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Psoriasis and Low Dose Naltrexone by Paula Johnson
- Chronic plaque psoriasis, which is the most common type, this usually presents on the knees, elbows, trunk, scalp, behind the ears and between the buttocks although other areas can be involved too.
- Guttate psoriasis which consists of small plaques of psoriasis scatters over the trunk and limbs – this can be caused by streptococcus bacteria which can cause sore throats.
- Palmoplantar psoriasis more commonly affects the palms and soles of the feet.
- Pustular psoriasis is rare, but like guttate psoriasis, it affects the trunk and limbs but comes with yellow pus-filled spots. This can be localised or generalised and flares rapidly and can require hospitalization for treatment.
- Erythrodermic psoriasis is an aggressive form which affects nearly all of the skin and can also require hospitalization.
- Nail psoriasis affects roughly 50% of people with psoriasis and causes pitting, discolouration, separation of the nail from the nail bed and thickening and yellowing of the nails.
Psoriasis is much more than a skin disease; it causes anxiety, depression, arthritis and can increase the risk of heart disease and stroke. It can also be associated with diabetes, obesity, venous thromboembolism, high cholesterol and high blood pressure, inflammatory bowel disease and there is thought to be a small increased risk of skin cancer. Effective treatment of psoriasis may reduce these risks.2
Scientists believe that a person can be genetically predisposed to develop psoriasis. In 2006 the National Psoriasis Foundation began collecting DNA samples for the National Psoriasis Victor Henschel BioBank. The biobank is stated to be the world’s largest collection of psoriasis-related DNA in the world. 25 genetic variants that make a person more likely to develop psoriatic disease have been identified.3
The triggers for psoriasis in susceptible individuals can be stress, skin injury, medications and infections. Medicines known to aggravate psoriasis are beta-blockers, Inderal (blood pressure medication), lithium (for psychiatric disorders), quinidine (a heart medication), indomethacin (NSAID) and some anti-malarial medications. Suddenly stopping some steroid medications can trigger or worsen psoriasis.
Anything that can affect the immune system can trigger psoriasis, strep throat in particular, but earache, bronchitis, tonsillitis or respiratory infection too are implicated. Obesity and smoking are associated with a poor response to psoriasis treatments.
Psoriasis is an itchy, painful and psychologically distressing disease and treatments for it are often not totally effective, complete clearance of skin lesions may not always be possible. There are topical treatments; creams, ointments and lotions. Phototherapy which usually requires attendance at a phototherapy unit at a hospital and can take 8 – 10 weeks for a course of treatment. Then there are systemic treatments with medications such as immune suppressants - ciclosporin, methotrexate and acitretin, injectable treatments with biologics such as infliximab, adalimumab and etanercept, to name a few.
For all systemic medications that suppress immune system function the patient needs to be monitored as the side effects can be unpleasant and can cause anything from headaches, fatigue, increased risk of infections, to lymphoma and other cancers as the medication reduces the body’s immune response to cancer cells.4
Better choices for first-line treatment
Naltrexone is a non-toxic, generic drug that was developed in 1963 by Endo Laboratories. As an opiate antagonist, it was originally approved for treating alcohol dependence and opiate addiction. Used for this purpose, the dosage is commonly between 50mg/day and 150mg/day. At these doses, the safety profile is good and the side effects are mild and transitory. There is also no abuse potential with naltrexone and no development of tolerance for its efficacy. At very high doses, typically 300mg, there is a risk of hepatotoxicity; this rarely occurs and is typically reversible.5
In the mid-1980s, Dr Bernard Bihari discovered that a low dose of naltrexone, typically between 1.5mg and 4.5mg each night, had beneficial effects on his HIV/AIDS patients. He began to see people in his private practice with a variety of cancers as well as a host of autoimmune disorders – many of which also appeared to benefit from low dose naltrexone.
Dr Bihari recognised that encephalins and endorphins could be considered as immunomodulators and modifiers of the biological response, as encephalins and endorphins are deficient in people with immune system disorders. By taking naltrexone in smaller doses, the opioid receptors are blocked for several hours, creating a rebound effect of increasing endorphins and receptors by 300%. This increase in endorphins lasts all day, long after the naltrexone has left the system. Endorphins are natural peptides produced in many cells which regulate cell growth, reduce inflammation and pain.6
Effective treatment for psoriasis – case studies
A 68-year-old male had psoriasis for over 20 years, plaques over multiple body areas and he had been prescribed biologics and had developing disease. After 10 years he started with psoriatic arthritis which got worse despite the biologics, steroids and DMARDS that he was given. His disability increased along with this pain. He had other issues; coronary artery disease, hypertension, peripheral artery disease, irritable bowel syndrome and prediabetes. After commencing LDN, the gentleman found that his IBS improved, plaques began to reduce, and his pain decreased – all within 2 months of LDN treatment. After other interventions to help his other ailments, his disease state reduced to around 20% of what it was after a year of treatment.7
A 38-year-old female had a 16-year history of erythrodermic psoriasis. This lady had seen many dermatologists previously and had used a wide variety of topical steroidal creams with little benefit. On her last visit to a previous dermatologist, he had put her on oral methotrexate plus folic acid and a topical cream. She reported poor results and discontinued her treatment due to side effects of methotrexate (anaemia, thrombocytopenia and leukopenia). She reported that after two weeks on methotrexate she experienced an acute worsening of her condition and she went to another dermatologist. Her erythrodermic psoriasis was extremely bad, her psoriasis area severity index (PASI) score was 48, and she was very concerned about her condition but refused further treatment of immunosuppressive cytotoxic drugs due to the aggressive side effects experienced. At this time, Low Dose Naltrexone was one of the remaining options and she agreed to try it. 4.5mg of LDN was taken alongside 25mg of hydroxyzine (an antihistamine) every 12 hours and topical colloidal oat cream 8-hourly.
After 10 days of treatment, the patient showed significant improvement; she no longer experienced itchy sensations and discontinued hydroxyzine after 9 days of treatment. Signs of regression of facial swelling and edema were notable. After 20 days the patient showed complete improvement with just the LDN and topical cream – notably a further reduction in facial edema and upper extremity swelling by more than 50% and considerable reduction in disseminated pruritic plaque on the skin surface were also evident.
She saw complete remission of psoriasis at 3 months, PASI score of 0 along with her normal laboratory results, and at 6 months the same clinical condition was evident, no signs of plaques anywhere on the patient’s body.
The conclusion of this study was that the benefits of LDN were clearly shown for erythrodermic psoriasis. A remarkable improvement to the patient’s quality of life in a short space of time with no adverse side effects throughout the treatment.8
Other dermatologic examples
Mariusz Sikora et al. wrote an article regarding the use of naltrexone in dermatology. Stating that at a dose as low as 1 to 5 mg per day, naltrexone demonstrates immunomodulatory action:
- Modulates Toll-like receptors signalling,
- Decreases release of proinflammatory cytokines,
- 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.9
Brigette Lee and Dirk Elston studied current data of naltrexone that were relevant to dermatologic practice using PubMed literature. They concluded that as naltrexone affects inflammation, cell adhesion and keratinocyte proliferation and migration it would suggest that naltrexone could be helpful in the treatment of pruritis and a variety of inflammatory and acantholytic skin diseases that are refractory to other treatments.10
A review of existing literature on naltrexone by Chloe Ekelem et al. studied 22 articles which included randomized clinical trials, case reports and series. The conclusion of the study suggested that low dose naltrexone is safe and effective in the treatment of Hailey-Hailey disease and lichen planpilaris, and both low and high dose naltrexone successfully treat pruritis attributable to various pathologic conditions. High doses caused more adverse reactions but low dose has the potential for the treatment of chronic inflammatory skin conditions. The study concludes with “Additional evidence is needed for dosing and long-term treatment guidelines”.11
Naltrexone and Low Dose Naltrexone are prescription-only drugs and should never be purchased online without a prescription as these products have bypassed safety and efficacy testing, they could be harmless or deadly there is no way of telling. We always recommend a patient obtaining LDN from a respected LDN prescriber and expert LDN pharmacist. Check out the lists of Prescribers and Pharmacists www.ldnresearchtrust.org; Should you wish to be listed please email: firstname.lastname@example.org
The primary aim of the LDN Research Trust is to initiate clinical trials of Low Dose Naltrexone for autoimmune diseases and cancers. We have helped many people with MS, Crohn’s, IBS, ME, skin disorders and cancer, to name a few of the conditions that LDN can effectively treat. The use of LDN is spreading across the world, and we will continue to raise awareness of this low-cost, non-toxic and effective drug.
The LDN Research Trust is a non-profit registered charity with many willing volunteers helping us to achieve our ultimate goal for everyone to be prescribed LDN by the NHS and around the world for all conditions where LDN could be of benefit.
- National Psoriasis Foundation, https://www.psoriasis.org/content/statistics
- The British Skin Foundation, https://www.britishskinfoundation.org.uk/psoriasis
- Denise C Hsu and Constance H Katelaris, “Long Term Management of Patients Taking Immunosuppressive Drugs”, Australian Prescriber, 32 (Jun 2009), 68-71, Aust Prescr 2009;32:68-71
- Deanna Windham, DO, “Psoriasis: A Novel Approach to Treatment”, The LDN 2017 Conference, https://ldnresearchtrust.org/conference-2017
- Eduardo P Beltran Monasterio, “Low Dose Naltrexone: An Alternative Treatment for Erythrodermic Psoriasis”, Cureus, 11, 1 (Jan 2019), e3943 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6433456/
- Mariusz Sikora et al., “The Use of Naltrexone in Dermatology. Current Evidence and Future Directions”, Current Drug Targets, 20, 10 (2019), 1058-67, PMID: 30887922.
- Brigette Lee and Dirk M Elston, “The Uses of Naltrexone in Dermatologic Conditions”, Journal of the American Academy of Dermatology, 80, 6 (Jun 2019), 1746-52, PMID: 30582992.
- Chloe Ekelem et al., “Utility of Naltrexone Treatment for Chromic Inflammatory Dermatologic Conditions: A Systemic Review”, JAMA Dermatolgy, 155, 2 (Feb 2019), 229-36, PMID: 30484835