As innovation in dermatology continues, so do questions on the efficacy of cannabinoid use for psoriasis, among other skin diseases.
A recent survey published in the Journal of Drugs in Dermatology showed that many patients with acne, rosacea, psoriasis, and several other dermatologic conditions frequently use over-the-counter (OTC) medical cannabis products to treat their disease. Additionally, under 1 in 5 patients use these products without dermatologist recommendation.1
Widespread legalization of medical cannabis in recent years has led to a significant increase in research on its therapeutic potential. Likewise, there has been an increase in the utilization of these products among patients with dermatologic conditions, among other diseases, despite the limited data available to support their clinical utility.
Corresponding study investigator Adam Friedman, MD, professor and chair of dermatology at the George Washington University School of Medicine and Health Sciences, Washington, DC, explained that there is also an increased desire among the public to identify products that are marketed as “natural,” likely driving the increased utilization of cannabis-related products for health reasons. “There are a lot of marketing terms that are strictly absurd and that really don't relate to skincare,” he told Dermatology Times®.
But one of the largest alluring factors for cannabis-related products, Friedman suggested, relates to the historic controversy over cannabinoids. “Up until the Farm Bill, every component of the cannabis plant, regardless of whether it was psychoactive or not, was considered illegal,” he said. “There is this mystification and excitement around something that is kind of taboo, which I think always drives sales and people capitalize on that.”
Despite the marketing claims, Friedman notes that there are some promising preclinical and emerging clinical data on cannabinoids but emphasizes that the understanding of these compounds, at least in the context of treating dermatologic conditions, is still in its infancy.
“I think some of the very exciting preclinical data, mixed with the controversies and the hype around cannabis, leads to excited consumers to try something new that could be ‘natural’ and could also potentially have a biological impact,” he added.
In their study, Friedman and colleagues emailed a survey to 700 United States adults to gauge consumers’ usage patterns and beliefs of medical cannabis products for the treatment of dermatologic conditions. A total of 504 participants completed the surveys. More than half of participants (54%) were male, and nearly one-third (31%) of participants were between 35 and 44 years of age.
Survey respondents were queried on their use of dermatologist-recommended medical cannabis products that required a Department of Health medical card, OTC medical cannabis products purchased with a dermatologist recommendation, and OTC medical cannabis products purchased without a dermatologist recommendation.
Approximately 89% of all respondents said they supported the use of medical cannabis products, but only 7% had a medical cannabis card. A majority of respondents (55%) said they approved of the use of medical cannabis products to treat skin conditions, and 73% endorsed being comfortable with seeing a dermatologist who recommends these products.
Around 38% of respondents said they believed over-the-counter cannabis products have therapeutic value in treating skin diseases. Nearly 18% of respondents stated they used an OTC cannabis product to treat a skin condition without a dermatologist recommendation. The most common indications for use included acne (28%) and psoriasis (26%).
In respondents who were recommended by a dermatologist, 15% said they used an OTC medical cannabis product, including 32% of respondents who used the products for psoriasis and 30% who used it for rosacea.
Only 8% of respondents used a medical cannabis product that required a Department of Health-approved card per a recommendation by their dermatologist. For these respondents, the most common indications for use of the cannabis products included acne (68%) and psoriasis (28%).
The limitations of the study included the small sample size as well as the survey’s potential selection bias. Additionally, the researchers suggest that the changing legality of cannabis as well as the shifting attitudes toward product that contain cannabis “indicates that the attitudes found in the survey will likely be transient and subject to rapid change over the next decade,” according to the study.
The researchers noted that additional investigation is needed to understand not only the therapeutic potential of cannabinoids in dermatology, but also the safety of products that contain these compounds. “I think this is a very exciting field, but we need to treat this like we would any therapeutic area,” Friedman said.
Friedman explained that to date, certain safety issues associated with OTC cannabinoid products have been documented, but these safety issues were largely related to impurities in the product formulations rather than the cannabinoids themselves.
While he supports the potential therapeutic value of cannabinoids, he suggested that there is a greater need for quality assurance of OTC medical cannabis products. As a first step, he suggested clinicians should tell their patients to search the website selling these products for statements on how they ensure the safety and purity of their products.
“There also needs to be sufficient evidence, both mechanistic and clinical, and real-world evidence to warrant use and create guidelines [for cannabis-related products].” Friedman said. “We will get there with cannabinoids, I have no doubt.”
He noted that many patients use OTC products without supervision by a clinician, underscoring the need for health care providers to be aware of and educated on the potential impact these products might have on medical conditions and medications.
“You have to be considerate of whether there could be a potential interaction with drugs you're already giving in terms of topicals or systemics,” he said. “To be effective health care practitioners, we need to know the whole picture.”
In addition, Friedman explained that dermatologists, among other clinicians, need to be ready to answer questions regarding cannabinoids and their effects on disease. Unfortunately, many dermatologists have a suboptimal knowledge of cannabinoids despite a high desire to learn more about these compounds, according to a study on such knowledge in the Journal of Drugs in Dermatology.2
“I think that this space not only offers a unique opportunity to manage many different skin diseases, but it's also an opportunity to serve as a spark and stimulus for educational and investigative excitement,” he said. “It's an opportunity to learn something new, and it feeds the constant hunger for innovation that characterizes the dermatology community.”