PracticeUpdate Dermatology Best of 2018

AAD 2018 29

Topical Cannabidiol Recommended as Adjunct Treatment for Acne, Eczema, and Psoriasis Anti-inflammatory properties of topical cannabidiol and other cannabinoids documented. W here legal, topical cannabidiol (CBD) or palmitoyleth- anolamide (PEA) can be recommended as an adjunct measure for acne, eczema, and psoriasis, participants attending the 2018 AAD meeting were told. Human tissues have at least two types of cannabinoid receptors, CB1 and CB2. The former are usually involved with the euphoria linked to tetrahydrocannabinol, more commonly called THC. CB2 receptors, on the other hand, are mainly found in the skin, other organs, and immune cells and respond to CBD and many other cannabinoids.

“There are studies documenting the anti- inflammatory properties of topical CBD and other cannabinoids, and studies in PubMed on the many different mechanisms of topical cannabinoids work in acne, eczema, and psoriasis,” Jeanette Jacknin, MD, a board- certified dermatologist based in Encinitas told Elsevier’s PracticeUpdate . The skin’s own endocannabinoid system helps to regulate the production of various

To date, approximately 130 cannabinoids have been discovered. CBD, however, is the predominant cannabinoid used today, often for conditions with an inflammatory component, such as pain. “We are at the forefront of a whole new science, biochemistry, and industry,” Dr. Jacknin told physicians attending her hour-long presentation Scientific Studies Which Support the Topical Use of Hemp, CBD, and THC for Anti-aging, Psoriasis, Eczema, and Acne. “Cannabis’s strong anti-aging and protective capabilities make this herb the next big thing in skin care, providing more than just moisturizing and nutritive properties of hemp oil with only minis- cule amounts of CBD,” she added. “Many CBD skin care lines are already out there.” Topical cannabidiol may also be useful in treating acne, eczema, psoriasis, and itchy skin. Three studies have been done on the effectiveness of CBD for acne including one that used a 3% topi- cal cannabis cream that was found to be effective. “If your patients are using reputable brands of topical CBD or cannabis cream for their acne, I would encourage you to follow and record what their results are,” said Dr. Jacknin. Other studies have demonstrated the effectiveness of topical can- nabinoids, PEA, or oral hemp oil for the symptoms of itch, eczema, and psoriasis. According to Dr. Jacknin, those who experience a contact der- matitis rash after applying a topical cannabis product are likely reacting to another ingredient in that product, rather than the can- nabis itself. To avoid such reactions, she recommends testing a new product on a small area of skin before using it. She also noted that euphoria is not a side effect, an issue that may concern parents of teens using CBD-based products, even if only topically. “Topical cannabis products are not going to get you high. These formulations contain little or no THC, which gives marijuana its psychoactive properties.” Medical marijuana is now legal in more than half of all US states. As its presence has increased over the last decade, so has research into the different medical applications of cannabis – including topical cannabis for dermatologic treatment. Still more work is required before CBD-related products will become mainstream in dermatology. Double-blind clinical studies in humans need to be done on various products to prove their efficacy and safety. As well, the FDA has not yet approved a marketing application for marijuana for any indication. Greater insight into the most effective use of CBD for skin conditions is also needed, said Dr. Jacknin. “There are many unanswered questions as to the best delivery system and CBD combination with other topicals for each skin problem. There may also be many other of the over 130 cannabinoids that work even better for each skin disorder.” More research is needed to answer these questions. www.practiceupdate.com/c/64728

Dr. Jeanette Jacknin

hormones and proteins, including cytokines, also involved in the immune response, and helps to regulate cellular proliferation, dif- ferentiation, and cell death. “Imbalance of this system may also be responsible for the flares of chronic skin conditions and the development of targeted cannabinoid therapies may help to con- trol them,” noted Dr. Jacknin, author of the book Smart Medicine for Your Skin .

colleagues have now successfully restored pigment in a patient using tofacitinib and subsequently observed a similar result in another patient using a different JAK inhibitor, ruxolitinib. “Our recent results in a series of 10 patients suggested that it is the combination of the JAK inhibitor plus ultraviolet light that leads to recovery of pigment in these patients.” The results from two consecutive patients show a quick and dramatic repigmentation using this combination therapy, said Dr. King. “This therapy has the potential to become the stand- ard of care for vitiligo.” Until last spring, when dupilumab, a monoclonal antibody designed for the treatment of allergic diseases such as eczema, was approved by the FDA, there was no reliably effective ther- apy for atopic dermatitis. “Two and a half years ago we showed that tofacitinib treated refractory disease in six patients. Subse- quently, a large trial using topical tofacitinib showed excellent results in mild-to-moderate atopic dermatitis,” said Dr. King. “I suspect that the next few years will see FDA approval of JAK inhibitors in atopic dermatitis,” he added. In the interim, further research is required to both confirm effi- cacy and establish safety. Recent data, for instance, suggests that use of JAK inhibitors may be associated with an increased risk of thromboembolic adverse events. “There are many ques- tions to be answered, including how JAK inhibitor specificity bears on efficacy in different diseases and whether this speci- ficity bears on safety,” said Dr. King. www.practiceupdate.com/c/64727

VOL. 2 • NO. 4 • 2018