It has been known that the human endocannabinoid system (ECS) modulates cutaneous biology. Receptors from the ECS have been identified in the skin, and systemic misuse/abuse of synthetic cannabinoids has also been associated with the manifestation of dermatological disorders, indicating the effects of the ECS on skin biology. Preclinical evidence suggests topical application of CBD products may be beneficial for skin disorders such as eczema, psoriasis, pruritis, and inflammatory conditions. However, confirmed clinical efficacy and the underlying molecular mechanisms of CBD on cosmetic improvement have yet to be fully identified. Research indicates that both Cannabinoid 1 (CB1) and Cannabinoid 2 (CB2) receptors are found in epidermal keratinocytes, cutaneous nerve fibers, dermal cells, melanocytes, eccrine sweat glands, and hair follicles. Endocannabinoids are involved in various dermatological functions, such as formation and maintenance of the skin barrier, cell growth, and cell differentiation, as well as immunological and inflammatory processes.
Because the ECS plays an important regulatory function in the skin, it is reasonable to suggest that treatment with topical cannabinoids could be efficacious for certain disorders, or for skin health in general. Not surprisingly, there is lacking research investigating the therapeutic potential for topical applications of cannabinoids. Historically, there is evidence to suggest applying CBD topically may be a viable route of administration for certain skin conditions. For example, researchers previously investigated the efficacy of topically applied CBD (1–10%) in a gel format, specifically for reduction of inflammation-associated symptoms in a monoarthritic rat model, and found that it was well absorbed - the plasma concentration directly correlated with the dose applied (dose-dependent reaction). As of 2020, no clinical trials investigating the topical absorptive capability of CBD in humans have been identified. Further work is warranted to better understand the appropriate doses and delivery methods for therapeutic CBD skin applications. The authors of this study conclude that while there is absolutely potential for CBD in the treatment of acne, seborrhea, eczema/dermatitis, and skin barrier function is promising, larger and more structured studies are needed to fully validate its efficacy.
1) Baswan SM, Klosner AE, Glynn K, et al. Therapeutic Potential of Cannabidiol (CBD) for Skin Health and Disorders. Clin Cosmet Investig Dermatol. 2020;13:927-942. Published 2020 Dec 8. doi:10.2147/CCID.S286411
There are several forms of alternative medicine that are being investigated for their potential therapeutic benefits. Many of these compounds have not been regarded as therapeutic, but rather have had a negative stigma against these compounds. One of the most infamous therapeutic agents is cannabidiol (CBD). Cannabidiol is a low tetrahydrocannabinol which is derived from cannabis stavia. Cannabis stavia is the plant that is associated with the use of illegal marijuana use. The use of medical marijuana has been quite controversial, but there have been many evidenced based studies studying the use of medical marijuana. In June of 2018, a controversial FDA approval put the spotlight on CBD based products once again. Epidiolex is a CBD based product for the treatment of rare forms of epilepsy. This medication reignited the discussion regarding the use of CBD oil and cannabis. There is also a lot of controversy surrounding the legality of medical marijuana and CBD oil. One of the contributing factors to the controversy is the recent spike in opioid use and opioid related fatalities. This has sparked a sense of fear within communities regarding all substances thought to be harmful.
There is a moderate amount of clinical use to support the use of cannabinoids for the use in pain control. There have been many studies showing the benefit of CBD and other cannabinoids for pain. This is one indication that is particularly interesting due to the recent uptick in opioid pain relief and addiction. There has been thought as to how cannabinoids can help counteract the opioid epidemic, or if this approval and legalization will compound the current issue. There have also been products approved for the use in chemotherapy induced nausea and vomiting. Cancer patients have also had an increased appetite when taking cannabinoids, and this can be a major cause of morbidity in these patients. Malnutrition has always been an issue for cancer patients, and specifically now there are options to help them gain back their appetite while reducing nausea and vomiting. Cannabinoids have also been associated with increased weight in patients with HIV, who are also usually underweight and malnourished. There is also evidence supporting the use of cannabinoids in sleeping and seizure disorders. All of these indications should lead the medical field to lean into more randomized clinical trials.
There still remains the debate about the legality of CBD and cannabinoids despite the growing body of evidence supporting their use. Since 1970, hemp and marijuana derived products have been considered to be illegal. However, in 2014, the Agricultural Act distinguished hemp from marijuana. This was based on the amount of THC in the products. Laws regarding CBD and medical marijuana vary state-by-state. Currently in New York, there is a comprehensive medical marijuana program, which allows for patient access to medical marijuana.
Although there is controversy surrounding the use of medical marijuana and other CBD products, one cannot ignore the amount of evidence that is being generated which favors the use of these products. Clinical discretion as well as a risk-benefit calculation must be performed for any patient who is a candidate for medical marijuana.
VanDolah HJ, Bauer BA, Mauck KF. Clinicians' Guide to Cannabidiol and Hemp Oils. Mayo Clin Proc. 2019 Sep;94(9):1840-1851.