Bray Eric R, Morrison Brian W
Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida.
JAMA Dermatol. 2024 Dec 1;160(12):1334-1337. doi: 10.1001/jamadermatol.2024.4098.
Nail lichen planus has the potential to cause permanent destruction of the nail unit and remains challenging to treat. Studies suggest that low-dose naltrexone is a safe and potentially effective treatment for other dermatologic conditions, including lichen planopilaris.
To assess the effectiveness of low-dose naltrexone in treating nail lichen planus.
DESIGN, SETTING, AND PARTICIPANTS: This case series evaluates 7 adult patients with biopsy-proven nail lichen planus who were treated with low-dose naltrexone (3 mg per day) at the University of Miami dermatologic clinics from November 2022 to December 2023. The data were analyzed in March 2024. Patients were treated for at least 2 months and had in-person follow-up evaluation while receiving treatment.
The main outcome was posttreatment clinical nail lichen planus severity index, which was scored as clear, mild, moderate, or severe. Patients were evaluated for oral and cutaneous disease during the course of treatment. Tolerance and adverse events were noted.
A total of 7 patients (mean [range] age, 60 [38-77] years; 3 female individuals) were included. All but 1 patient had been previously treated and did not respond to at least 1 prior treatment (median [range], 2.5 [0-4.0] treatments). Treatment duration ranged from 2 to 11 months. Clinical response was observed in 4 of 7 patients, with an overall 35% reduction in nail lichen planus severity index. Two patients with severe disease achieved a reduction to mild severity. None of the patients had to discontinue low-dose naltrexone due to adverse events, and no adverse events were reported.
The results of this study suggest that low-dose naltrexone may be a therapeutic approach for treating nail lichen planus. Further controlled studies are warranted to better understand its clinical efficacy and safety profile in treating nail lichen planus.
甲扁平苔藓有可能导致甲单位的永久性破坏，且治疗仍具有挑战性。研究表明，低剂量纳曲酮对其他皮肤病，包括扁平毛发苔藓，是一种安全且可能有效的治疗方法。
评估低剂量纳曲酮治疗甲扁平苔藓的有效性。
设计、地点和参与者：本病例系列评估了7例经活检证实为甲扁平苔藓的成年患者，这些患者于2022年11月至2023年12月在迈阿密大学皮肤科诊所接受低剂量纳曲酮（每日3毫克）治疗。数据于2024年3月进行分析。患者接受治疗至少2个月，并在接受治疗期间进行面对面随访评估。
主要结局是治疗后临床甲扁平苔藓严重程度指数，分为清除、轻度、中度或重度。在治疗过程中对患者的口腔和皮肤疾病进行评估。记录耐受性和不良事件。
共纳入7例患者（平均[范围]年龄，60[38 - 77]岁；3名女性）。除1例患者外，所有患者此前均接受过治疗，且对至少1种先前治疗无反应（中位数[范围]，2.5[0 - 4.0]次治疗）。治疗持续时间为2至11个月。7例患者中有4例观察到临床反应，甲扁平苔藓严重程度指数总体降低了35%。2例重症患者病情减轻至轻度。没有患者因不良事件而不得不停用低剂量纳曲酮，也未报告不良事件。
本研究结果表明，低剂量纳曲酮可能是治疗甲扁平苔藓的一种治疗方法。有必要进行进一步的对照研究，以更好地了解其治疗甲扁平苔藓的临床疗效和安全性。
