The Risks and Benefits of Cannabis in the Dermatology Clinic
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Cannabis is a category of plants that have been around for thousands of years. Native to Central Asia, but widely grown, it has several varieties and has dozens of general uses including the making of food products, oils, paper, textiles, and ropes. The hemp plant, (Cannabis sativa L) and marijuana (Cannabis sativa or cannabis indica) come from different varieties of the same family yet have different chemical compositions.

Marijuana has been used for both medicinal and recreational purposes for years.1 Most recreational marijuana is cultivated to have high levels of THC (tetrahydrocannabinol), the psychoactive plant component that makes you feel “high.”

Atopic dermatitis and cannabis

Atopic dermatitis (AD) is the most common form of eczema and is an inflammatory skin condition that causes irritation and rashes. The condition can develop at any age, but is most common in children. Managing the discomforts of AD has posed challenges when trying to get people to follow a specific skin care and medication regimen. Corticosteroids, a common therapeutic approach, have perceived risks associated with its use. Topical treatments that include derivatives of cannabis have been demonstrated in clinical studies to reduce itching, swelling, and redness in patients with atopic dermatitis. There are some dermatological and autoimmune medical indications for cannabis use (smoking marijuana), including psoriasis, lupus, nail-patella syndrome, and severe pain.

Cannabinoids

Cannabinoids or cannabidiols (CBD) are natural compounds that can be extracted from cannabis plants and are not psychoactive.2 They are one of over 400 chemical components of the cannabis plant that give it its medical and recreational properties. There are over 100 different kinds of cannabinoids. Endocannabinoids are a kind of cannabinoid that occur naturally in the human body. Exogenous cannabinoids or phytocannabinoids are cannabinoids produced outside of the body; these are what are in plants.2

The endocannabinoid system consists of cannabinoids and cannabinoid receptors. They interact with the immune system, working along similar regulatory pathways.3 Recent research suggests that cannabinoids have anti-inflammatory properties. The use of cannabinoid components in creating topical skin treatments for atopic dermatitis holds real promise.

Legalization

29 states plus the District of Columbia have now legalized medical marijuana. The laws vary by state for fees, possession and physician prescription. Cannabinoids or CBD extract, often in oil form has minimal THC and is not regulated by the same rules. Some are available over the counter by companies not overseen by the FDA. The government has not verified the safety and efficacy of these products.

Traditional medical use

There are approved medical indications for cannabis use, including, but not limited to, pain management, nausea, multiple sclerosis, Alzheimer’s and bipolar disorder. The THC not only has psychoactive components but it also has recognized effect of reducing nausea and vomiting.

10% of those who use marijuana do so for medicinal purposes.3 It has been indicated for reducing stress, alleviating spasticity and other motor function disruptions, and a variety of other medical conditions.

Medical use in dermatology

Medical use of cannabis derivatives, particularly select cannabinoids, have demonstrated success in research studies in the treatment of acne, dermatitis, pruritus (itching), wound healing, and skin cancer.1 The most significant use for cannabinoids may be in the treatment of itching. 3There is some research to suggest that cannabinoids also have antitumor effects on keratinocyte carcinoma and melanoma.3

Dermatologists have begun to use cannabinoid treatments through the use of PEA-containing creams. PEA stimulates endocannabinoid activation of certain receptors, which in studies reduced itch by 85% and was well tolerated by patients.3 Study results even eliminated itch completely in some patients. A clinic at the University of Colorado has documented these results but also suggests that further clinical research is needed.3

AD flare-ups may be preventable with good medical management, including cannabinoid cream treatments to reduced skin redness, scaling, itching, chafing and thickening, in people with eczema and other forms of AD.

Improved quality of life

Evaluation of symptoms demonstrated positive results and a marked improvement days and weeks after treatment completion. Not only was there a reduction in itching, scaling, and oozing, but many people also achieved better sleep along with the substantial relief of other symptoms and a reduction in need for corticosteroids. Further studies need to be conducted to evaluate effectiveness and safety over time. Remember to talk to your doctor before using products that have not been prescribed specifically for you.

view references
  1. Dhadwal, G. Kirchof, M. The Risks and Benefits of Cannabis in the Dermatology Clinic. Journal of Cutaneous Medicine and Surgery. Published October 23, 2017 http://journals.sagepub.com/doi/abs/10.1177/1203475417738971. Accessed online November 8, 2017
  2. What Are Cannabinoids? Leaf Science.com website. Published October 25, 2017. https://www.leafscience.com/2017/10/25/what-are-cannabinoids/.
  3. Mounessa JS, Siegel JA, The role of cannabinoids in dermatology. J Am Acad Dermatol. 2017;77(1):188-190. Published July 2017. http://www.jaad.org/article/S0190-9622(17)30308-0/abstract. Accessed online November 7, 2017.
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