Psoriasis and Cannabinoids by Dr. Stanley R Manstof
Psoriasis is a chronic systemic disease that manifests itself in several different forms, but typically involves skin lesions, rashes, redness, scaling, itching, or inflamed skin. Caused by the excessive growth of skin cells, psoriasis can affect one body part or a small localized area, but occasionally can be widely distributed or cover large areas. Cyclic patterns occur with the disease, and it can go into remission spontaneously. Patients suffer from the discomfort caused by the itchy and peeling skin, often inflamed and reddened, and in psoriatic psoriasis, the joints can be inflamed and painful as well. There are several different types of the disease. Evidence suggests that this condition is related to T-cell and neutrophil activity, and therefore psoriasis can be classified as an auto-immune disease. It is postulated by some researchers that the T cell Lymphocytes travel into the dermis and attack healthy cells causing inflammation, redness, and swelling. Treatment modes include phototherapy, topical lotions, and medicaments, as well as systemic drugs or oral medications.
For the purpose of this article, we are focusing on topical applications applied directly to the skin. This would include creams, lotions, oils, patches, or other transdermal delivery methods. Cannabinoids are phytochemicals found in the cannabis plant and can be derived, extracted, or processed from the plant itself and made into a lotion for topical application to the skin. There are over 70 known cannabinoids, the main ones being THC and CBD, but many others exist and have exhibited anti-inflammatory and beneficial therapeutic effects. So, let’s take a look at how these compounds may play a role in the treatment or symptoms of psoriasis… First, it is interesting to note that the skin itself has a high concentration of cannabinoid receptors, as well as the cells in the immune system. In addition to the skin, CB2 receptors are located on immune blood cells such as monocytes, macrophages, B-cells, and T-cells. Receptors on the skin surface absorb cannabinoids quickly, and the CB2 receptors are activated. In addition, the receptors on the cell membrane of the immune blood cells are also activated, and the net result may be ultimate suppression of immune function or modulation in the immune system. Also, the stimulation of the CB2 receptor has been credited in the reduction of inflammation and pain. Secondly, it has been shown that upregulation (stimulation) of the CB1 and CB2 receptors by THC produces suppression of keratinocyte proliferation and inflammation, possibly slowing the growth of skin cells. Other cannabinoids such as CBD, CBN, and CBG have also been shown to inhibit skin cell proliferation. Also, angiogenesis needed for skin cell growth may be inhibited by cannabinoids according to quite a few studies.
Furthermore, one research article states: “Cannabinoids are able to inhibit HIF-1 α, VEGF, MMPs, bFGF, IL-8, IL-17, and other mentioned cytokines and adhesion molecules both in vivo and in vitro. Altogether, authors suggest using this cannabinoid for treatment of psoriasis due to its potential in suppressing the two main steps of psoriatic pathogenesis.” 2017 Norooznezhad et al The overall consensus concerning cannabis and this disease are similar to other research areas with medical cannabis – i.e. more research is needed, perhaps involving dermatologists. These studies are done in lab animals or in test tubes - not with controlled clinical trials in humans. However, there is anecdotal evidence available from patients with the disease who claim it can be a benefit to help their symptoms. Also notable is the fact that many lotions have a combination of agents several of which are non-cannabinoids, so this complicates evaluation. Future research should be focused on the medicinal effectiveness of a balanced THC-CBD dermatologic agent (similar to Mary’s Medicinal 1:1) with patients who are suffering from the disease. Other cannabinoids can also be examined, and systemic ingestion researched, along with topical applications, as there is also a psychological component to the disease. As state laws change and the stigma surrounding cannabis is lifted, more financial resources and large institutional research will become available to unravel the many mysteries of this complex plant, including further studies on psoriasis and other related diseases.