermatologic Therapy

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Cutaneous involvement of the scalp is a common manifestation of dermatomyositis (DM), occurring in up to 82% of adults with DM. Scalp DM predominantly affects women and is characterized by dermatitis, alopecia, pruritus, and/or burning. While cutaneous DM negatively impacts quality-of-life, scalp symptoms in particular are often severe, debilitating, and recalcitrant to standard DM therapies. Currently, there is a paucity of guidelines to inform management of scalp symptoms in patients with cutaneous DM. In this narrative review, we summarize the treatments utilized to manage scalp DM and highlight potential areas for future research. We identified eight studies that reported on 27 treatments focused on cutaneous DM and described outcomes on scalp symptoms. A majority of the treatments were standard therapies for cutaneous DM and resulted in no or minimal improvement in scalp symptoms. Five therapies did result in complete resolution of scalp symptoms and were recommended as potential areas of future research. These included low-dose naltrexone and platelet-rich plasma, as well as two frequent and one less common therapy for cutaneous DM respectively: intravenous immunoglobulin, rituximab, and apremilast. Though the literature was not systematically assessed in this review, these findings illustrate not only that strategies for refractory scalp DM are lacking, but also that those demonstrating potential efficacy are limited by low levels of evidence. Additional studies, especially randomized controlled trials, are needed to better inform management of scalp DM.

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“…Exposure of LDN at low dosages exhibited a paradoxical effect by increasing the production of endogenous opioids, including β-endorphins, exhibiting anti-inflammatory properties. Therefore, it was proposed that LDN can be an adjunctive treatment for symptomatic alopecia at appropriate dosages ( Tortelly et al ., 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Hair Growth Promotion by δ-Opioid Receptor Activation

Zheng¹,

Choi²,

Balboni

et al. 2021

Biomol Ther (Seoul)

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Literature has revealed that the delta opioid receptor (DOR) exhibited diverse pharmacological effects on neuron and skin. In the present study, we have investigated whether the activation of DOR has hair-growth promotion effects. Compared with other opioid receptor, DOR was highly expressed in epidermal component of hair follicle in human and rodents. The expression of DOR was high in the anagen phase, but it was low in the catagen and telogen phases during mouse hair cycle. Topical application of UFP-512, a specific DOR agonist, significantly accelerated the induction of the anagen in C 3 H mice. Topical application of UFP-512 also increased the hair length in hair organ cultures and promoted the proliferation and the migration of outer root sheath (ORS) cells. Similarly, pharmacological inhibition of DOR by naltrindole significantly inhibited the anagen transition process and decreased hair length in hair organ cultures. Thus, we further examined whether Wnt/β-catenin pathway was related to the effects of DOR on hair growth. We found that Wnt/β-catenin pathway was activated by UFP-512 and siRNA for β-catenin attenuated the UFP-512 induced proliferation and migration of ORS cells. Collectively, result established that DOR was involved in hair cycle regulation, and that DOR agonists such as UFP-512 should be developed for novel hair-loss treatment.

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Low-dose naltrexone: a novel adjunctive treatment in symptomatic alopecias?

Cited by 4 publications

References 5 publications

Oral Low-Dose Naltrexone in the Treatment of Frontal Fibrosing Alopecia and Lichen Planopilaris: An Uncontrolled Open-Label Prospective Study

Oral Low-Dose Naltrexone in the Treatment of Frontal Fibrosing Alopecia and Lichen Planopilaris: An Uncontrolled Open-Label Prospective Study

A narrative review of therapies for scalp dermatomyositis

Hair Growth Promotion by δ-Opioid Receptor Activation

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