Knowledge, Attitudes, and Perceptions of Cannabinoids in the Dermatology Community
December 2018 | Volume 17 | Issue 12 | Original Article | 1273 | Copyright © 2018
Elizabeth S. Robinson MD,a Emily C. Murphy BS,a,b and Adam J. Friedman MDa
aGeorge Washington University School of Medicine and Health Sciences, Washington, DC bGeorgetown School of Medicine, Washington, DC
BACKGROUND: Recent research has identified potential uses of cannabinoids in dermatology, including psoriasis, atopic dermatitis, and wound healing. OBJECTIVE: The extent of dermatologists’ familiarity with and interest in cannabinoids as therapeutics is unknown. METHODS: This study examined dermatology providers’ knowledge, attitudes, and perceptions on therapeutic cannabinoids using a 20-question online survey. RESULTS: The response rate was 21% (n=531). Most responders thought cannabinoids should be legal for medical treatment (86%). Nearly all (94%) believed it is worthwhile to research dermatologic uses of cannabinoids. 55% reported at least one patient-initiated discussion about cannabinoids in the last year. Yet, 48% were concerned about a negative stigma when proposing cannabinoid therapies to patients. While most responders (86%) were willing to prescribe an FDA-approved cannabinoid as a topical treatment, fewer (71%) were willing to prescribe an oral form. 64% of respondents did not know that cannabidiol is not psychoactive and 29% did not know that tetrahydrocannabinol is psychoactive. LIMITATIONS: Limited survey population. CONCLUSIONS: Dermatology providers are interested in prescribing cannabinoids and patients are speaking about cannabinoids with their dermatologists. However, providers’ fund of knowledge on this subject is lacking. These results highlight the need for further education and research to detangle the dermatologic benefits and risks of cannabinoids. J Drugs Dermatol. 2018;17(12):1273-1278.
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The cannabis plant, cannabis sativa, and its derivatives have been used in medicinal preparations for millennia to treat pain, nausea, and epilepsy. Recent research has identified a number of other potential therapeutic indications for cannabinoids, including many inflammatory disease states such as joint inflammation,1 proliferative retinopathy,2 and inflammation-induced neurodegeneration.3 Cannabinoids are also being researched for their therapeutic value in dermatology. Potential applications include psoriasis, atopic dermatitis, systemic sclerosis, dermatomyositis, wound healing, allergic contact dermatitis, and melanoma.4-10 The activity of cannabinoids occurs through binding of endogenous cannabinoid type 1 (CB1) and type 2 (CB2) receptors.The CB1 receptor was originally thought to be localized to the central nervous system, where it mediated the psychoactive effects of cannabinoids such as tetrahydrocannabinol (THC). The CB2 receptor was initially found in peripheral immune cells, where it played a role in modulating and resolving inflammation.11,12 However, recent research has also found these receptors present in multiple organ systems including throughout the skin in cutaneous nerve fibers, mast cells, macrophages, keratinocytes, follicular epithelial cells, sebaceous glands, and eccrine glands.13 Despite increasing research on the cutaneous endocannabinoid system, dermatologic uses of cannabinoids, and frequent discussions on the use of cannabinoids as therapeutics in the media, dermatologists’ perspective on using such therapies and their knowledge of cannabinoids is unknown. This survey study sought to determine the perspectives of dermatology providers on the uses and potential benefits of cannabinoids as therapies in dermatology as well as their knowledge about cannabinoids in general.
DESIGN AND METHODS
Survey data were collected via a web-based survey platform. The survey was emailed to all attendees of the 2018 Orlando Dermatology Aesthetic and Clinical Conference. The use of this email list was approved by its owners. The survey was voluntary, and respondents were optionally entered into a gift card raffle for completing the questionnaire (gift cards donated by SanovaWorks). The survey was composed of 19 multiple-choice questions and one free response question. The survey included questions on demographics as well as perspectives on and knowledge of cannabinoid use in dermatology (Table 1). Prior to data collection, the survey was reviewed by 10 dermatologists; suggestions on design were incorporated into the final survey. Statistical analysis was completed with GraphPad Prism,