Eosinophilic pustular folliculitis due to naltrexone: A case report

The effectiveness of naltrexone in treating both alcohol and opioid use disorders is unique when compared with other agents used for substance use disorder (SUD). It is estimated that 2 million Americans suffer from opioid use disorder, and 14.5 million have alcohol use disorder, underscoring the need for medication-supported SUD treatment. The aims of this case report are 2-fold: (1) to underscore the importance of conducting a thorough medication history when considering a recent adverse drug reaction and(2) to report a novel cutaneous reaction to naltrexone oral tablet.

A 20-year-old female with a medical history significant for bipolar disorder, obsessive compulsive disorder, major depression disorder, and polysubstance use disorder experienced a drug-induced cutaneous adverse reaction on 2 separate occasions, about 3 months apart. Drug-induced adverse reactions can lead to treatment modifications, resulting in differences in efficacy and undesirable adverse effects. The purpose of this case report is to introduce naltrexone-induced skin reactions and emphasize the importance of a careful medication history when determining which medication is related to an adverse reaction.

Naltrexone will continue to be used to manage cravings related to SUD. This case brings awareness to severe cutaneous adverse reactions associated with enteral naltrexone. Monitoring upon initiation for any adverse effects should be part of a holistic treatment plan. In addition to conducting a complete and thorough medication history, adverse drug reactions can be correctly attributed to the offending agent and prevent future adverse reactions.