Efficacy of Low Dose Naltrexone in Psoriasis
Efficacy of Low Dose Naltrexone in Psoriasis
Objective of the study is to determine the efficacy of low dose naltrexone in the patients of
 psoriasis, which is a chronic relapsing and remitting disease. A non-randomized clinical
 trial was carried out in the Department of dermatology in Jinnah Postgraduate Medical Center,
 Karachi. All patients with mild, moderate and severe psoriasis with age above 13 years
 without any co-morbid, were prescribed tablet Naltrexone 6 mg daily after assessing PASI, BSA
 and DLQI scores before starting treatment. Patients were called monthly for follow up to
 monitor lipid profiles and liver function tests. After 3 months of treatment, PASI, BSA and
 DLQI scores were assessed again. The results were significant when analysed with paired t
 test in SPSS 23.
Psoriasis is a chronic T-cell mediated disorder. The activated T cell secretes cytokines that
 result in keratinocytes hyper-proliferation and abnormal differentiation. These cytokines
 result in chemo-taxis of neutrophils and lymphocytes in skin. It is a multi-factorial
 disease. Individual has genetic susceptibility for psoriasis, but environmental factors
 trigger the disease like infections, drugs, cold, trauma and stress. It is a multi-system
 disease but mainly affects skin, nails and joints. It impacts adversely on patients' quality
 of life, causes embarrassment, limitation in clothing choice, psychological distress which
 further aggravates the disease. It impacts economically due to off days from work as well. In
 its most common form, it presents as salmon pink plaques, covering with thick silver scales,
 mostly on scalp, trunk, buttocks and external surfaces of limbs.

 In the management of psoriasis, there are multiple treatment options which includes topical,
 systemic and photo-therapy. But all have their side effects and contraindication. Low dose
 naltrexone(LDN) is an attractive emergent therapy with analgesic, anti-pruritic and
 anti-inflammatory properties for various dermatological disorders including psoriasis. In
 this study, the effectiveness of low dose naltrexone in cases of psoriasis was assessed.

 The study was conducted in the department of dermatology in Jinnah Postgraduate Medical
 Centre, Karachi, after receiving approval letter from the institutional ethical and research
 committee of the hospital.Forty two patients were selected of either gender with age ranging
 from 13-60 years, after excluding hypertension, cardiovascular disorders, pregnancy and
 lactation. The procedure has been explained to each patient & written consent has been taken.
 Before prescribing LDN treatment, Psoriasis area and severity index(PASI), Body surface
 area(BSA) and Dermatology life quality index(DLQI) has been calculated. Each case has
 prescribed tablet naltrexone 6mg daily after checking all baselines investigations of
 complete blood picture , renal and liver function profiles. The cases were asked to follow up
 monthly to observe patient compliance, response of medicine and its side effects. After 3
 months of treatment, PASI, BSA and DLQI have been calculated to assess the effectiveness of
 treatment.

 PASI score is used to measure the severity and extent of disease, in terms of intensities of
 erythema, induration and scaling of lesion and the area of body involved with disease.

 Body surface area (BSA) is calculated through 'rule of nine' which is a convenient and rapid
 method of estimating the extent of body surface area affected with disease. If BSA is <3%,
 3-10%, or >10%, it is categorized as mild, moderate and severe disease, respectively.

 The dermatology life quality index is a simple questionnaire, that consists of 10 questions
 to assess the impact of disease and its treatment on daily activities and the impact on the
 social behavior of the patients. DLQI scores has been interpreted in terms of effect of
 disease on patients' life as follows:

 -  0-1 = No effect

 -  2-5 = Small effect

 -  6-10 = Moderate effect

 -  11-20 = Very large effect

 -  21-30 = Extremely large effect After 3 months, all three scores were assessed again to
 observe the effectiveness of treatment. The evaluation was done by SPSS version 23. The
 side effects were assessed regarding nausea, headache, decreased appetite, dizziness,
 palpitation, liver enzymes level, renal and complete blood profiles.
Inclusion Criteria:

 -  minimum age 13 years

 -  maximum age 60 years

 -  both males and females affected with mild, moderate and severe psoriasis.

 Exclusion Criteria:

 -  hypertension

 -  cardiovascular disorders

 -  pregnancy

 -  lactation

 -  renal failure

 -  liver failure

 -  hypersensitivity to drug