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Brief Report
October 2017

Low-Dose Naltrexone Treatment of Familial Benign Pemphigus (Hailey-Hailey Disease)

Author Affiliations
  • 1Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
  • 2Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio
JAMA Dermatol. 2017;153(10):1015-1017. doi:10.1001/jamadermatol.2017.2445
Key Points

Question  Is low-dose naltrexone hydrochloride effective in the treatment of familial benign pemphigus (Hailey-Hailey disease)?

Findings  This case series presents 3 patients who exhibited at least an 80% reduction in extent of Hailey-Hailey disease after treatment with low-dose naltrexone.

Meaning  Low-dose naltrexone may represent a low-cost and low-risk alternative or adjunct in the treatment of Hailey-Hailey disease.

Abstract

Importance  Familial benign pemphigus, or Hailey-Hailey disease (HHD), is a rare and debilitating genetic dermatosis characterized by chronic, recurrent vesicles, erosions, and maceration in flexural areas. Despite the reported therapeutic modalities, such as topical and systemic corticosteroids, systemic immunomodulators, topical and systemic retinoids, and laser, HHD can still be markedly difficult to control.

Objective  To assess low-dose naltrexone hydrochloride in the treatment of recalcitrant HHD.

Design, Setting, and Participants  In this case series, 3 patients with biopsy-proven recalcitrant HHD were evaluated in the outpatient dermatology clinic at the Cleveland Clinic. Each patient was treated with low-dose naltrexone hydrochloride at a dosage of 1.5 to 3.0 mg per day. No laboratory monitoring was necessary. Clinical response (healing of erosions, improvement in erythema, and alleviation of pain), adverse effects, and subjective quality of life were monitored throughout the treatment. The study dates were January 2016 to January 2017.

Main Outcomes and Measures  Objective clinical response as assessed by the treating dermatologist, subjective quality of life as reported by the patient, and recorded adverse effects were monitored throughout the treatment at intervals of 2 to 3 months.

Results  The 3 patients included a woman in her 40s and 2 men in their 60s. Each patient exhibited at least an 80% improvement in extent of disease, with one patient demonstrating 90% clearance. All 3 patients had substantial improvement in quality of life, with one patient reporting improvement in his depression. No adverse effects were recorded.

Conclusions and Relevance  Low-dose naltrexone may represent a low-cost and low-risk alternative or adjunct in the treatment of HHD.

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