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Can Cannabis Help Treat Psoriasis?

by Gleb Oleinik

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Cannabis is a popular alternative to standard medication, especially for chronic conditions resistant to standard treatment. One such condition is psoriasis, an inflammatory autoimmune disorder affecting the skin. 

Some people report improvement in their psoriasis symptoms after using CBD oil and other cannabis-based preparations, particularly those applied directly to the skin. This may be the result of the interaction between cannabis-derived cannabinoids and the body’s endocannabinoid system (ECS).

Research shows that the ECS plays an important role in skin health, and that its dysfunction could contribute to psoriasis. There haven’t been many clinical studies on cannabis treatment of psoriasis, but those that have been done were promising.

How cannabis works on psoriasis

Cannabis contains active compounds called cannabinoids, such as THC and CBD. Cannabinoids affect the body by interacting with the ECS, which is composed of endocannabinoids (cannabinoids made by the human body), cannabinoid receptors (primarily CB1 and CB2), and special enzymes that build and break down endocannabinoids.

The ECS regulates essential processes such as immunity, inflammation, mood, pain, stress, metabolism, appetite, and sleep in order to maintain a state of internal balance called homeostasis. The system is present in every part of the body, including the skin.

Research suggests the endocannabinoid system plays an essential role in skin health, particularly by regulating skin cell growth and inflammation. Dysfunction in this system may contribute to the development of psoriasis and other skin diseases.

Researchers have found that psoriasis sufferers have elevated endocannabinoid levels. People with psoriatic arthritis, which affects up to 30% of psoriasis patients, had higher levels of CB1 cannabinoid receptors, while those with regular psoriasis seem to have higher numbers of CB2 receptors. 

A study of skin biopsies from psoriasis patients suggests that their skin cells differ in endocannabinoid-related gene expression (the process where cells read DNA to create proteins) from healthy cells. All of these findings imply that the endocannabinoid system is involved in psoriasis.

Combined with the known regulatory effects of the endocannabinoid system on stress, inflammation, and immune system function — all processes that play a key role in psoriasis  — this evidence suggests that cannabinoid-based medicines can offer relief for the condition.

Medical studies on cannabis and psoriasis

Few studies have examined the use of cannabis and cannabinoids in psoriasis, but those that exist have yielded promising findings. 

Most notably, a 2019 study human study looked at the beneficial effects of a topical ointment infused with CBD on chronic skin conditions. Twenty people (five with psoriasis, five with atopic dermatitis, and 10 with scarring from the two conditions) used the ointment daily for three months, resulting in significant improvement in their PASI index (a measure of psoriasis severity) as well as their symptoms and markers of skin health, including elasticity. 

A 2007 study of isolated human skin cells reported that THC, CBD, and other cannabinoids reduced the hyper-proliferation (rapid growth) of keratinocyte skin cells, which are the main cause of psoriasis. 

A 2016 study reported that cannabinoid-like compounds reduced skin inflammation in mice with dermatitis by reducing mast cell activation, an inflammatory process that also occurs in psoriasis. 

There are also studies of cannabinoids in similar inflammatory skin conditions, such as atopic dermatitis and acne. In a 2013 study, researchers applied THC to the skin of mice with allergic atopic dermatitis, resulting in reduction of inflammation. 

Similarly, a 2014 study of isolated skin cells found that CBD reduced inflammation and cell proliferation, two effects that are beneficial in psoriasis. 

Studies also suggest that cannabinoids can help with itching, one of the symptoms of psoriasis. A 2002 clinical study reported that a THC-based medication called dronabinol suppressed itching caused by liver disease. 

Cannabis may also help alleviate three other potential psychological symptoms of psoriasis: pain, depression, and anxiety. A 2015 review of 28 clinical studies finding concluded that there’s solid evidence to back the use of cannabinoids for pain

There’s evidence that both of the major components of cannabis, CBD and THC, can improve mood and anxiety. A 2011 study found that CBD alleviated anxiety in people with social anxiety disorder, while a 2013 study reported that THC improved mood-related measures in healthy individuals, suggesting that it may be helpful for depression. 

More human studies are needed to confirm that cannabis can treat psoriasis effectively, but current evidence suggests that it may help with some of its causes and symptoms.

Side effects

Cannabis does have potential side effects, which vary depending on what type of preparation you’re using. For example, standard, THC-rich cannabis can cause impaired memory and reaction time, increased heart rate, red eyes, dry mouth, sleepiness, and dizziness. It can also cause paranoia and anxiety in some people, especially at higher doses.

Cannabis Side Effects

Meanwhile, CBD-rich cannabis preparations such as CBD oil don’t contain enough THC to cause intoxication. They may cause minor side effects such as diarrhea, low blood pressure (hypotension), dry mouth, lightheadedness, sleepiness, and changes in appetite. However, these effects have only been reported in studies using high doses of CBD (300 mg and above).

These symptoms only occur when cannabinoids are able to reach the bloodstream, as when you inhale, ingest, or apply a cannabis preparation under the tongue. Cannabinoids applied topically (to the skin) via a cream, ointment, or another method will not cause these effects, because they cannot penetrate deep enough to reach the bloodstream.

Disclaimer

The Cannigma content is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Always consult with an experienced medical professional with a background in cannabis before beginning treatment.

About Psoriasis

Psoriasis is a chronic, common skin condition where the immune system attacks the skin cells, leading to red, itchy, dry patches of skin on our body.  Like all autoimmune conditions, it can be very mild where it is hardly noticeable, to severe, with patches all over the body.

Psoriasis generally isn’t a serious threat to long-term health, but it can cause significant discomfort and pain. About 60% of sufferers state that it negatively impacts their daily life. It’s thought that 2-3% of the population, or 125 million people worldwide, have psoriasis, making it quite prevalent. There is no cure for psoriasis, but there are treatments that can help manage the symptoms.  

Symptoms

There are a few different types of psoriasis, and each one has slightly different symptoms. Most people only have one type of psoriasis, but sometimes they can have two types together.  Psoriasis symptoms also tend to come in cycles, with periods of more severe symptoms alternating with times when the symptoms subside. 

There are a number of different types of psoriasis:

  • Plaque psoriasis. This is the most common type of psoriasis, accounting for 80-90% of psoriasis cases. It leads to red, dry, itchy patches of skin called plaques, covered with silvery-white scales. They mainly appear on the elbows and knees, scalp, and lower back, but they can appear anywhere on the body including the genitals and soft tissue inside the mouth. Sometimes the skin around the joints also cracks and bleeds.
  • Nail psoriasis affects around 50% of people with psoriasis. It makes dents and pits in the nails and causes them to become discolored or to grow abnormally. Nails can become loose and separate from the nail bed, or even crumble. 
  • Pustular psoriasis appears as raised bumps on the skin and each bump can have liquid, or pus, inside.  
  • Scalp psoriasis affects the scalp, covering it with red patches of skin and thick white scales. It can cause hair loss in severe cases, but the hair usually grows back. 
  • Guttate psoriasis generally affects children and teenagers, most often after a strep throat infection. It causes small drop-shaped sores with fine scales on the chest, arms, legs, and scalp. Guttate psoriasis tends to clear up, but in some people it can develop into plaque psoriasis.
  • Inverse psoriasis only affects the folds and creases in the skin, like under the breasts, in the groin and genitals, and in the armpits. It causes smooth, red, itchy patches that can be made worse by friction and sweating. 

There are also more rare types of psoriasis, palmoplantar pustulosis, acropustulosis, and erythrodermic psoriasis.

Psoriatic arthritis is a chronic inflammatory condition where sufferers have a psoriatic rash combined with pain and inflammation of the joints. It most commonly affects the joints of the fingers and toes but can affect any of the joints in the body.  

Seborrheic-like psoriasis is a common form of psoriasis that has commonalities between both psoriasis and seborrheic dermatitis. It consists of red plaques over scalp, forehead, next to the nose, chest and skin folds.  

Diagnosis

Diagnosing psoriasis mainly relies on examining your skin and asking about your medical history. A dermatologist, or skin specialist, will usually perform the workup and manage the condition. Usually a physical exam alone is enough to diagnose psoriasis, but occasionally further workup, such as a skin biopsy, will be performed.  

Causes

The exact cause of psoriasis remains unknown, though it is thought to stem from both genetic and environmental factors. There is a hereditary component, and one third of people who have psoriasis have a first degree relative with the disease, such as a parent, sibling or child.  Specific genes and chromosomes have also been implicated in the disease. Psoriasis is not contagious and cannot be passed on to someone else. 

Environmental factors also play a role, and may be triggers for exacerbations or worsening symptoms. These include:

  • Infections like strep throat
  • A cut, scrape, insect bite, sunburn, or other injury to your skin, called the Koebner response
  • Heavy alcohol consumption
  • Stress
  • Smoking tobacco 
  • Vitamin D deficiency
  • Some medications like lithium, which is prescribed for bipolar disorder, or beta blockers, antimalarial drugs, and iodides
  • Other immune disorders like HIV

Psoriasis is a type of autoimmune disorder.  In all autoimmune disorders, the body’s immune system perceives another part of our own body to be the enemy and attacks it, much like it would attack a virus or bacteria in our body.  

T-cells are part of your body’s immune system, but when you have psoriasis these cells trigger your body to produce new skin cells too fast. The new skin cells move to the surface too quickly, building up into red, thick scaly patches.   

Treatment

There’s no cure for psoriasis, but there are a number of treatment options that can ease the symptoms and improve quality of life. Doctors often start by prescribing the mild treatments, mild topical creams, and then move on to stronger oral medications, depending on the severity of the disease.  

Topical treatment 

  • Corticosteroids are prescribed for mild to moderate psoriasis, to reduce inflammation and relieve itching. Long- term use can thin the skin and make the cream stop working, so it’s recommended as a short-term treatment for flare-ups. 
  • Vitamin D analogues are synthetic forms of vitamin D that slow down skin cell growth. 
  • Anthralin helps slow skin cell growth, remove scales, and make the skin smoother, but it can also be an irritant, so it’s usually applied for a short time and then washed off.
  • Topical retinoids are vitamin A derivatives that can reduce inflammation.
  • Calcineurin inhibitors reduce inflammation and plaque buildup, but increase the risk of skin cancer and lymphoma when taken for a long time.
  • Salicylic acid is an over-the-counter treatment that helps slough off dead skin cells and reduces scaling. 
  • Coal tar is derived from coal and reduces scaling, itching, and inflammation. 
  • Moisturizers are not enough to heal psoriasis on their own, but they can help reduce itching together with other treatments.

Biologic therapy


Biologic therapy that specifically targets specific aspects of the immune system has also been found to be very effective for psoriasis, eliminating the entire rash in most individuals. As a result they are used more and more to fight the disease. They are generally safe and well tolerated, though by decreasing the strength of the immune system, there is a higher risk of infections.  

The medications most often prescribed are infliximab (Remicade), adalimumab (Humira), and etanercept (Enbrel), though there are many others available.  

Oral medications

Psoriasis that doesn’t respond to topical treatment or light therapy is treated with oral medications, called systemic treatment. It can have severe side effects, so it’s only used for a short time and alternated with other treatments. Oral medications include:

  • Retinoids 
  • Methotrexate 
  • Cyclosporine
  • Biologics 

Light therapy 

Therapy with natural and artificial ultraviolet light exposes your skin to UVA and/or UVB light. There are a few types of light therapy:

  • Sunlight slows skin cell turnover and reduces scaling and inflammation, but too much sun exposure can cause skin damage.
  • UVB phototherapy and narrow-band UVB phototherapy uses controlled doses of artificial UVB light.
  • Goeckerman therapy combines UVB treatment with coal tar treatment.
  • Psoralen plus UVA light (PUVA) is a type of photochemotherapy that combines light-sensitizing medication called psoralen with UVA light. 

Alternative treatments

Alternative treatments can ease the symptoms of psoriasis and reduce itching, but they are most effective in connection with other treatments. Popular treatments include:

  • Aloe vera
  • Omega-3 fish oil
  • Oregon grape
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