An Observational Study of the Application of a Topical Cannabinoid Gel on Sensitive Dry Skin

December 2020 | Volume 19 | Issue 12 | Original Article | 1204 | Copyright © December 2020


Published online November 25, 2020

Jalal Maghfour MDa*, Hope R. Rietcheck BSb*, Chandler W Rundle MDb, Taylor M Runion BSc, Zainab A Jafri MDd, Sam Dercon BSe, Peter Lio MDf, Jon Fernandez BAg, Mayumi Fujita MD PhDb, Robert P Dellavalle MD PhD MSPHb, Helena Yardley PhDg,h

aTulane University, Medical School, New Orleans, LA, United States of America
bUniversity of Colorado, Dermatology, Aurora, CO
cRocky Vista University College of Osteopathic Medicine, Parker, CO
dArizona College of Osteopathic Medicine, Glendale, AZ
eUniversity of Southern California Keck School of Medicine, School of Medicine, Los Angeles, CA
fNorthwestern University Feinberg School of Medicine, Dermatology, Chicago, IL
gCQ Science, Denver, CO
hNaturally Curious Consulting, Boulder, CO
*co-first authors

Abstract
Atopic dermatitis (AD) is a chronic skin disorder characterized by pruritus, erythema and excoriation. While AD has a multifactorial etiology, neuro-signaling pathways are now recognized to play an essential role in the pathogenesis of AD, particularly pruritus. Neuromodulators, such as topical naltrexone, are being utilized in AD treatment. Another class of neuromodulator, Palmitoylethanolamide (PEA), has demonstrated effectiveness in the treatment of itch, excoriation and erythema in AD patients. Phytocannabinoids including cannabidiol (CBD) are becoming increasingly accessible to the public and continue to be advertised for their efficacy to treat inflammatory skin disorders such as eczema. However, no human studies have been conducted to support the claim. Therefore, this study aimed to explore the effects of CBD in individuals with self-reported eczema.

Twenty individuals consented to participate and 16 completed a 28-item online questionnaire assessing subjects’ disease severity using Patient Oriented Eczema Measure (POEM) and psychosocial burden of their disease through the emotional domain of Quality of Life Hand Eczema Questionnaire (QOLHEQ). Findings demonstrated a significant reduction in the mean score of POEM from baseline (mean ±SE: 16±1.35) and at a two weeks interval (8.25 ±1.80), P<0.0007. Similar reduction was seen in emotional domain of QOLHEQ from a mean score of 20.9±2.06 to 8.375 ±1.609 at 2 week-interval, P<0.004. 67% of subjects reported a decrease in itch and 50% perceived an improvement in their eczema by more than 60%. This observational study shed light on the potential clinical utility of topical CBD in the treatment of atopic dermatitis.

J Drugs Dermatol. 2020;19(12):1204-1208. doi:10.36849/JDD.2020.5464

INTRODUCTION

Atopic dermatitis (AD) is a chronic, multifactorial skin disorder characterized by dry skin and pruritus. In AD patients, pruritus can range from mildly irritating and distressful to completely disabling, resulting in a negative impact on patients’ quality of life.1 Application of topical emollients to help restore the skin barrier has been a cornerstone of treatment, but often results in limited clinical benefits.2 While topical corticosteroids are effective, adverse effects such as skin atrophy and dyspigmentation are associated with prolonged application, which limits their use.3 Recently, the role of the nervous system has become recognized in the pathogenesis of AD.4 Specifically, dysregulation of neuro-cutaneous physiology, at the skin-nerve interface level appears to be central in the pathogenesis of itch.3

Studies on atopic skin lesions have demonstrated an increase in nerve density and an upregulation of inflammatory neuropeptides such as substance P.5 The understanding of this mechanism has led to the use of off-label neuromodulators such as topical capsaicin and naltrexone. Both these therapies have shown to improve itch in AD patients.6

Another class of neuromodulators that has been explored is palmitoylethanolamide (PEA), which is considered an endocannabinoid.7 Several studies3,8-11 have demonstrated efficacy of PEA in the treatment of various dermatologic disorders including AD. In a study by Eberlein et al, it was demonstrated that emollient containing PEA reduced pruritus, erythema, and excoriation by 58.6%.12 Similar to endocannabinoids,