Posted on June 9, 2018
Not all cannabinoids make people feel “high”. Best known as the main chemical agent in marijuana, THC is responsible for its psychoactive properties, which has stigmatized the plant in the minds of many people. However, cannabinoids are a diverse group of compounds that have great potential to treat many medical conditions without making the patient feel intoxicated.
There are five major cannabinoids found in marijuana:
delta (9)-tetrahydrocannabinol (THC)
Since the first human cannabinoid receptors were discovered in the late 20th century, many applications for these extracts of the cannabis plant have been found.
Of particular interest in AD are these respective cannabinoids’ anti-inflammatory and anti-itch properties. Additionally, the high safety profile and relatively low levels of cannabinoids needed to have an effect on the skin result in low systemic absorption into the bloodstream, which eliminates the risk of potential intoxication from THC.
How does cannabis help eczema?
It has long been observed that cannabinoids possess anti-inflammatory, antimicrobial and anti-itch qualities, but not until recently has high-quality research been published to understand the physiological effects underlying these anecdotal reports.
Dr. Henry Granger Piffard, MD (1842-1910), was one of the founders of American dermatology. He was the founding editor of the Journal of Cutaneous and Venereal Diseases, known by its current name, JAMA Dermatology.
The first textbook of dermatologic therapeutics was also written by Piffard. In it he notes, “a pill of cannabis indica at bedtime has at my hands sometimes afforded relief to the intolerable itching of eczema.” Since then, there have been myriad studies published on the potential benefits of cannabinoids in skin conditions.
Many features of AD contribute to itch, particularly dry skin, histamine release and sensory nerve fibers. Cannabinoids, however, have a powerful anti-itch effect. There are receptors in the skin that interact with cannabinoids that could reduce the symptoms and appearance of AD. These effects happen through a constellation of interactions between phytocannabinoids and our endogenous cannabinoid system.
Another way cannabinoids hold promise as a treatment are through management of Staphylococcus aureus colonization, which is both a complication and a driving factor of AD.
The antimicrobial characteristics of cannabinoids have been referenced since the 1980s, but a more detailed analysis of individual cannabinoids found that all five major cannabinoids showed potent activity against a variety of S. aureus strains.
What does this mean? Cannabinoids have an anti-microbial effect, but more testing is needed to understand the risks and benefits of cannabinoids in dermatology.
Cannabinoids also exhibit anti-inflammatory properties. Researchers demonstrated that topical THC suppresses allergic contact dermatitis in mice by activating CB1 receptors. Other molecules, similar to those present in cannabis, have also demonstrated significant anti-pain properties in rat models.
There are reports of direct improvement of AD with topical cannabinoids. A recent study demonstrated that a molecule interacting with the endocannabinoid system inhibited mast cell activation. Mast cells are immune cells that release histamine when activated, which leads to intense itching and inflammation.
In a human trial for patients with AD, an endocannabinoid cream improved severity of itch and loss of sleep by an average of 60 percent among subjects. Twenty percent of subjects were able to stop their topical immunomodulators, 38 percent ceased using their oral antihistamines, and 33.6 percent no longer felt the need to maintain their topical steroid regimen by the end of the study.
The future of cannabis creams for eczema
For eczema patients, extra caution should be taken because a variety of known irritants are very prevalent in many “weed creams”. The indiscriminate addition of terpenes that can be irritating are often included in these formulations.
Special attention should be given to choosing a product to ensure that only non-irritating terpenes are included in the formula. Topicals should be chosen based on the profile of ingredients that are known to reduce pain, inflammation and irritation for the skin, not formulations that may have been developed for muscle and joint pain. Additionally, excess solvents from the manufacturing process could also be present.
With 29 states and counting having some form of legalization of medical marijuana, this means that there are at least 29 state regulatory schemes.
To further complicate things, hemp-based products (low THC varieties) can be purchased online and have virtually no regulatory oversight for potency, consistency or contaminants including pesticides and metals.
Incorrect dosing and inaccurate labeling has plagued the industry since inception. A recent study by Penn State University determined that up to 70 percent of online CBD products are inaccurately labeled.
Until clinical data is created for specific products, the best advice may be to pay special attention to the ingredient lists and make sure that products are tested by a third-party laboratory instead of the manufacturer themselves. State markets with dispensaries typically regulate testing, which is an added consumer protection compared to purchasing a product on the internet.
Cannabinoids represent an exciting prospect for the future of AD therapy. With measurable anti-itch, anti-pain, anti-microbial and anti-inflammatory properties, the effect of cannabinoids in patients with AD has already begun to be demonstrated.
Survey data released last week by the Colorado Department of Public Health and Environment (CDPHE) indicate that marijuana use among high school students continues to decline, despite warnings that legalization would make pot more appealing to teenagers. In the 2013 Healthy Kids Colorado survey, 37 percent of high school students reported that they had ever tried marijuana, down from 39 percent in 2011. The percentage who reported using marijuana in the previous month (a.k.a. "current" use) also fell, from 22 percent in 2011 to 20 percent in 2013.
Three executives of a Surrey, B.C. farm equipment company on their way to the U.S. to discuss the design of a bud trimming machine were grilled for six hours at the border in April and slapped with lifetime bans on entering the United States.
Disclaimer: The information provided in this article has not been evaluated or approved by the U.S. Food and Drug Administration (FDA). It is not medical advice. If you are considering making any changes to your lifestyle, diet or nutrition, you should consult with your doctor or other health care provider. Conflicts of interest statement: Helena Yardley, Ph.D. and Jon Fernandez, SVP are employees of Franklin BioScience, the manufacturer of Altus products. Peter Lio, M.D. is on the advisory board of Franklin BioScience.