Evaluation of Cannabis and Cannabinoid Product Use, Knowledge, and Attitudes in the Eczema Community

April 2022 | Volume 21 | Issue 4 | Original Article | 413 | Copyright © April 2022


Published online March 29, 2022

Cleo Whiting BA,a Xuejing Duan PhD,b Adam J. Friedman MDa,*

aDepartment of Dermatology, The George Washington School of Medicine and Health Sciences, Washington, DC
bDepartment of Biostatistics, George Washington Milken Institute School of Public Health, Washington, DC

Abstract
Background: Data to date supports the potential for targeting the cutaneous endocannabinoid system to treat eczematous dermatoses. However, our understanding of patient knowledge and utilization of cannabis/cannabis-derived products as treatments for eczema is limited, highlighting both a gap and opportunity to engage with the eczema community.
Methods: An online survey assessing the use, knowledge, and attitudes of a broad scope of cannabis product types was advertised by the National Eczema Association (NEA) via social media and NEA network dissemination.
Results: Of 76 respondents to the survey, 69 (90.79%) were individuals diagnosed with eczema, 7 (9.21%) were primary caregivers of a dependent diagnosed with eczema. Respondents most frequently used OTC products purchased without recommendation from a dermatologist (22 [36.07%], n=61) and least frequently used medical cannabis recommended by a dermatologist (2 [3.12%], n=64). All respondents supported medical cannabis use (50 [100%], n=50) and most respondents (47 [94%], n=50) would be comfortable seeing a dermatologist who recommended medical cannabis. 94% of respondents (47, n=50) would be interested in learning about using medical cannabis for treatment of eczema, but most had never discussed this topic with their healthcare provider (54 [93.10%], n=58). 46.67% of respondents (28, n=60) were unsure if OTC cannabis-derived products were regulated by the FDA.
Conclusion: Eczema patients are open to learning about cannabinoids and many are already using OTC products. As both consumer interest/use and the cannabis industry continue to outpace medical research and guidelines, dermatologists need to be prepared to counsel patients on cannabinoid applications in dermatology.

J Drugs Dermatol. 2022;21(4):413-419. doi:10.36849/JDD.6615

INTRODUCTION

The passage of the 2018 Farm Bill was a historical event for the cannabis industry. This legislation differentiated hemp cannabis (containing < 0.3% delta-9 tetrahydrocannabinol [THC] on a dry-weight basis) from non-hemp cannabis (containing > 0.3% THC, ie, marijuana), removing the Schedule I of the Controlled Substances Act from hemp and allowing significant expansion of cultivation and the interstate commerce of hemp and hemp-derived products.1 Yet, US scientists continue to face substantial regulatory hurdles and limitations in the cannabis products they may study2 while cannabis products available commercially online or through dispensaries are sparsely regulated,3 inaccurately labeled,4,5 and promote misleading claims.6 Combined with the increasing legalization and public acceptance of medical and recreational cannabis across the United States of America,7-10 it is unsurprising that scientific research and recommendation guidelines for medical use of cannabis products cannot keep pace with the growth of this industry.

This rapidly changing landscape impacts the field of dermatology. Research implicates the potential for targeting the extensive endocannabinoid system (ECS) of the skin to treat dermatological disease,11 including eczematous dermatoses.12 Studies using animal models of atopic dermatitis have demonstrated the significant role of cannabinoid receptors 1 (CB1)13,14 and 2 (CB2),15 and transient receptor potential vanilloid type 1 (TRPV1) receptors16- all of which can be modulated by cannabinoid compounds - in regulating inflammation and pruritus in the skin. Extending this knowledge to small studies in humans, endocannabinoid and phytocannabinoid compounds have shown therapeutic promise in treating pruritus,17 atopic eczema (dermatitis),18-21 asteatotic eczema,22 and sensitive skin.23

This survey aimed to determine the use and knowledge of and attitudes about cannabis products in individuals diagnosed with a form of eczema, a group of dermatological conditions that research has shown may benefit from cannabinoid therapies.

MATERIALS AND METHODS

Survey MonkeyTM, an online survey platform, was used for survey development and data collection. The survey used branching logic (42 question maximum) and various question