Cannabinoids in dermatology
Author: Dr Varitsara Mangkorntongsakul, Senior Medical Officer, Central Coast Local Health District, NSW, Australia. Dr Yi Jia Lee, Junior Medical Officer, Sir Charles Gairdner Hospital, Nedlands, WA, Australia. Technical Editor: Mary-Elaine Luther, medical student, Ross University School of Medicine, Barbados. DermNet NZ Editor in Chief: Adjunct A/Prof. Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. January 2020.
Cannabis, Cannabis sativa, Marijuana, Hashish, Hash oil, Hemp, Phytocannabinoids, Endocannabinoids, Synthetic cannabinoids, Cannabinoid receptors, Topical cannabinoids, Therapeutic use of cannabinoids, Adverse effects of cannabinoids
398707004, 763662005, 10083006, 78854007, 218791008, 763661003, 723949005, 737226008, 72024007, 763660002, 22924007
What is cannabis?
Cannabis refers to one of two notable subspecies of the cannabis plant.
- Cannabis sativa, also known as marijuana, has psychoactive properties.
- Cannabis sativa L., also known as hemp, is the non-psychoactive form of cannabis used in manufacturing products such as oil, cloth, and fuel. (The L was included in the name in honour of botanist Carl Linnaeus).
Cannabis is also known as pot, weed, hash, dope, ganja, joint, stick, yarndi, cone, mull, 420, dabs, dabbing, BHO, choof, and mull [1,2].
Cannabis comes in various forms .
- Marijuana — the dried leaves and flowers of the plant.
- Hashish — the resin of the dried plant, usually mixed with tobacco and smoked or added to foods and baked; levels of tetrahydrocannabinol (THC) are higher than in marijuana.
- Hash oil — a thick, golden-brown to black liquid extracted from hashish and added to the tip of a joint or cigarette and smoked; hash oil is used sparingly due to its high potency.
- Concentrates — extracts (dabs, wax, or shatter) typically use butane hash oil as a solvent and are vaporised in small quantities due to high content of THC.
What are cannabinoids?
Cannabinoid refers to any chemical substance that binds to the cannabinoid receptors CB1 and CB2 in the body producing similar effects to C. sativa. There are three types of cannabinoid [1,3].
- Plant-derived cannabinoids (phytocannabinoids), such as THC, which is found exclusively in cannabis plants.
- Endogenous cannabinoids (endocannabinoids), such as palmitoylethanolamide (PEA), anandamide (AEA), and oleoyl ethanolamide (OEA), which are produced naturally in the human body.
- Synthetic cannabinoids are produced in a laboratory. Synthetic cannabinoids are pure agonists with high affinity at the CB1 receptor , which contributes to their psychoactive effects. Synthetic cannabinoids can be taken orally or applied topically for a therapeutic effect.
What are the effects of cannabinoids on the body?
Cannabis can be smoked, ingested (eaten), or vaporised to induce a temporary state of euphoria and sense of relaxation . The psychoactive properties of cannabis are primarily due to THC; THC concentration is commonly used as a measure of cannabis potency.
Endogenous and exogenous cannabinoids activate the cannabinoid receptors CB1 and CB2 [2–4].
- The CB1 receptor is expressed in the central and peripheral nervous systems, including vascular endothelium , liver, and adipose tissue.
- The CB2 receptor is mainly located in non-neuronal tissues and on immune cells throughout the whole body.
Activation of the CB1 receptor results in:
- Enhanced release of presynaptic dopamine in the dopaminergic mesolimbic system, which mediates the positive reinforcing and rewarding effects of almost all drugs of abuse [2,3]
- Reduced axon reflex–flare response, scratching reflex, and vasodilation in the skin 
- Inhibition of the anandamide-metabolising enzyme [fatty acid amide hydrolase (FAAH)]. The FAAH enzyme breaks down AEA into ethanolamine and arachidonic acid. Inhibiting AEA metabolism results in elevated endogenous AEA levels, which is therapeutic [5,6].
What are topical cannabinoids?
Topical cannabinoids are creams , patches, and gels containing plant-derived, endogenous, or synthetic cannabinoids that are intended for therapeutic use .
- Topical cannabinoids bind to cannabinoid receptors in sensory nerve fibres, inflammatory cells, and adnexal structures within the skin.
- This binding reduces pruritus , attenuates pain, mediates cellular response to ultraviolet B irradiation, inhibits epidermal keratinocyte proliferation , and promotes apoptotic death of keratinocytes [5,8,9].
- Binding of cannabinoid receptors also promotes anti-inflammatory effects relating to keratinocyte cytokine production and immune cell modulation .
In dermatology , topical cannabinoids are being investigated for the treatment of pruritus, inflammatory disorders, and skin cancer [5,10].
Topical cannabinoids in pruritus
Experimentally, creams containing PEA and synthetic cannabinoids have been shown to be effective and well-tolerated in the treatment of itch associated with atopic dermatitis , lichen simplex , nodular prurigo , and uraemia [3,6,11].
Topical cannabinoids in inflammatory skin disorders
Cannabinoids have immunosuppressive , anti-inflammatory, and other properties that may be useful in the treatment of inflammatory skin diseases, such as various forms of dermatitis, psoriasis, follicular disorders, and scleroderma [3,5,10,11].
Cannabinoids and skin cancer
The role of cannabinoids in skin cancer is confusing.
UVA and UVB can activate inflammation through the endocannabinoid system, thus potentially accelerating the initial stages of oncogenic transformation . Cannabinoids can also promote oncogenic viral transformation as a result of their immunosuppressive properties [5,10].
However in animal models cannabinoids have been found to have anti- tumour effects mediated by both the CB1 receptor and especially the CB2 receptor. These anti-tumour effects are expressed on melanoma and keratinocyte cancers, resulting in the induction of apoptosis in tumours but not of normal melanocytes , and inhibition of [3,5,9]:
- Tumour cell growth, reducing melanoma progression and metastasis
- Tumour cell proliferation and migration
- Angiogenesis .
Other therapeutic uses for cannabinoids
Oral cannabinoids have been used in the treatment of cancer-related side effects such as chemotherapy -induced nausea and vomiting, pain, and poor appetite.
Cannabis extracts have shown the following benefits for multiple sclerosis :
- Reduce spasticity
- Reduce frequency of spasms
- Particularly effective for neuropathic pain
- Particularly effective for non-neuropathic pain in multiple sclerosis.
Cannabis extracts have also shown be beneficial in the treatment of chronic pain [4,8,12].
Other potential positive effects of cannabinoids include reducing the following:
- Tics due to Tourette syndrome
- Levodopa-induced dyskinesia in patients with Parkinson disease
- Anorexia and weight loss associated with human immunodeficiency virus ( HIV ) infection or acquired immune deficiency syndrome (AIDS).
Further studies are required to explore the potential benefits of medical cannabis for the treatment of the following conditions [4,8,12]:
- Irritable bowel syndrome
- Huntington disease
- Traumatic brain injury
- Sleep disorder
- Posttraumatic stress disorder
- Schizophrenia and other psychoses.
What are the adverse effects of cannabinoids?
Potential side effects and safety of topical cannabinoids have not been well elucidated. Some of the systemic effects of oral cannabinoids are listed below [4,12,13]:
|Neurological||Memory impairment, tremors, seizures|
|Anxiety, confusion, agitation, mood dysregulation , paranoia, psychosis (short-term and long-term), suicidal ideation, perceptual disturbances|
|Diaphoresis, chest pain, acute myocardial infarction , hypertension , tachycardia|
|Gastrointestinal||Cannabinoid hyperemesis syndrome: abdominal pain, nausea, and vomiting; symptoms can be relieved with a warm shower|
|Cannabinoid sensitisation or allergy ; cannabis arteritis : severe vascular disease, leading to limb loss (see Thromboangiitis obliterans)|
New Zealand approved datasheets are the official source of information for prescription medicines, including approved uses and risk information. Check the individual New Zealand datasheet on the Medsafe website.
If you are not based in New Zealand, we suggest you refer to your national drug approval agency for further information about medicines (eg, the Australian Therapeutic Goods Administration and the US Food and Drug Administration) or a national or state-approved formulary (eg, the New Zealand Formulary and New Zealand Formulary for Children and the British National Formulary and British National Formulary for Children ) .
4 skin problems that you can solve with CBD (and select herbs)
CBD oil is a natural active ingredient derived from the Cannabis sativa industrial cannabis species. CBD cannabinoid has so many positive effects on the human body, we often joke that every person has at least one ailment CBD oil could help with. CBD is used to relieve insomnia and chronic pain, and to help relieve autoimmune diseases, anxiety and depression. It is also popular as a natural remedy against insomnia and as an additional boost for the immune system. Lately, the use of CBD oil for the skin has also been gaining a lot of attention. Because the skin has its own endocannabinoid system to which the CBD cannabinoid binds, it is effective in a wide range of skin problems. What skin problems does CBD work on best?
CBD and psoriasis
Psoriasis is a chronic autoimmune disease where skin cells grow and divide at an accelerated rate. Eczema start appearing on the skin as a result of this division and they are usually red with a silver outline but can also be pink or brown in colour. Psoriasis is a disease that doesn’t have a cure yet, but various therapies do exist to mitigate its symptoms. A lot can be done to alleviate the symptoms by adjusting your lifestyle, maintaining a balanced diet and with moderate exposure to the sun. CBD cannabinoid is also becoming an increasingly popular natural remedy for psoriasis outbreaks and several studies have shown the effect it has on decelerating skin cell division. CBD cannabinoid also has anti-inflammatory properties which additionally soothe psoriasis conditions. You can read more about CBD cannabinoid use in psoriasis treatments in one of our previous posts: Does CBD oil help with psoriasis?
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Great texture, lovely smell, absorbs easily and really helps the irritated and flaky atopic skin on my arms hands and face.
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Acne and skin impurities – CBD’s double effect
Acne and skin impurities are not exclusive to teenagers, they often occur in adulthood as well. Most commonly the causes of adult acne are hormonal imbalances, stress, an unhealthy diet and improper skin care. Their formation is caused by an increased secretion of sebum (tallow) and the Propionibacterium acnes bacteria. Sebum normally plays an important role in skin protection, but when the skin produces too much of it, it can also cause unwanted acne. Our fight against acne can take place on multiple levels – with a healthy diet, regular cleansing of dead skin cells, avoiding stress and regular physical activity. Of course, proper skin care that balances the skin and brings it to a healthy and radiant state is crucial. And CBD cannabinoid is undoubtedly an active ingredient which, when it comes to acne skin care, is very promising. Why is CBD a great ally in the fight against acne?
1. CBD reduces the formation of sebum in sebaceous tissues
Clinical studies have shown that the CBD molecule reduces the formation of sebum in the sebaceous glands, which is highly desired in acne-prone skin care, as the formation of sebum is the most common culprit of acne.
2. CBD has antibacterial and anti-inflammatory properties
CBD carries out complex anti-inflammatory and antibacterial actions demonstrated also in many other experimental studies on diabetes, rheumatoid arthritis, etc. Red acne (not blackheads) are the result of inflammatory skin changes that CBD cannabinoid can successfully calm down.
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New favorite product in my skin care routine!
“I’ve used several other brands and skin care lines with hemp and CBD based products and found the Balancing Face Cream to be the most helpful in moisturizing and preventing acne. This moisturizer is light, non greasy and balances my skin.” – Sarah V.
A healthy, clean and refreshed complexion is something that we all long for! This set includes: Balancing Face Cream 50ml, which restores balance and normality, and moisturizes combination an oily skin. Purifying Face Cleanser 100 ml, which gently and effectively cleanses skin
CBD cannabinoid and atopic dermatitis
Dermatitis is an inflammatory skin disease that most commonly occurs in children. About 10% of children under the age of 6 are affected. Dermatitis is more common in cold months and is characterized by red, itchy rashes. If you visit your doctor with a case of dermatitis, they will almost always prescribe treatment with corticosteroid creams. Such creams are effective in relieving the symptoms, but unfortunately, they also have a lot of negative side effects on the skin and body. Often, when the treatment with corticosteroids is completed, the original problem returns.
CBD cannabinoid has an anti-inflammatory effect on the skin and body. Atopic dermatitis is an inflammatory disease, so CBD has a positive effect on it.
CBD is all the more effective because our skin has its own endocannabinoid system onto which CBD can bind itself directly when it’s in the form of an ointment. This way it has a quick and targeted effect on the problem, calming the skin and restoring its balance. CBD also soothes itchiness and redness, two of the more prominent problems of atopic dermatitis. Read how Therapeutic CBD Skin Balm was the answer for a desperate mommy looking for the solution to her son’s skin problem in this interview. Interview: Finally we have got rid of topical steroid creams.
Concentrated CBD treatment balm tackles the toughest symptoms of atopic skin, alleviates skin reactions and soothes eczema flare-ups. Reach for it when skin needs fast-acting help for inflamed, reddened and itchy conditions. It provides intense relief and unique nourishing care. Ingredients: High concentration of CBD extract is a powerful anti-inflammatory and skin-soothing properties. Hemp seed oil, rich in essential fatty acids omega 3 & 6, Vitamin E and minerals – the building blocks of healthy skin. Calendula, shea and mango butter soothe and nurture.
CBD oil is also effective with seborrheic dermatitis
Seborrheic dermatitis is a fairly common chronic inflammatory skin disease that most often affects the face and scalp area. It appears in the form of red, scaly skin on the scalp and around the hairline, often manifesting itself behind the ears and in the skin folds (elbows, knees, under the breasts). The main cause is the increased production of sebum in the sebaceous glands. CBD is a great ally in the care of seborrheic dermatitis. Why?
1. CBD slows the secretion of sebum
The most common cause of seborrheic dermatitis is the excessive secretion of sebum from the sebaceous glands. Because CBD has been proven to reduce sebum secretion, it is effective in the fight against seborrheic dermatitis. Because of this, it is also effective in treating acne and impure skin.
2. CBD slows down cell proliferation on the skin
The rapid reproduction of skin cells caused by the Malassezia fungus is another important factor in the onset of seborrheic dermatitis. Clinical studies have proven that the CBD molecule reduces sebum secretion from the sebaceous glands and inhibits the rapid reproduction of sebocytes, the cells that make up sebaceous glands and affect the onset of seborrheic dermatitis.
Why is CBD cannabinoid so effective when dealing with skin conditions?
CBD cannabinoid binds to the endocannabinoid system in our body. It contains phytocannabinoids, which are cannabinoid molecules very similar to the endocannabinoids our body contains naturally. Endocannabinoids coordinate the functions of our whole organism, helping the body when it is sick or under stress. It could be said that the endocannabinoid system is the conductor of our body, ensuring that our bodies stay in tune and work harmoniously. CBD cannabinoid is so effective in fighting skin problems because our skin has its own endocannabinoid system. This system ensures that our skin is healthy and balanced. Ointments containing CBD cannabinoid bind directly to the endocannabinoid system in the skin, helping the skin find its balance quickly and effectively.
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Relieves, protects and revitalises acutely irritated skin.
“Keeps psoriasis spots under control. . I’m fighting with my psoriasis for about 40 years now. It was CBD oil and skin balm that helped me keep it under control. Many thanks. ” – Robert W.
“It really helps the irritated and flaky atopic skin on my arms, hands and face.” – Cheryl