Naltrexone as an Antipruritic Agent for Surgical Scar Pruritus

Naltrexone is a competitive opioid receptor antagonist that is FDA-approved for the treatment of alcohol and opioid use disorders. It is also used as an off-label treatment for a plethora of conditions spanning multiple specialties, including multiple sclerosis, chronic pain, Crohn's disease, and compulsive disorders. Naltrexone has also been used off-label for the treatment of pruritus in patients with burn injuries, atopic dermatitis, cholestatic dermatitis, chronic urticaria, and immunotherapy-induced pruritus. Naltrexone is thought to alleviate pruritus through its antagonist effect on the µ-opioid receptor at pain-transmitting and pruritoceptive dorsal horn neurons. This case report explores the treatment of persistent surgical scar pruritus following endoscopic brow lift and bilateral upper eyelid blepharoplasties under general anesthesia. After trialing first-line treatments of oral antihistamines and topical antipruritics, naltrexone was initiated. The treatment dose was titrated between 25 and 100 mg daily, and the pruritus is currently well-controlled with a dose of 25 mg twice a day. While our case report supports the limited available data for the use of naltrexone as treatment for pruritus in certain conditions, more research is warranted to further establish efficacy, safety, and specific diagnosis indications. Naltrexone is not currently FDA-approved to treat pruritus.