QIs there a need for CBD in dermatology?

Cannabidiol (CBD) is a phytocannabinoid from the cannabis plant, without the hallucinogenic properties of delta(9)-tetrahydrocannabinol (THC). Cannabinoids exert effects via a series of G-protein coupled receptors, primarily cannabinoid receptor 1 (CB1, found in the stratum spinosum and stratum granulosum) and cannabinoid receptor 2 (CB2, found in stratum basale), resulting in inhibition or activation of keratinocyte proliferation, sebum production, hair production, and inflammation. There are also novel cannabinoid receptors known collectively as the non-CB1/CB2 receptors or orphan receptors. Over the last few years two important receptors have been identified—GPR55 and GPR18. Activation of GPR18 by N-arachidonoylglycine (a metabolite of the endocannabinoid anandamide) leads to apoptosis of inflammatory leukocytes thereby dampening local inflammation. GPR55 is expressed in the central nervous system and has been identified as a possible target for the treatment of inflammation and pain. 

Cannabinoids have demonstrated anti-inflammatory and antipruritic properties and may have a role in the management of atopic dermatitis, allergic contact dermatitis, and pruritis. One study found CB1 agonists decreased mast cell recruitment and histamine concentration in the bloodstream.¹ CBD has also been shown to inhibit the migration, proliferation and cell maturation processes involved in Th12, Th1, and Th2 immune responses and induce a state of anergy via the Erg2 pathway leading to reduced T-cell activity. CBD may also inhibit inflammatory responses due to the addition of IL-17A or IFN-c, not only leading to decreased inflammation but also improved skin barrier adherence by reducing IFN-c mediated inhibition of long-chain fatty acid ceramide production in the skin. Another study found showed 38% of patients using a topical CBD-containing cream had complete resolution of itch and 81% had complete reduction of xerosis² while another study found that a CBD-derivative reduced erythema, pruritus, lichenification, and dryness associated with atopic dermatitis by 58.6% in pediatric patients with atopic dermatitis after 4-6 weeks of use.³ 

Certainly, more studies are needed to better understand how and where CBD can be used in dermatology. CBD may prove to be a more “natural” therapeutic option for dermatology patients seeking a holistic approach to their skin health needs. 

References:

1. Nam G, Jeong SK, Park BM, et al. Selective cannabinoid receptor-1 agonists regulate mast cell activation in an oxazolone-induced atopic dermatitis model. Ann Dermatol. 2016;28(1):22–29 
2. Szepietowski JC, Szepietowski T, Reich A. Efficacy and tolerance of the cream containing structured physiological lipids with endocannabinoids in the treatment of uremic pruritus: a preliminary study. Acta Dermatovenerol Croat. 2005;13(2): 97–103. 
3. Eberlein B, Eicke C, Reinhardt HW, et al. Adjuvant treatment of atopic eczema: assessment of an emollient containing Npalmitoylethanolamine (ATOPA study). J Eur Acad Dermatol Venereol. 2008;22(1):73–82.