What is Psoriasis?
Psoriasis is a skin condition that is characterized by the appearance of red, crusty patches on the skin covered with whitish scales. These lesions typically appear on the elbows, knees, scalp, and lower back; however, they can appear anywhere on the body. These psoriatic patches or plaques are small in most cases, but in other cases, their size varies and might become itchy or sore.
Psoriasis can develop at any age, but in the majority of cases, it develops in people under 35 years of age. Both men and women are equally affected. The severity of this condition varies from an individual to another. For some, it might cause minor skin irritation; however, it might become very severe in some cases, causing a great burden on the affected person’s quality of life. Psoriasis is a long-lasting condition that has an alternating course of no symptoms followed by periods of severe symptoms.
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What are the Treatment Options for Psoriasis?
Unfortunately, there is no cure for psoriasis to date. However, a wide variety of drugs are occasionally prescribed to improve the symptoms and the appearance of the psoriatic plaques.
In the majority of cases, topical treatments are usually used, such as vitamin D analogue creams or topical corticosteroids. However, in cases where the disease is more severe or if the topical treatment becomes ineffective, a treatment called phototherapy is indicated. In the phototherapy sessions, the treating physician will apply certain types of ultraviolet rays to the psoriatic plaques. If all of the previous approaches are not effective, then systemic drugs may be prescribed, and typically, these drugs affect the immune system and have side effects.
Since psoriasis causes a huge burden on the affected person and since all of the currently available drugs are of limited effectiveness in treating this condition, researchers became interested in investigating other potential therapeutic options, including cannabidiol (CBD), which has been shown to be effective in treating many skin conditions.
The Endocannabinoid System (ECS) and the Skin
Generally, cannabinoids don’t exist only in the hemp plant; however, they are also present inside our bodies in the form of endocannabinoids. These endocannabinoids exert important functions inside our bodies through a system called the endocannabinoid system (ECS). This ECS consists of the following components: (1) endocannabinoids, (2) cannabinoid receptors (type 1 and type 1- CB1 and CB2), and (3) enzymes that help in the synthesis or the breakdown of endocannabinoids.
The role of the ECS has been thoroughly studied, and it has been deemed highly important for the modulation of the central nervous system and the immune system in our bodies. That being said, recent research indicates a critical role of the ECS in maintaining the function and viability of the skin. Also, the dysregulation of the ECS is associated with the development of a wide variety of skin disorders, such as atopic dermatitis, itch, acne, abnormal hair growth or loss, and hyper/hypopigmentation of the skin.
Since the ECS has been shown to be of great value in maintaining the function of the nervous as well as the immune function, this led to thinking that the ECS would also be highly important for protecting the skin while maintaining its vitality.
Many endocannabinoids exist in our skin, the most abundant of which are anandamide (AEA) and 2-arachidonoyl glycerol (2-AG). Other endocannabinoids that are also involved with the skin include N-palmitoyl ethanolamide, N-oleoyl ethanolamide, N-stearoyl ethanolamide, and N-docosahexaenoyl ethanolamide. These endocannabinoids interact with their target receptors (cannabinoid receptors) in the skin to exert their actions.
The cannabinoid receptors include type 1 (CB1) receptors and type 2 (CB2) receptors. CB1 receptors are majorly found in the central nervous system (the brain and the spinal cord), while CB2 receptors are mainly found in the peripheral nervous system, as well as the digestive system and the immune system. That being said, recent research highlights that both CB1 and CB2 receptors are also found in the various components of the skin, including epidermal keratinocytes, the nerve fibers of the skin, dermal cells, melanocytes (melanin-secreting cells), sweat glands, and hair follicles.
The interaction between these endocannabinoids and the cannabinoid receptors has been reported to play a critical role in maintaining the skin barrier, cellular growth, cellular differentiation, and immunological and inflammatory processes. Additionally, these cannabinoids also possess neuroprotective, anti-inflammatory, and analgesic properties.
The Potential Role of CBD in Psoriasis
Since the ECS plays a great role in regulating the function of the skin, it is plausible that the treatment with topical cannabinoids might be effective for the management of certain skin disorders, including psoriasis. Most of the available evidence is focused on the potential therapeutic role of CBD in alleviating the symptoms of psoriasis since CBD has been shown effective in treating many inflammatory conditions.
Of note, CBD is mainly consumed orally, and despite the limited research investigating the effectiveness of topical applications, there is evidence to suggest that applying cannabinoids, particularly CBD, topically might be a viable route of administration for particular skin conditions. In some preclinical studies, CBD was shown to be successfully absorbed through the skin in murine models. Other research studies investigated the applicability of using CBD topically in a gel format in a rat model with arthritis. It was found that CBD was readily absorbed, and the degree of inflammation was significantly reduced, while inflammation-associated symptoms were alleviated.
In some vitro diffusion studies using the normal human skin, the CBD’s permeation potential through the skin was remarkable. However, it should be noted that, to date, there are no clinical trials investigating the effectiveness of topical CBD in the management of psoriasis. Therefore, until more studies are conducted and published, you should discuss with your physician the various treatment options for psoriasis.
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