Naltrexone is a competitive opioid receptor antagonist approved as supportive treatment in
alcohol dependence and opioid addiction. At a dose of 50-100 mg daily, naltrexone is used off-label in
dermatology for the treatment of trichotillomania and different types of pruritus. At a dose as low as 1-
5 mg per day, naltrexone demonstrates immunomodulatory action i.e. modulates Toll-like receptors
signaling, decreases release of proinflammatory cytokines (tumor necrosis factor, interleukin-6, interleukin-
12), inhibits T lymphocyte proliferation, down-regulates the expression of chemokine receptors
and adhesion molecules. The efficacy of standard and low doses of naltrexone in a variety of dermatological
disorders has been reported. These include diseases such as familial benign chronic pemphigus
(Hailey-Hailey disease), dermatomyositis, systemic sclerosis, psoriasis and lichen planopilaris.
Optimistic preliminary findings, low cost of therapy and good tolerance make naltrexone a promising
alternative therapy or adjunct drug in dermatology.
Keywords: Alopecia, low dose naltrexone, opioid growth factor, pruritus, psoriasis, toll-like receptor.
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