Low-Dose Naltrexone for Lichen Planopilaris?Four Evidence Checks

For diagnosed lichen planopilaris, LPP, a naltrexone proposal deserves a specific treatment goal: less scalp inflammation, less discomfort or something else. Ask how the prescriber will judge it.

Check the randomized add-on result

A trial published in 2022 analyzed 34 participants. Both groups received topical clobetasol; one also received 3 mg oral naltrexone, the other placebo. Over six months, the difference between groups on the Lichen Planopilaris Activity Index was not statistically significant, P=.813. Improvement within the naltrexone group does not establish an added benefit over clobetasol.¹

Only the original abstract was accessible for this review. It does not supply enough detail to independently audit the complete methods or funding disclosures. This finding concerns disease activity, rather than proof of hair regrowth.¹

Read the one-year study separately

A 2023 uncontrolled study enrolled 43 people, mostly with frontal fibrosing alopecia, FFA. 34 were confirmed to have started naltrexone; 26 completed the year under the study’s per-protocol definition. Other treatments continued.²

In that 26-person analysis, redness fell by 0.93 points on a 0–3 scale at 12 months. Itch, burning/pain and scale did not show significant improvement at that final comparison. The absence of a control group, concurrent treatments and only six LPP-only participants prevent attributing the redness change to naltrexone or treating this as confirmation of LPP benefit. The American Hair Research Society supported the study.²

Ask about the exact preparation

The US oral naltrexone label covers alcohol dependence and opioid blockade, not LPP. The labeled tablet contains 50 mg. A proposed low-dose preparation needs its own prescribing and pharmacy discussion.³

If it is compounded, FDA⁴ has not approved that finished product or reviewed its safety, effectiveness and quality before marketing. Ask which preparation and pharmacy the prescription specifies. The trial’s dose is not a tablet-cutting or home-mixing instruction.⁴

Review opioids and monitoring

The oral label contraindicates use with opioid pain medicines and warns about precipitated withdrawal in opioid-dependent people, including those taking tramadol. It also warns about liver injury. Tell the prescriber about pain medicines, opioid-containing cough products, liver disease and planned procedures; agree how pain treatment and monitoring would work. A low dose does not establish that these concerns disappear.³

The “Your Hair Log” section of Hair, Everywhere records treatment start dates and consistent photos. Its six-month observation period for shedding does not apply to burning, tenderness or suspected scarring changes. Use the dermatologist’s review schedule, and keep symptom changes separate from photographs when assessing any treatment.