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Can CBD help relieve psoriasis? Scientific evidence and how to use it

Learn about the newest studies con CBD & Psoriasis and how CBD’s action on our Endocannabinoid system and anti-inflammatory action could relieve psoriasis.

Can CBD help relieve psoriasis? Scientific evidence and how to use it
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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)
  • Guttate
  • Inverse
  • Pustular
  • Erythrodermic
  • Nail
  • Arthritic

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 our neuro-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 properties of 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?”.

CBD’s effects on psoriasis: clinical & scientific studies

In the last 15 years there have been more clinically backed trials to investigate CBD’s potential use as a treatment for psoriasis. At the moment there are four interesting ways that CBD has been researched to help in psoriasis treatments.

  1. Regulating skin cell growth: In a 2007 study, cannabinoids, including CBD, showed a promising ability to inhibit hyper-proliferation of skin cells, one of the root causes of psoriasis.(5) This could potentially minimize the buildup of skin cells, decreasing psoriasis plaques.
  2. As an anti-inflammatory: CBD’s potent anti-inflammatory effect has sparked interest for dermatological issues related to overactive inflammation responses. (6)
  3. For pain management: CBD’s well known activity as an analgesic has made it an interesting option for those with arthritic psoriasis, studies are undergoing.
  4. As an antioxidant: Psoriasis has shown to be influenced as well by oxidative stress, thus it’s potent antioxidant properties have also been studied for decreasing oxidative stress.(7)
  5. Regulating neuro-endocrine immune network: As mentioned above, Cannabinoids have shown possible modulation in our neuro-endocrine immune network, a key factor in the erroneous response which causes psoriasis.(2)

At the moment there are a variety of clinical trials underway, most topical and internal. According to M.D. Hervé Damas, “Depending on the severity of the disease, I will use either topical creams or a combination of topical and systemic treatments.”   Graphic Psoriasis and CBD: CBD helps break the cycle of overactive immune response and inflammation reducing the symptoms which create the most discomfort There are ongoing trials like the double-bind randomized trial taking place in Aalborg University in Denmark to relieve Arthritic psoriasis in hands. This particular case has been using ingested 10 mg CBD tablets, once a day for two weeks and then 2 times a day for 2 weeks and if results are not presented 3 times a day, a total of 30 mg.(8) There have also been clinical cases with different ointments and salves. In an study completed in 2019 Israeli study, completed in 2019, they used a combination CBD & THC to study to the maximum dose possible, sadly the results have not been shared. (9) In another 2019 study conducted in Italy, CBD-enriched ointments were used to study the anti-inflammatory effects and possibilities of improving the quality of life in patients with dermatitis (5 patients), psoriasis(5 patients) and cutaneous scars(10 patients). The results were optimistic however with such a small sample size, and no placebo control, it’s hard to find conclusive evidence.(10) 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?”.

Kinds of psoriasis where CBD could be an ally

One of the most interesting studies for psoriasis and CBD is in the treatment of Arthritic psoriasis. Nearly 1 in 3 people with psoriasis will develop Arthritic psoriasis in their lifetime. The inflammation caused by psoriasis can affect different organs and tissues of our body, and it can especially affect our joints, causing inflamed and stiff joints, resembling arthritis. Treating PsA early on can help prevent permanent joint damage. CBD’s analgesic and anti-inflammatory activity can calm and relieve pain inflicted by arthritic psoriasis.

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.

Dosage

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.

Complementary habits

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

Precautions

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)

Side effects

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. In 2019 Lekhram Changoer Lekhram and George Anastassov were awarded a patent for their topical six week treatment of CBD & 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.  

Bibliography

  1. Stern RS, Nijsten T, Feldman SR, Margolis DJ, Rolstad T. Psoriasis is common, carries a substantial burden even when not extensive, and is associated with widespread treatment dissatisfaction. J Investig Dermatol Symp Proc. 2004;9(2):136-139.
  2. Cintosun A, Lara-Corrales I, Pope E. Mechanisms of Cannabinoids and Potential Applicability to Skin Diseases. Clin Drug Investig. 2020 Apr;40(4):293-304. doi: 10.1007/s40261-020-00894-7. PMID: 32060787.
  3. Bíró T, Tóth BI, Haskó G, Paus R, Pacher P. The endocannabinoid system of the skin in health and disease: novel perspectives and therapeutic opportunities. Trends Pharmacol Sci. 2009;30(8):411-420. doi:10.1016/j.tips.2009.05.004
  4. Sheriff T, Lin MJ, Dubin D, Khorasani H. The potential role of cannabinoids in dermatology. J Dermatolog Treat. 2019 Oct 10:1-7. doi: 10.1080/09546634.2019.1675854. Epub ahead of print. PMID: 31599175.
  5. Wilkinson JD, Williamson EM. Cannabinoids inhibit human keratinocyte proliferation through a non-CB1/CB2 mechanism and have a potential therapeutic value in the treatment of psoriasis. J Dermatol Sci. 2007 Feb;45(2):87-92. doi: 10.1016/j.jdermsci.2006.10.009. Epub 2006 Dec 6. PMID: 17157480.
  6. Scheau C, Badarau IA, Mihai LG, Scheau AE, Costache DO, Constantin C, Calina D, Caruntu C, Costache RS, Caruntu A. Cannabinoids in the Pathophysiology of Skin Inflammation. Molecules. 2020 Feb 4;25(3):652. doi: 10.3390/molecules25030652. PMID: 32033005; PMCID: PMC7037408.
  7. Jarocka-Karpowicz, I.; Biernacki, M.; Wroski, A.; G.gotek, A.; Skrzydlewska, E. Cannabidiol Effects on Phospholipid Metabolism in Keratinocytes from Patients with Psoriasis Vulgaris. Biomolecules 2020, 10, 367.
  8. CBD Treatment in Hand Osteoarthritis and Psoriatic Arthritis. Sponsor: Aalborg University Hospital. 2019-2020.
  9. A Phase I, Double Blind, Randomized, Placebo Controlled, Maximal Dose Study to Determine the Safety, Tolerability of Topical Cream Containing MGC (Medical Grade Cannabis) in Healthy Volunteers. Sponsor: One World Cannabis Ltd. 2016-2019
  10. Palmieri B, Laurino C, Vadalà M. A therapeutic effect of cbd-enriched ointment in inflammatory skin diseases and cutaneous scars. Clin Ter. 2019 Mar-Apr;170(2):e93-e99. doi: 10.7417/CT.2019.2116. PMID: 30993303.
  11. Brown JD, Winterstein AG. Potential Adverse Drug Events and Drug-Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use. J Clin Med. 2019;8(7):989. Published 2019 Jul 8. doi:10.3390/jcm8070989
  12. Sarrafpour, S., Urits, I., Powell, J. et al. Considerations and Implications of Cannabidiol Use During Pregnancy. Curr Pain Headache Rep 24, 38 (2020).

Christina Schwertschlag (Author)

Christina dedicates her time to research and development in the cannabis world. With experience in design, innovation and sustainability projects, she seeks to unite different entities in the cannabis world to help destigmatize the plant and make it more accessible to users.

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Joanna Kreitinger (Reviewer)

Joanna Kreitinger is a cellular biologist and immunologist currently leading dermatology and autoimmune disease research for the treatment of inflammatory skin conditions. Throughout her training and career, Joanna has been committed to understanding the ways in which exposure to pollutants, pathogens, and plant-derived chemicals can suppress the human immune system, with keen interest in harnessing these mechanisms for translational therapeutics to treat autoimmune diseases.

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