Cannabinoids like CBD, THC and CBG have shown an array of promising properties for skin afflictions like eczema, atopic dermatitis, acne, itch and rosacea, as well as for psoriasis.
CBD (Cannabidiol) is a promising cannabinoid with, to name a few, regulating, analgesic, anti-inflammatory, antipruritic and antioxidant properties.
Though CBD research is still very young, many researchers are excited about it’s myriad of properties, internally and externally used, to treat pathologies from anxiety to cutaneous conditions like psoriasis.
In this article we will briefly explain the findings on CBD & psoriasis and how this hemp-derived cannabinoid could be used as a treatment to regulate and relieve symptoms of this skin affliction, which to this day still has no known cure.
What is psoriasis?
Psoriasis is a chronic, genetically predisposed, but environmentally triggered auto-immune disease which affects our skin. It is characterized by inflammation caused by an erroneous response by our immune system. The inflammation commonly appears as red and scaly plaques. According to the World Psoriasis Day consortium, psoriasis affects almost 2-3% of the world population. Psoriasis is a severe skin disease which, according to statistics collected by the World Psoriasis Consortium, negatively affects the quality of life of 60% of those with this disease (1).
Why does this happen?
Psoriasis is caused by an overactive immune system which speeds our skin cell growth (or turnover), also known as a dysregulation of keratinocyte differentiation or hyperkeratinization disorder. Healthy skin cells usually grow and shed throughout a month’s time, giving space for new skin cells. However psoriasis speeds skin cell differentiation to up to 3-4 days not giving the skin cells enough time to shed. Skin cells thus accumulate and create plaques which are not supple like healthy skin but instead crack and break open leading to irritation, itching, stinging, and burning. The most common spots for psoriasis are the elbows, knees and scalp, however psoriasis can appear in any part of the body. According to the National Psoriasis Institute, psoriasis can manifest itself in two peaks, the first being between the ages 15-25 and the second between the ages of 50-60. These two age groups happen to be prominent hormonal/endocrine shifts as well…food for thought. There are a variety of different kinds of psoriasis:
Plaque (Most common)
Currently the most common treatments for psoriasis, according to Mayo Clinic, are:
Topical therapies (including Corticosteroids, Calcineurin inhibitors, Coal tar treatment)
Light Therapy (UVB, Laser therapy)
Oral or Injected therapies* (Retinoids, Steroids, Biologics which alter our immune system).
*Systemic therapies can have very severe side effects.
So how come cannabinoids can help our skin?
In the last 50 years scientific research on Cannabis has grown quickly, starting from Mechoulam’s synthesis of CBD & THC to the discovery of our Endocannabinoid System in the endocannabinoids in the 1990’s. CBD’s anti-inflammatory, antipruritic(anti-itch), antioxidant, antitumoral and analgesic properties have sparked interest in researchers’ as an alternative or complement to traditional treatments. Offering fewer side effects, helping prevent flare ups and managing pain and discomfort. As usual, the best explanation will start with our Endocannabinoid System. The skin is an extremely important and overlooked organ, it’s crucial in protecting ourselves from external factors. It also is a part of our neuro-endocrine immune network (a network connecting our nervous, endocrine and immune systems), which, surprise surprise, our Endocannabinoid System (ECS) regulates. This means that stimuli received by our skin can influence our endocrine, immune and nervous systems, which can all be regulated by our ECS. New data shows that most cells in the skin highly express cannabinoid receptors and suppression of skin inflammation is considered a leading function of dermal ECS. Cannabinoids may be involved in the modulation of our skin’s functions through ourneuro-endocrine immune network, however their role in dermatological conditions is still unclear. (2) What many studies have pointed to is that the Endocannabinoid Systems’ unbalance or dysregulation could be a key factor in dermatological afflictions.(3) Raphael Mechoulam, the father of cannabis research, said it as well, “The endocannabinoid system is very important. Almost all illnesses we have are linked to it in some way or another. And that is very strange.” In 2019, a study confirmed that more research was necessary but that the anti-inflammatory, antipruritic, anti-aging, and anti-malignancy propertiesof cannabinoids and their interaction with the Endocannabinoid System in our skin was likely to signal that cannabinoids could be “promising alternatives to traditional treatments.”(4) This has led researchers to investigate the possible use of cannabinoids for relieving serious cutaneous conditions including; Atopic Dermatitis, Eczema, Acne Vulgaris and Psoriasis. If you want to know more about our Endocannabinoid System’s relationship with our skin, check out our article “Why is CBD beneficial for our skin?”.
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En 2019, un estudio confirmó que se necesitaban más investigaciones, pero que las propiedades de los cannabinoides y su interacción con el sistema endocannabinoide en nuestra piel probablemente indican que podríamos estar ante "alternativas prometedoras a los tratamientos tradicionales”. (4)
Esto ha llevado a los investigadores a investigar el posible uso de cannabinoides para aliviar afecciones cutáneas graves como; dermatitis atópica, eczema, acné y psoriasis.
Efectos del CBD en psoriasis: estudios clínicos y científicos
En los últimos 15 años se han realizado multitud de ensayos respaldados clínicamente para investigar el uso potencial del CBD como tratamiento para la psoriasis. De momento, hay cuatro importantes hallazgos en cuanto a cómo puede influir el CBD para ayudar en los tratamientos de la psoriasis.
Regulación del crecimiento de las células de la piel: en un estudio de 2007, los cannabinoides, incluido el CBD, mostraron una capacidad prometedora para inhibir la hiperproliferación de las células de la piel, una de las causas fundamentales de la psoriasis. (5) Esto, potencialmente, podría minimizar la acumulación de células de la piel, disminuyendo placas de psoriasis.
Como antiinflamatorio: el potente efecto antiinflamatorio del CBD ha despertado interés por los problemas dermatológicos relacionados con las respuestas inflamatorias hiperactivas. (6)
Para el manejo del dolor: la conocida actividad del CBD como analgésico lo ha convertido en una opción interesante para las personas con psoriasis artrítica, actualmente se están realizando estudios clínicos.
Como antioxidante: se ha demostrado que la psoriasis también está influenciada por el estrés oxidativo, por lo que sus potentes propiedades antioxidantes también se han estudiado para disminuir el estrés oxidativo. (7)
Regulación de la red inmune neuroendocrina: como se mencionó anteriormente, los cannabinoides han mostrado una posible regulación de nuestra red inmune neuroendocrina, un factor clave en la respuesta errónea que causa la psoriasis. (2)
En este momento hay una variedad de ensayos clínicos en curso, la mayoría utilizan exclusivamente el CBD de forma tópica o interna. Según M.D. Hervé Damas, "Dependiendo de la gravedad de la enfermedad, se usarán cremas tópicas o una combinación de tratamientos tópicos y sistémicos."
Un ejemplo prometedor es el ensayo que se está llevando a cabo en la Universidad de Aalborg en Dinamarcapara aliviar la psoriasis artrítica en las manos. Este caso particular ha estado usando tabletas de CBD de 10 mg ingeridas, una vez al día durante dos semanas y luego 2 veces al día durante 2 semanas. Si no se presentan resultados la dosis sube a 10 mg 3 veces al día, un total de 30 mg. (8)
También ha habido casos clínicos con diferentes pomadas y ungüentos. En un estudio israelí, completado en 2019, utilizaron una combinación de CBD y THC para estudiar hasta la dosis máxima posible; desafortunadamente, los resultados no se han compartido. (9)
En otro estudio de 2019 realizado en Italia, se utilizaron pomadas enriquecidas con CBD para estudiar los efectos antiinflamatorios y las posibilidades de mejorar la calidad de vida en pacientes con dermatitis (5 pacientes), psoriasis (5 pacientes) y cicatrices cutáneas (10 pacientes). Los resultados fueron optimistas; sin embargo, con un tamaño de muestra tan pequeño y sin un grupo de control, es difícil encontrar evidencia concluyente. (10)
Tipos de psoriasis donde el CBD podría ser un aliado
Uno de los estudios más interesantes para la psoriasis y el CBD se encuentra en el tratamiento de la psoriasis artrítica.
Casi 1 de cada 3 personas con psoriasis desarrollará psoriasis artrítica (PsA) en su vida. La inflamación provocada por la psoriasis puede afectar a diferentes órganos y tejidos de nuestro cuerpo, y puede afectar especialmente a nuestras articulaciones, provocando inflamación y rigidez, parecidas a la artritis. El tratamiento temprano de la PsA puede ayudar a prevenir el daño articular permanente.
La actividad analgésica y antiinflamatoria del CBD puede calmar y aliviar el dolor causado por la psoriasis artrítica.
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Cases in which CBD has not been helpful
CBD can help relieve symptoms and regulate our immune system, however some forms of psoriasis are extremely severe and research is still lacking to support the sole use of CBD to help these forms of psoriasis. At the moment the most we know on this subject is that not using your prescribed medication while using CBD can cause flare ups to come back and at the moment CBD has not been researched enough to prove to be functional alone, in severe cases.
How to use CBD to help treat psoriasis
So if you have decided to use CBD to treat psoriasis, here is how to do it safely.
Route of administration
Based on current clinical trials, it seems as though CBD is best to be used internally* and externally. Ingested use, or internal use which reaches the bloodstream, could be done with a tablet, a transdermal patch or with CBD oils, sublingually. Sublingual administration is one of the most common uses of CBD oils for its rapid effect, as it reaches the bloodstream quickly.
Topical application will not reach the bloodstream but can offer much needed relief. CBD enriched ointments and salves can help as well as oils. *Internal use is not regulated in Spain, however is quite common in places like EEUU and the UK.
According to the conclusions of a study from the Alborg University in Denmark, one could start with 10 mg a day and raise the dose, from once a day to twice a day after 2 weeks.
Topical application will not reach the bloodstream but can offer much needed relief. CBD enriched ointments, salves and oils can help.
CBD nor any medication are cure-alls and should always be accompanied by complementary habits. The Mayo Clinic’s list of complementary therapies is a great way to start implementing habits which could help relieve psoriasis symptoms:
Take daily baths (Epsom Salts, Bath oils and colloidal oatmeal can help)
Use moisturizer, always + Oils to trap in moisture
Cover the affected areas overnight
Expose your skin to small amounts of sunlight, a tiny bit of Vitamin D can help!
Apply medicated ointments
Avoid psoriasis triggers (Infections, injuries to your skin, stress, smoking and intense sun exposure)
Avoid drinking alcohol
Strive to maintain a healthy lifestyle. In addition to quitting smoking and drinking moderately, if at all, you can manage your psoriasis by being active, eating well and maintaining a healthy weight
CBD can have interactions with certain medications due to its inhibition of an enzyme, responsible for metabolizing certain medications. One should also always check with their doctor to make sure there are no interactions between their current medication and CBD.(10) It is also important for anyone that is pregnant or breastfeeding to discuss CBD use with their doctor as CBD can cross the placenta and can accumulate in breastmilk.(12)
CBD’s known side effects are known to be low to moderate and include: drowsiness, dry mouth, dizziness and loss of appetite.
Conclusion: So will CBD work for psoriasis or not?
At the moment, like most data on CBD, it is too early to make conclusive claims however what is clear is that CBD and other cannabinoids pose a promising future for certain dermatological diseases, especially those which are auto-immune and cause inflammation.
At the moment some experts see a bright future, however many others are skeptical. Jordan Tishler, MD and physician said to Health Magazine, “The effects of cannabis are relatively weak compared to topical steroids like hydrocortisone.
In short, at this time I would not recommend any topical cannabis or CBD products to treat a serious illness like psoriasis.” However others have been granted patents to continue the study and use of cannabidiol and even other cannabinoids, like Cannbigerol, CBG.
We can hope that studies will continue so we can have more information about this up-and-coming cannabinoid and the many other promising substances that the Cannabis Sativa L plant has to offer! We can hope that studies will continue so we can have more information about this up-and-coming cannabinoid.
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