Skin diseases are ranked the fourth most common cause of human illness worldwide, resulting in an enormous global health burden. Some believe the problem may be even more widespread, because many affected people do not consult a healthcare provider for treatment and their cases are therefore unreported and not included in statistics.
Several chronic and debilitating skin disorders are surprisingly common.
According to the American Academy of Dermatology,
- Acne is the most common skin condition in the United States, affecting up to 50 million Americans annually. Its occurrence in adults is increasing, affecting up to 15 percent of women.
- One in 10 people will develop atopic dermatitis during their lifetime. This condition affects up to 25 percent of children and 2 to 3 percent of adults.
- Approximately 7.5 million people in the United States have psoriasis. Around 25-30 percent of people with psoriasis experience joint inflammation that produces symptoms of arthritis (this condition is called psoriatic arthritis).
Unfortunately, many pharmaceutical medications for skin conditions come with serious side effects, and some aren’t very effective. Still others are not meant for long-term use, even though many skin disorders are life-long afflictions.
Thankfully, cannabinoids including CBD are showing more and more promise in the management of skin-related concerns. Not only can CBD provide relief for many symptoms associated with skin disorders, it contains antioxidants and appears to protect the skin and repair damage from UV rays and environmental pollutants.
Cannabinoids have potent anti-bacterial, antipruritic (anti-itch), antinociceptive (pain sensation), pain-relieving, and anti-inflammatory properties, so it is no wonder they can provide therapeutic benefits to those with skin disorders.
An important note: Nothing in this article should be considered medical advice. This guide is for informational purposes only. CBD is a very safe substance and is generally well tolerated. However, it can interfere with certain medications. Please consult with your healthcare practitioner before taking CBD, especially if you are taking medication or have serious health concerns.
A growing body of research shows cannabinoids may provide relief for a wide range of skin conditions.
Of particular interest in dermatology is CBD’s application for inflammation, the immune system, and skin homeostasis. According to a 2018 report published by Practical Dermatology,
Applications for cannabis have been explored in many conditions including anorexia, chronic pain, nausea, spasticity, atherosclerosis, autoimmune disorders, inflammatory bowel disease, multiple sclerosis, and tumorigenesis.
Cannabinoids have sought a place in dermatological disorders as well, including use in acne, eczematous disorders, lichen simplex, melanoma and nonmelanoma skin cancer, melasma, prurigo, pruritus, psoriasis, scleroderma and systemic sclerosis, and seborrheic dermatitis.
That report goes on to explain that CBRs (cannabinoid receptors) have been found in keratinocytes and on peripheral nerve fibers, and that this distribution may play an important role in skin disease therapy.
Keratinocytes constitute 90% of the cells of the epidermis, the outermost layer of the skin. The primary function of keratinocytes is the formation of a barrier against environmental damage by pathogenic bacteria, fungi, parasites, viruses, heat, UV radiation, and water loss. Once pathogens start to invade the upper layers of the epidermis, keratinocytes can react by producing pro-inflammatory mediators, particularly chemokines. Chemokines are small protein molecules that are produced by the cells of the immune system. These act as chemoattractants, leading to the migration of immune cells to an infection site so they can target and destroy invading bodies such as microbes.
“Early research demonstrated that cannabinoids act upon CBRs, but newer studies have demonstrated their wide array of associations with other channels and receptors, such as TRPV1, GPR55, PPAR-γ, PPAR-α, as well as their direct effects on keratinocytes independent of CBRs, opening up even more potential targets in dermatological disease treatments,” the report states.
Tina Alster, M.D., clinical professor of dermatology at Georgetown University Medical Center in Washington, DC, recently discussed the use of CBD for skin health with Dermatology Times. She explained that CBD has anti-inflammatory properties that can benefit the skin, and that it can reduce oil production, provide moisture, and relieve pain and itching:
“Topical CBD is safe and works effectively for all skin types. The products are easy to administer. Sufferers of serious medical skin conditions and those who are seeking innovative skincare options can benefit from topical CBD use,” Dr. Alster says. “Anti-inflammatory properties associated with CBD are beneficial in treating such dermatologic conditions as acne, psoriasis, and eczema due to reduction of dryness, irritation and redness. CBD-containing creams, oils, gels and serums not only moisturize and soothe the skin but are also showing encouraging results in relieving pain caused by certain skin disorders.”
A small study (20 participants observed for 3 months) conducted in Italy in 2019 found that topical CBD improved symptoms and quality of life in people with four skin disorders: atopic dermatitis, psoriasis, cutaneous blemishes, and acne scars.
In a very detailed 2019 study titled Cannabinoid Signaling in the Skin: Therapeutic Potential of the “C(ut)annabinoid” System, researchers explain that cannabinoid receptors CB1 and CB2 are expressed in bodily tissues, including the skin:
Although the best-studied functions over the ECS are related to the central nervous system and to immune processes, experimental efforts over the last two decades have unambiguously confirmed that cutaneous cannabinoid (“c[ut]annabinoid”) signaling is deeply involved in the maintenance of skin homeostasis, barrier formation and regeneration, and its dysregulation was implicated to contribute to several highly prevalent diseases and disorders, e.g., atopic dermatitis, psoriasis, scleroderma, acne, hair growth and pigmentation disorders, keratin diseases, various tumors, and itch.
That study goes on to explain that
several lines of evidence demonstrate that both endogenous and phytocannabinoids can exert various biological effects in the skin, implicating cannabinoid signaling as a key contributor to cutaneous homeostasis. The presence of different eCBs (endocannabinoids), cannabinoid receptors, as well as other members of the ECS has already been shown on many different cell types of the skin, including, but not limited to epidermal keratinocytes, melanocytes, mast cells, fibroblasts, sebocytes, sweat gland cells, as well as certain cell populations of hair follicles. (source)
The conclusion of that study says
Although the most prevalent dermatological disorders are usually not directly life-threatening ones, their symptoms can dramatically impair quality of life of millions of patients worldwide. As discussed above, research efforts of the past two decades have undoubtedly proven that cannabinoid signaling profoundly influences several aspects of the cutaneous biology, and its dysregulation is likely to contribute to the pathogenesis of several skin diseases.
(To learn more about cannabinoids, cannabinoid receptors, and the endocannabinoid system, click here: Everything You Need to Know About the Endocannabinoid System.)
A 2018 research review published in Dermatology Online Journal states that the researchers “found that cannabinoid products have the potential to treat a variety of skin conditions, including acne vulgaris, allergic contact dermatitis, asteatotic dermatitis, atopic dermatitis, hidradenitis suppurativa, Kaposi sarcoma, pruritus, psoriasis, skin cancer, and the cutaneous manifestations of systemic sclerosis.”
Embedded in that review is a table that provides a summary of skin diseases that may benefit from treatment with cannabinoids. To view the table, click here and scroll to page 11: Cannabinoids in dermatology: a scoping review
To gain a better understanding of the skin’s endocannabinoid system, take this virtual tour from Phytecs.
Note: Scroll inside of the window in order to view the skin virtual tour.
Cannabinoids appear to provide relief for itchy skin.
A 2017 study published in the Journal of the American Academy of Dermatology found that cannabinoids may be effective against eczema, psoriasis, atopic dermatitis, and contact dermatitis.
“Perhaps the most promising role for cannabinoids is in the treatment of itch,” said the study’s senior author Dr. Robert Dellavalle, MD, associate professor of dermatology at the University of Colorado School of Medicine, in a press release:
He noted that in one study, eight of 21 patients who applied a cannabinoid cream twice a day for three weeks completely eliminated severe itching or pruritus. The drug may have reduced the dry skin that gave rise to the itch.
Dellavalle believes the primary driver in these cannabinoid treatments could be their anti-inflammatory properties. In the studies he and his fellow researchers reviewed, they found that THC (tetrahydrocannabinol) the active ingredient in marijuana, reduced swelling and inflammation in mice.
At the same time, mice with melanoma saw significant inhibition of tumor growth when injected with THC.
“These are topical cannabinoid drugs with little or no psychotropic effect that can be used for skin disease,” Dellavalle said.
Other studies on cannabinoids for various skin conditions
Acne is a condition that occurs when excess oil, dirt, and dead skin cells clog pores. The bacteria Propionibacterium acnes can build up in the pores, causing angry, red blemishes.
Treatment involves keeping the skin clean and free from acne-causing bacteria, and cutting back on excess oil that can clog pores.
Most of the research surrounding acne and CBD is related to CBD’s power in stopping the processes known to cause acne, such as excess oil buildup. One of the most promising studies was published in 2014 in The Journal of Clinical Investigation.
For this study, researchers measured the effects of CBD compounds on human skin samples and oil-producing glands in a laboratory.
The researchers found that CBD inhibited oil production and also had anti-inflammatory effects on oil-producing glands. The study authors wrote that CBD is a potent “universal” anti-acne agent, possessing a unique “triple anti-acne” profile. “These data, together with our current findings, point to a promising, cost-effective, and, likely, well-tolerated new strategy for treating acne vulgaris, the most common human skin disease,” they concluded.
While taking CBD internally was shown to provide benefit, the study authors wrote that the CBD doses that exerted the most robust effects in their research “could easily be achieved after topical CBD application.”
Other studies have found that CBD has antibacterial and antifungal properties. These effects may help reduce infections from dirt and other pollutants on the skin. A recent study found that CBD is remarkably effective at killing a wide range of Gram-positive bacteria (Propionibacterium acnes – also known as Cutibacterium acnes – is a Gram-positive bacterium).
In a 2010 report titled Cannabidiol as a Treatment for Acne?, author Fred Gardner (co-founder of Project CBD and editor of O’Shaughnessy’s, the journal of cannabis in clinical practice) wrote that “the sebaceous glands and hair follicles (which also produce oil) have endocannabinoid receptors, as do the surface keratinocytes.” For that report, he spoke with researcher Tamas Biro (one of the scientists who conducted the 2014 study and the 2019 study referenced in this article). Here’s a fascinating excerpt from that report:
CBD, he [Biro] hastened to add, “is very efficient —actually, in our model system, it was much more efficient than the Vitamin A derivatives like Accutane. Of further importance, CBD was universally inhibitive of lipid synthesis. It was able to inhibit not only the actions of endocannabinoids but also the effects of other inflammatory mediators such as steroid hormones that stimulate fat production in these cells.
“Another important result: we found that low concentrations of CBD were very effective in inhibiting lipid synthesis but did not affect the viability of cells. This was also in contrast to the effects of Vitamin A derivatives which inhibit the fat production of sebocytes by killing them.”
We asked Biro what happens to the normal cells surrounding the zit? He said, “We found that at the right nontoxic concentration, CBD doesn’t suppress basal lipid synthesis in normal cells. Why bother those guys that are okay? It would create dry skin. Dry skin and itching —that’s also impairment of quality of life. At the right concentration you get only the cells that are pathologically increased.”
Atopic Dermatitis and Eczema
Eczema is the name of a group of conditions that cause the skin to become red, itchy, cracked, and inflamed. It is very common. In fact, more than 30 million Americans have some form of eczema, according to the National Eczema Association.
There are several types of eczema. Atopic Dermatitis (AD) is the most common, and unfortunately, is often severe.
There are numerous treatment options for eczema, but there is no cure. Conventional treatments such as topical steroid creams (corticosteroids) have shown mixed results and come with undesirable side effects.
Here’s an interesting historical fact, shared by the National Eczema Association,
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.”
Skin colonization with Staphylococcus aureus is prevalent in children and adults with AD, and can aggravate skin inflammation, as a 2011 article explains:
The bacterial colonization is well recognized as an important exacerbation factor that can promote AD flare-up. The density of S aureus has been shown to correlate with cutaneous inflammation and severity of eczema.
Staphylococcus aureus–associated resistance has been recognized as a growing problem. A report indicated that resistance levels to fucidin increased from 2% in the past decade to 10% to 38%. In the face of increased prevalence of antibiotic resistance and the lack of satisfactory data on benefits, long-term use of systemic or topical antibiotics for AD is not recommended.
According to Merck Manuals
Skin infections are the most common form of staphylococcal disease. Superficial infections may be diffuse, with vesicular pustules and crusting (impetigo) or sometimes cellulitis, or focal with nodular abscesses (furuncles and carbuncles). Deeper cutaneous abscesses are common. Severe necrotizing skin infections may occur.
S aureus is a Gram-positive bacteria, and as mentioned in the Acne section of this article, a recent study found that CBD is remarkably effective at killing a wide range of Gram-positive bacteria, including types of staph and strep bacteria – as well as strains that have become resistant to other antibiotic drugs.
As explained earlier in this article, cannabinoids have powerful anti-itch and anti-inflammatory properties.
According to the National Eczema Association,
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.
Eczema patients should be careful when using CBD products topically, as many contain ingredients that may irritate the skin. Products that do not contain terpenes may be a better choice for this reason, as the compounds may cause irritation. Combining pure CBD powder with your choice of carrier oil (like coconut or olive oil) or another moisturizing base may be a good option. As always, consult with your health care provider for guidance.
Epidermolysis bullosa (EB) is a group of rare genetically inherited diseases involving connective tissue failure and blistering skin. EB is difficult to manage due to skin fragility and repeated wound healing which causes itching, pain, limited mobility, and recurrent infections.
The findings of two studies suggest that CBD may provide some relief for those suffering from the condition. A 2018 case study published in Pediatric Dermatology observed three children with epidermolysis bullosa who self-initiated use of topical CBD. One patient was able to completely cease their oral opioid analgesics (pain relievers), while all three reported faster wound healing, less blistering, and pain relief.
The other study, published in the British Journal of Dermatology in 2018, observed three adults with EB. All three patients reported improved pain scores, reduced pruritus (itching), and reduction in overall analgesic drug intake with oral CBD use.
Psoriasis occurs due to rapid overproduction of skin cells that build up on the surface of the skin. Occasionally the skin patches can crack and bleed. People with psoriasis may also experience swelling and inflammation in other parts of the body (this condition is called psoriatic arthritis). Note – My interest in CBD began over 3 years ago when I used it for a psoriatic arthritis flare. You can read about my personal experience here: I Tried CBD Oil For My Psoriatic Arthritis. Here’s What Happened.
Conventional treatment for psoriasis includes steroid creams, occlusion (covering treated areas), light therapy, and oral medications including biologics. However, all of these treatment options require long-term administration, which results in them becoming less effective over time (not to mention possible unpleasant side effects).
A small 2019 study found that applying topical CBD helped relieve symptoms in participants who had the disorder.
Endocannabinoid system dysfunction (as in Clinical Endocannabinoid Deficiency) appears to be involved in the development of psoriasis. Some studies have found that several important “cannabinoid- relevant” genes were differentially expressed in people with psoriasis.
Anandamide, an endogenous cannabinoid receptor ligand, inhibits epidermal keratinocyte differentiation – and psoriasis happens to be an inflammatory disease characterized in part by epidermal keratinocyte hyper-proliferation (the skin cells multiply too rapidly, in other words).
Several studies have found that cannabinoids can “shut off” the receptors that cause this excess skin cell buildup. A study conducted in 2007 found that “cannabinoids inhibit keratinocyte proliferation, and therefore support a potential role for cannabinoids in the treatment of psoriasis.” And, a study published in the journal PeerJ Life & Environment in 2013 found that cannabinoid receptors in the skin have the power to reduce excess skin cell growth.
CBD is very safe, but it may interfere with some medications
CBD has an excellent safety profile that shows it is generally well-tolerated, even in very high doses. Side effects are very rare and transient when they do occur, typically lasting between four to six hours. At very high doses, CBD may cause appetite changes or drowsiness. It is not known to be addictive or habit-forming.
While very safe to take on its own, in certain instances CBD can interact with some medications. It may interfere with the way the body metabolizes certain prescription drugs in the liver. This interaction potentially reduces or increases the effectiveness of these medications over time.
Talk to your doctor before adding CBD to your wellness plan if you are concurrently taking any prescription medications. Your doctor may need to monitor your individual response to the combination of CBD with your prescribed drugs and adjust your dose accordingly. In many cases, people are able to reduce or eliminate their use of prescription medications and replace them with CBD, but that is best done under the supervision of a health care provider.
Have you tried CBD for any skin conditions?
What was your experience like? Please share your thoughts in the comments.