Can CBD or Other Cannabis Products Help Ease Psoriasis?
In recent years, cannabinoids, including CBD and THC, have been gaining popularity with people managing chronic conditions. But what exactly are cannabinoids—and can they play a role in managing psoriasis and psoriatic arthritis?
CBD, THC, THC-A: What to Know About Popular Cannabinoids
Cannabinoids are molecules found in the cannabis sativa plant. Though there are more than 100 types of cannabinoids, the two most commonly used are cannabidiol (CBD) and tetrahydrocannabinol (THC).
"CBD is the second most prevalent active ingredient in cannabis—THC is the first,” explains Adam Friedman, M.D., professor and interim chair of dermatology at the George Washington School of Medicine and Health Sciences in Washington, D.C.
Confused as to which is which? THC is the ingredient that has a psychoactive effect that can make a person feel “high.” CBD does not. Instead, CBD works by binding to different receptors in the body, which can help your skin by being anti-inflammatory and inhibiting cell growth, explains Friedman.
Another less commonly used cannabinoid known as THC-A has been shown to help people with certain autoimmune diseases like Crohn’s and rheumatoid arthritis, and may also help people with psoriatic arthritis, says Jordan Tishler, M.D., founder of inhaleMD in Boston, Massachusetts, and president of the Association of Cannabis Specialists.
The Role of Cannabinoids in Psoriasis and Psoriatic Arthritis
There’s very little evidence that cannabinoids can help control a psoriasis condition, says Tishler. However, some studies suggest they have promise in helping patients cope with their symptoms in several ways:
- Reducing underlying inflammation. One 2009 study found that cannabinoids may help regulate the immune system and reduce inflammation. More recently, a 2020 study suggests that cannabinoids may be able to treat inflammatory skin conditions like psoriasis.
- Slowing skin cell growth. One 2007 study found that cannabinoids help inhibit the buildup of skin cells; and, a review published in 2016 suggests that cannabinoids may be a useful addition to psoriasis treatment.
- Relieving itchy skin. A review published in 2017 noted that certain cannabinoids applied topically may help relieve itchy skin.
- Healing cracked skin lesions. A 2016 study of mice found that cannabinoids may play a role in repairing wounded skin.
- Relieving pain and discomfort. According to an article published in 2015 in JAMA, cannabinoids found in medical marijuana can help reduce pain from chronic health conditions.
- Reducing stress related to living with a chronic condition. A study published in 2017 found that low doses (7.5 mg) of THC provide stress-relieving effects; though higher doses may actually worsen mood.
And a study published in October 2019 in the Journal of Dermatological Treatment suggests that cannabinoids have the potential to help treat psoriasis by reducing inflammation and calming itchy skin. Still, overall, more research is needed.
“We need well-formulated clinical trials with medical cannabinoids to know safety and efficacy,” says Friedman. “There is enough preclinical and anecdotal data to support the investment.”
What to Look for in Cannabinoid Products
Interested in trying a cannabinoid? There are a variety of products available, which can be applied topically, taken orally, or inhaled as smoke or vapor. It’s important to know that these products are generally not regulated by the FDA—with a few exceptions: an anti-seizure drug derived from CBD called Epidiolex, and several anti-nausea drugs that contain a synthetic THC and are most commonly used in chemotherapy and HIV/AIDS patients.
That said, there are a few considerations to keep in mind:
For topicals: Topicals like lotions, creams, and oils are considered one of the safest ways to use cannabinoids, according to Americans for Safe Access.
“Topicals can help smooth the skin, decrease scales, redness, and irritation,” says Tishler. “This may take several weeks to be noticeable, but if it hasn’t improved after about a month, then it’s likely not going to work.”
“Look for a lotion with few irritants,” adds Tishler, such as fragrances and/or preservatives. “Aim for a mixture of THC and CBD. Since neither will be absorbed through your skin, there’s no need to be concerned about intoxication.”
But be careful if you’re using other treatments, as well.
“I would caution against mixing two different topicals at the same time, as there could be interactions,” says Friedman. “For example, if you’re also using a topical steroid, I recommend applying the cannabinoid topical in the morning and the steroid topical in the evening, or vice versa.”
For orals: These products can be eaten as edibles, used in cooking oil, or even taken as pills. Orals are also thought to be one of the safest ways to consume cannabis—however, it can take some trial and error to find the right combination of product types and dosages that work best for you.
When it comes to assessing efficacy of orals or systemics, it may take anywhere from eight to 12 weeks, says Friedman. “There can [also] be drug interactions and, at higher doses, greater than 1500 mg/d, liver toxicity,” he adds.
For medical marijuana: While most commonly smoked or inhaled as a vapor, medical marijuana can also be administered either topically or orally. It’s primarily used for alleviating pain, as well as for reducing stress and anxiety.
To be able to use medical marijuana, “Your physician would need to submit a recommendation,” says Friedman. “Psoriasis is not an indication in most states outside of Connecticut—however, pain is, and psoriasis, and especially psoriatic arthritis, can be disabling.”
If you smoke cannabis, it should provide immediate pain relief, according to Americans for Safe Access.
Work with a Cannabis Specialist and Keep Your Doctor in the Loop
Keep in mind that these products are not a replacement for your prescribed psoriasis treatment—instead, they’re meant to help alleviate any lingering symptoms. “My overall experience is that treatment of psoriasis is better accomplished using conventional medications,” says Tishler.
That said, if you’re looking to try out cannabinoid products to help you manage your condition, it’s important to work with a cannabis specialist. Cannabinoid products are not regulated by the FDA, so these experts can help guide you toward specific products, potencies, and dosages that may be most beneficial for your individual needs—whether you’re looking to alleviate pain or skin symptoms or help you manage stress. Find a specialist near you through the Association of Cannabis Specialists.
Working with a specialist is especially important if you’re interested in THC-A, Tishler adds. “THC-A is a non-intoxicating, strong anti-inflammatory,” he says, explaining that it would be more likely to help psoriatic arthritis than psoriasis. “THC-A is not commonly available commercially, but is easily made from ordinary cannabis if done correctly. Dosing and administration of THC-A is a bit more complicated, as well,” he adds.
Because there’s very limited data to prove what cannabinoids do help people with psoriasis, it is always a good idea to keep your psoriasis care team in the loop about any complementary therapies you’re adding to your psoriasis treatment plan. They can help monitor for side effects, as well as potential interactions with other psoriasis medication you’re taking.
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