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Case Reports
. 2019 Aug 28;10(5):567-570.
doi: 10.4103/idoj.IDOJ_453_18. eCollection 2019 Sep-Oct.

Low-Dose Naltrexone-Induced Remission in Hailey-Hailey Disease Maintained in Remission with Topical Combination of Ketamine and Diphenhydramine

Sidharth Sonthalia  1 , Mahima Agrawal  2 , Ankur Talwar  3 , Mohamad Goldust  4
Affiliations
Case Reports

Low-Dose Naltrexone-Induced Remission in Hailey-Hailey Disease Maintained in Remission with Topical Combination of Ketamine and Diphenhydramine

Sidharth Sonthalia et al. Indian Dermatol Online J. .

Abstract

Recent anecdotal evidence suggests that oral low-dose naltrexone (LDN) is effective for Hailey-Hailey disease (HHD) but suffers the limitation of immediate relapse following cessation of the medication. With lack of safety data on long-term administration of LDN, we explored the utility of a topical diphenhydramine/ketamine (DK) cream in maintaining the remission achieved with LDN. A 42-year-old male with treatment-refractory HHD remitted with 5 mg naltrexone/day but relapsed on stopping the drug. Symptoms abated after restarting LDN. The impact of regular twice-a-day application of a specially formulated DK cream containing diphenhydramine (2% w/w) and ketamine (1% w/w) over the affected areas on maintenance of remission was explored till the next relapse. Our approach enabled dose reduction of naltrexone to 3 mg/day without loss of treatment benefit. After 3-month overlap of naltrexone and DK cream, withdrawal of naltrexone maintained remission with only the topical regime with no adverse effects till 4 months of follow-up. The use of topical agents with anti-inflammatory, antipruritic, antinociceptive, and naltrexone-mimicking properties merits exploration as an option to provide short but significant period of naltrexone-free maintenance of remission to patients with HHD.

Keywords: Benign familial pemphigus; Hailey–Hailey disease; diphenhydramine; ketamine; low-dose opioid; naltrexone.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a and b) Clinical picture depicting the discolored macerated eroded plaques of Hailey–Hailey disease over the patient's groins at baseline and (c and d) at third month after stopping of low-dose naltrexone (taken for 7 months) showing significant improvement in lesions maintained only on topical regime (c and d)
Figure 2
Figure 2
Schematic line diagram depicting the sequential changes made in the patient's treatment protocol and corresponding effect on disease activity
See this image and copyright information in PMC

Comment in

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