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Abstract

Objective. To investigate the therapeutic effect of CBD-ointment administered on severe skin chronic diseases and/or on their outcome scars. Methods. A spontaneous, anecdotal, retrospective study of 20 pa-tients with two most frequent skin disorders: psoriasis (n: 5 patients), atopic dermatitis (n: 5) and resulting outcome scars (n: 10). The sub-jects were instructed to administer topical CBD-enriched ointment to lesioned skin areas twice daily for three months treatment. Results. Based on skin evaluations (hydration, TEWL, elasticity), clinical questionnaires (SCORAD, ADI, PASI), and supported by photographic data and investigators’ clinical assessment, the results showed that topical treatment with CBD-enriched ointment signifi-cantly improved the skin parameters, the symptoms and also the PASI index score. No irritant or allergic reactions were documented during the period treatment. Conclusions. The topical administration of CBD ointment, without any THC, is a safe and effective non-invasive alternative for improve the quality of life in patients with some skin disorders, especially on inflammatory background.
e1
Titolo breve ???????????????
A therapeutic effect of cbd-enriched ointment in inflammatory
skin diseases and cutaneous scars
B. Palmieri1,2, C. Laurino1,2, M. Vadalà1,2
1Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic,
Modena; 2Second Opinion Medical Network, Modena (MO), Italy
XXXX Clin Ter 2019; 170 (2):e?-?. doi: 10.7417/CT.2019.????
Copyright © Società Editrice Universo (SEU)
ISSN 1972-6007
Correspondence:
M. Vadalà. E-mail: mary.vadala@gmail.com. Tel. 3397695748
Introduction
Several chronic inflammatory skin disorders, including
atopic dermatitis (or eczema), psoriasis, cutaneous infec-
tions, and familial cold autoinflammatory syndrome reduce
significantly the patients’ quality of life, health outcomes
and work productivity (Kimball et al. 2010, Senra and
Wollenberg 2014, Chisari et al. 2018, Fallari et al. 2016).
Atopic dermatitis (AD) affects 15-30% of children (Shaw et
al. 2011, Bieber 2010) and 1-8% of adults, it is characteri-
zed by recurrent and often excoriated erythematous patches
(papules), associated with severe itching (Guttman-Yassky,
Nograles and Krueger 2011, Leung and Guttman-Yassky
2014). The pathogenesis of AD is not fully understood:
skin barrier defects driven by a combination of genetic and
environmental factors (allergen exposure, stress, coloniza-
Abstract
Objective. To investigate the therapeutic effect of CBD-ointment
administered on severe skin chronic diseases and/or on their outcome
scars.
Methods. A spontaneous, anecdotal, retrospective study of 20 pa-
tients with two most frequent skin disorders: psoriasis (n: 5 patients),
atopic dermatitis (n: 5) and resulting outcome scars (n: 10). The sub-
jects were instructed to administer topical CBD-enriched ointment to
lesioned skin areas twice daily for three months treatment.
Results. Based on skin evaluations (hydration, TEWL, elasticity),
clinical questionnaires (SCORAD, ADI, PASI), and supported by
photographic data and investigators’ clinical assessment, the results
showed that topical treatment with CBD-enriched ointment signifi-
cantly improved the skin parameters, the symptoms and also the PASI
index score. No irritant or allergic reactions were documented during
the period treatment.
Conclusions. The topical administration of CBD ointment, without
any THC, is a safe and effective non-invasive alternative for improve
the quality of life in patients with some skin disorders, especially on
inflammatory background. Clin Ter 2019; 170(2):e?-?. doi: 10.7417/
CT.2019.????
Key words: CBD, ointment, skin, quality of life
tion or infection of the skin with Staphylococcus aureus or
herpes simplex virus), and immune dysregulation (epider-
mal intercellular edema, increased numbers of IgE-bearing
Langerhans cells, inflammatory dendritic epidermal cells,
macrophages, eosinophils, and CD4-activated TH2 cells)
have been implicated (Leung and Guttman-Yassky 2014,
Wananukul et al. 2015, Nomura et al. 2003, Leung
2000). AD is often accompanied by allergic rhinitis (75%
of children), asthma (15-50%), and food allergy, as well as
conjunctivitis (Wananukul et al. 2015, Simpson 2012). In
contrast, the clinical picture of psoriasis presents erythema-
tous, well-demarcated red plaques covered with white scales
on the scalp, lower back, and extensor aspects of the elbows
and knees, associated with severe pruritus and changes in
fingernails and toenails (Nickoloff 2001, Guttman-Yassky
et al. 2011). The prevalence of psoriasis, occurred more fre-
quently in women than men, is 0-2% in children and 1-9%
in adults. It is characterized by the presence of neutrophil
overactivation and overproduction of interleukin (IL)-6
and IL-8 from keratinocytes (Komine and Tamaki 2000,
Iannaccone et al 2016). The main triggers for psoriasis
exacerbations are 1) environmental factors, including weight
gain, smoking, alcohol consumption, stress, withdrawal of
corticosteroids, HIV infection, and the use of medications
such as lithium, beta-blockers, or antimalarial agents (Parisi
et al. 2013, Roberson and Bowcock 2010), 2) microbial
factors, (fungi and viruses), e.g. a streptococcal throat in-
fection (Valdimarsson, Sigmundsdottir and Jonsdottir
1997, Prinz 2001), and 3) immune response dysregulation,
including epidermal hyperplasia and altered keratinocyte
differentiation (XSun L. 2014, Lowes, Suarez-Farinas
and Krueger 2014). Both the skin disorders share common
mechanisms of disease, including infiltration of circulating
immune cells in the skin (Guttman-Yassky et al. 2007),
altered expression of proinflammatory cytokines (Nomura
et al. 2003), and variable barrier alterations (Fartasch
1997), and can be recognized as systemic rather than lo-
calized cutaneous diseases because skin inflammation is
often complicated by metabolic, cardiovascular and other
comorbidities (Kim and Krueger 2017, Mansouri and
Guttman-Yassky 2015). Other chronic inflammatory skin
disease is acne vulgaris, resulting from androgen-induced
e2 B. Palmieri et al.
increased sebum production, altered keratinization, inflam-
mation, and bacterial colonization of hair follicles on the
face, neck, chest, and back by Propionibacterium acnes, and
it has a prevalence of 90% among adolescents and 10-15% in
adults (Bhate and Williams 2013, Thiboutot et al. 2009).
These inflammatory acne lesions can result in permanent
disfiguring sequelae (acne scars), that can be classified in two
basic types: atrophic and hypertrophic scars, depending on
whether there is a net loss or gain of collagen (Fabbrocini
et al. 2010). Regard the prevalence, minor scarrings occur
in up to 95% of the patients, while more severe scarrings
occur in up to 22% of patients (mostly aged 25-44 years)
(Layton, Henderson and Cunliffe 1994).
The traditional systemic treatments (e.g. methotrexate,
cyclosporine for psoriasis) present often some limitations,
including cumulative toxicity of target organs and potential
drug interactions (McClure, Valentine and Gordon 2002,
Christophers et al. 2006, Ferrandiz, Carrascosa and Bo-
ada 2010). In recent years, several researchers analyzed the
use of cannabinoids in the treatment of these dermatologic
disorders, including also melanoma and nonmelanoma skin
cancer, melasma, and seborrheic dermatitis, and reported
its anti-inflammatory properties and inhibitory effect on
rapidly proliferating tumorigenic cell lines (Mounessa et
al. 2017, Kogan 2005).
The cannabinoids or phytocannabinoids, e.g. cannabidiol
(CBD), cannabichromene (CBC), cannabigerol (CBG),
cannabinol (CBN) and delta (9)-tetrahydrocannabinol (Δ9
-THC), are the active constituents of the plant Cannabis
sativa, and elicit their activity by binding to specific re-
ceptors: the CB1 and CB2 cannabinoid receptors [found
on neurons and glial cells and in spleen tissue, respectively
(Van Sickle et al. 2005, Munro, Thomas and Abu-Shaar
1993)] that are part of the G-protein coupled class and their
activation results in inhibition of adenylate cyclase activity
(Baker et al. 2003, Iversen 2003, Di Marzo, Bifulco and
De Petrocellis 2004).
However, the CBD exerts multiple pharmacological
actions via no-CB1 and no-CB2 receptors, but by binding
transient receptor potential vanilloid type 1 (TRPV1) (Costa
et al. 2004), G protein-coupled receptor 55 (GPR55) (Per-
twee et al. 2010, Pertwee 2007), and 5-hydroxytryptamine
receptor subtype 1A (5-HT1A) (Russo et al. 2005).
Currently, CBD is a widespread ingredient in skin care
products formulated as body oils, moisturizers, lotions and
lip balms (Anwar F. 2006), but scientific studies on topical
safety and efficacy of this extract are lacking.
Therefore, we investigated, in spontaneous, anecdotal,
retrospective study, the therapeutic effect of CBD-ointment
administered on severe skin chronic diseases and/or on their
outcome scars.
Materials and methods
We reviewed medical records (electronic or paper-based)
of 20 patients that had appealed to our “Second Opinion
Medical Consulting Network”, Medical Centre (Modena,
Italy), between September 2016 and January 2017, because
of inflammatory skin disorders and cutaneous scars/blemi-
shes. The Second Opinion Medical Network is a consultation
referral web and Medical Office System recruiting suddenly
a wide panel of real-time available specialists, to whom
any patient affected by any disease or syndrome and not
adequately satisfied by the diagnosis or therapy can apply
for an individual clinical audit (Wunsch A. 2013). Due to
the doctor-patient communication gap, most of the patients
usually wander around the medical websites looking for
proper answers to their health problems. However, their
search often becomes compulsive and obsessive and often
ambiguous and frustrating (Palmieri B. 2017). Palmieri et
al. (Palmieri et al. 2011) describe this borderline or even pa-
thological behaviour as the “Web Babel Syndrome” – a psy-
chological imbalance affecting young and elderly patients,
especially those with multiple synchronous diseases who
receive from their caregivers heterogeneous and misleading
informations or advices, including confused, contradictory
statements and prescriptions (Palmieri and Iannitti 2011).
To deal with this problem, the Second Opinion Network aims
to be a useful “problem-solving” support revisiting each
diagnostic and therapeutic step and properly re-addressing
tailored treatments and prognoses, as well as preventing
unnecessary investigational procedures and unhelpful and
expensive medical and surgical interventions (Di Cerbo
and Palmieri 2012).
In this preliminary investigation, we adopted selective
inclusion criteria: 1) suffering from moderate/severe skin
disorders for at least 6 months and seeking an effective,
adequate therapy; and specific exclusion criteria: 1) pregnant
or breastfeeding women, 2) topical medication containing
steroids for the treatment of skin disease for at least one
month, 3) skin intolerance/allergies to the components of
product used in the study.
Twenty volunteers (14 females and 6 males) between
20 and 80 years of age (Fig. 1), were visited and informed
during a personal interview, gave their permission, and
signed an informed consent previously approved by the
Local Institutional Review Board, in accordance with the
Helsinki Declaration. These patients were complaining of the
two most frequent skin disorders: psoriasis (n: 5 patients),
atopic dermatitis (n: 5) and resulting scars (n: 10) (Fig.2).
The product, hemptouch organic skin care ointment (Hem-
ptouch Ltd, Novo mesto, Slovenia) contained CBD seed oil
and natural ingredients, including Mangifera Indica, Calen-
dula officinalis, Lavendula officinalis, Chamomile, Amyris
Balsamifera, and butyrospermum (shea butter) (Tab.1) The
subjects were instructed to administer topical ointment to
lesioned skin areas twice daily, in morning and evening, for
three months treatment. During this period, the patients not
utilized any skin care product. We performed the following
skin evaluations:
a) Hydration and transepidermal water loss (TEWL)
assessment at baseline and after three months treatment with
a DermaLab® USB instrument (Cortex Technologies, Had-
sund, Denmark), this Point of care (POCT) with hydration
probe, that is pressed upon the skin, relies upon the conduc-
tance principle, which measures the water binding capacity
of the stratum corneum (Laurino, Palmieri and Coacci
2015). TEWL is defined, instead, as a measurement of the
quantity of water that passes from inside a body through the
epidermal layer to the surrounding atmosphere via diffusion
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Titolo breve ???????????????
and evaporation processes, which is physiologically reduced
during age (Elias 2005).
b) Elasticity assessment at day 0 and day 90 with Ela-
stiMeter® (Delfin Technologies, Kuopio, Finland), it was
measured as stiffness, a physical measure of an object’s
resistance to change in shape under an external force in N/m.
The device consists of a 1 mm length indenter, a reference
plate and built-in force sensors. The probe head is quickly
pressed against the skin surface with a recommended stan-
dard pressure that is displayed on the screen. The indenter
induces a constant deformation when the reference plate is
in full contact with the skin, and the elasticity is determi-
ned by the skin resistance to this deformation (Iivarinen,
Korhonen and Jurvelin 2014).
c) Photographic assessment at baseline (day 0), day 30,
day 60 and day 90.
d) We also use several questionnaires to evaluate the
degree of the symptoms, including Scoring Atopic Derma-
titis (SCORAD) index for atopic dermatitis, Acne disability
Index (ADI) for acne, and Psoriasis Area Severity Index
(PASI), index used to express the severity of psoriasis.
Skin parameters were measured on five selected areas:
forehead (F), right and left malar area (RMA and LMA, re-
spectively), and right and left lateral-medial area of the neck
(RN and LN, respectively). We assessed also the elasticity
of the forearm (FO) as control, according to the manufac-
turer’s instructions, since skin arm elasticity changes less
quickly then skin face elasticity. The value of hydration
[(expressed in microSiemens units (μS)], TEWL (measured
by diffusion gradient in g/m2/h) and elasticity (expressed
in μS) is the arithmetic mean of 3-5 repetitive measures in
the same area.
Statistical analysis
The statistical analysis was performed using the Mann-
Whitney test (continuous variables not normally distributed)
and the chi-squared test (categorical variables). Statistical
significance was set at a P value < 0.05, and all data and
graphics were analyzed using the R software, version 3.1.2
(2015, Vienna, Austria) (RA. 2015).
Results
After a treatment period of three months, the evaluated
skin parameters significantly improved in all the patients.
Specifically, the hydration (p< 0.01) increased of 6.9% in F
area, 6.1% in RMA, 6.5% in LMA, 6.8% in RN and 5.5% in
LN (Fig.3). TEWL also significantly improved (p < 0.001)
in these selected sites: increase of 28.1% in F area, 20.7%
in RMA, 23.7% in LMA, 17.6% in RN and of 24.7% in LN
(Fig.4). At last, elasticity (p < 0.001) improved of 17.1%
in F field, 27.1% in RMA, 23.2% in LMA, 22.9% in RN
Tab. 1. Components of skin care ointment 50 ml/1.69 floz.
Composition of CBD-ointment
Component Concentration mg/ml
Mangifera Indica N/A
Calendula officinalis N/A
Lavendula officinalis N/A
Chamomile N/A
Amyris Balsamifera N/A
e4 B. Palmieri et al.
and of 26.1% in LN area (Fig.5). Unretouched photos taken
before treatment and after 12 weeks of treatment showed a
significant reduction of major signs of cutaneous blemishes
in a woman (73 aa) and of scar due a cyst removal surgery
in the men (78 aa), confirming significant improvement in
these symptoms and none experiencing worsening (Fig.
Fig. 6 Fig. 7
Fig. 8
6-8). Additionally, we recorded reductions in the numbers
of papules (−20%), pustules (−31%) in dermatological
patients. The topical ointment was significantly (p< 0.001)
efficacious in improving also PASI index score (excluding
the head, which was not treated) at day 90.
Fig. 6-8: Photography of cutaneous blemishes (sunspots)
on the right leg (Fig.6), and right arm (Fig.7) of the patient
(woman, 73 aa), and scar (Fig.8) due a cyst removal surgery
(men, 78aa) before and after 3 consecutive months of twice-
daily application of the study cream.
Discussion
Several studies evidenced that topical route of CBD
administration represents significant therapeutic tool in the
treatment of chronic conditions, encephalomyelitis (EAE),
multiple sclerosis (MS), with less side effects because due to
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Titolo breve ???????????????
the lower peak plasma levels (Lodzki et al. 2003, Touitou E
1988). For istance, Giacoppo et al, showed that a preparation
of 1% CBD-cream reduces the expression of Nitrotyrosine
(iNOS) in tissues from EAE treated C57BL/6 mice, sugge-
sting that plant-derived cannabinoids (CBD, THC, CBN),
may be responsible for the reduction of cytokines produc-
tion, that in turn counteract the rise of iNOS levels and the
downstream cascade of events triggered by the inflammatory
process, reducing thus oxidative stress (Giacoppo et al.
2015). Indeed, published studies evidenced that THC may
inhibite the proliferation of mouse lymphocytes and decre-
ase the production of interleukin-2 (IL-2) and interferon-c
(IFNc) (Klein et al. 2000, Klein, Newton and Friedman
2001, Klein et al. 1985); but also may reduce the secretion
of pro-inflammatory cytokines like IL-1a, IL-1b and tumor
necrosis factor-alpha (TNFa) in microglial cells. In another
study, CBD and CBN were shown to exert a suppressive
effect on human keratinocyte proliferation. Here, the syn-
thetic CB receptor agonists HU-210, a structural analogue
of THC, displayed an inhibitory effect on cell proliferation,
clearly confirming the anti-inflammatory activity of the
cannabinoids beyond its interaction with specific CB1 and
CB2 receptors. This is reminiscent of palmitolylethanola-
mide (PEA), an endogenous fatty acid with cannabimimetic
properties that attenuates skin inflammation, although it does
not bind to CB1 or CB2 receptor (Stander, Reinhardt and
Luger 2006, Jordt et al. 2004).
Our results showed that topical treatment with CBD-
enriched ointment significantly improved the quality of life
of patients with several skin diseases.
The mean skin elasticity level on baseline visit was 46
μs, whereas at the end of study, the same value was increased
gradually (70 μs). This effect may be due to essential fatty
acids, including α- linolenic acid, γ-linolenic acid, linoleic
and oleic acids, and phytosterols (β-sitosterol) (Dobrev
2007, Zaman S 2012), present in the used topical cream,
that may inhibit the enzyme 5-α-reductase, subsequently
inhibiting the excessive skin sebum secretion and improving
elasticity and hydration.
No irritant or allergic reactions were documented during
the period treatment. A topical product also improved severity
of itch and loss of sleep in the AD patients. Gaffal et al, de-
monstrated that CBD application may attenuate ovalbumin-
induced allergic airway inflammation in experimental mouse
model of atopic dermatitis (C57Bl/6 mice) as indicated by a
reduced number of lung-infiltrating immune cells and of the
serum IgE and IgG levels (Gaffal et al. 2013).
We observed also antiproliferative and antinflammatory
effects of CBD treatment in patients with acne scars. These
effects could be associated to specific sebostatic actions of
CBD: a) normalize the pathologically elevated lipogenesis
induced by “pro-acne” agents, b) suppresse cell prolifera-
tion and c) prevent the actions of toll-like receptor (TLR)
activation or “pro-acne” agents to elevate proinflammatory
cytokine levels (Olah et al. 2014). This is especially pro-
mising, because the currently available,anti-acne agent,
isotretinoin (accutane), is known to cause serious side
effects, including hypertriglyceridemia, hepatotoxicity, and
mood changes, e.g depression and psychosis (Kurokawa et
al. 2009, Ellis and Krach 2001, Rigopoulos, Larios and
Katsambas 2010).
Our results showed clearly that cannabinoids inhibited
the proliferation of keratinocytes, thus demonstrating a the-
rapeutic potential as well for the treatment of psoriasis, but
further investigation is urgently needed to identify its actions
mechanism. To date, the literature on human CBD safety and
pharmacokinetics is lacking, however, given the extensively
documented accumulation of phytocannabinoids from smo-
ked cannabis in the pilosebaceous unit (e.g hair, sebaceous
gland) (Kintz, Cirimele and Mangin 1995, Skopp et al.
2007), it is expected that CBD, due to its high lipophilicity,
may reach and accumulate in the sebaceous glands, via the
transfollicular route (Lodzki et al. 2003, Tubaro et al. 2010,
Hueber, Wepierre and Schaefer 1992). This accumulation
is been evidenced for several topically applied lipophilic
compounds, including steroid hormones, photosensitizers
(Hueber et al. 1992, Togsverd-Bo K 2012).
Main limitations of our study include the uncontrolled
and retrospective design study and the small clinically he-
terogeneous cohort.
Conclusions
The topical administration of CBD ointment, without
any THC, is a safe and effective non invasive alternative
for improve the quality of life in patients with some skin
disorders, especially on inflammatory background.
In a next future, further trials on safety, tolerability and
efficacy of topical cannabinoids combining CBD and THC
but also cannabis terpenes and other plant extracts, would
give us definite informatons about the most effective inte-
grated formula of this sort of panacea in the dermatological
setting.
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... Antipsychotic; Counteracts the intoxicating effects of cannabis; Anxiolytic; Addiction treatment; Antimicrobial (Gram-positives bacterial cutaneous infections); Antitumour [11,12,14,[17][18][19][20][21] CBG Muscle relaxant; Analgesic; Antifungal (modest); Antineoplastic; Antidepressant; Inhibition of keratinocyte proliferation in psoriasis; Antibiotic activity against methicillinresistant Staphylococcus aureus (MRSA); [11,12,14,17,18,21] Modulation of pain, spasticity, sedation, and mood; Bronchodilator; Neuroprotective and antioxidant; Antipruritic in cholestatic jaundice; Anti-inflammatory (power: 20× aspirin and 2× hydrocortisone); Analgesic; Anti-nausea/emesis (which is induced by chemotherapy); Appetite promoter Antitumorogenic [10][11][12][13][14][15][16][17][18] CBD Pharmaceutics 2022, 14, x FOR PEER REVIEW 2 of 16 cannabidiol (CBD), and cannabichromone (CBC) [4]. Table 2 depicts the significant therapeutic effects of various phytocannabinoids [11,12]. ...
... Antipsychotic; Counteracts the intoxicating effects of cannabis; Anxiolytic; Addiction treatment; Antimicrobial (Gram-positives bacterial cutaneous infections); Antitumour [11,12,14,[17][18][19][20][21] CBG Pharmaceutics 2022, 14, x FOR PEER REVIEW 2 of 16 cannabidiol (CBD), and cannabichromone (CBC) [4]. Table 2 depicts the significant therapeutic effects of various phytocannabinoids [11,12]. ...
... The topical administration of CBD ointment improved the quality of life in patients with skin problems (psoriasis, dermatitis and scars) [19]. Interestingly, a hydrophilic gel with 79% w/w propylene glycol showed the best performance for topical administration of CBD [104]. ...
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... These improvements were evident through a 34.5% average reduction in EASI scores (p < 0.005) and a 29% average decrease in the VAS scale (p < 0.05) in comparison to the baseline level [139]. Another clinical study was performed to assess the role of CBD-containing cream on atopic eczema, psoriasis, and scarring [140]. It was found that the CBD-containing cream increased hydration, transepidermal water loss, and elastic fibers of the skin [140]. ...
... Another clinical study was performed to assess the role of CBD-containing cream on atopic eczema, psoriasis, and scarring [140]. It was found that the CBD-containing cream increased hydration, transepidermal water loss, and elastic fibers of the skin [140]. However, SCORAD was not properly reported in the results. ...
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... Additionally, the therapeutic effects of these commercial products cannot be judged solely on their cannabinoid content because they contain other antiinflammatory or analgesic components. 13,14,17 Apart from the Hemp Production Program and the 2018 Farm Bill in the United States setting a legal threshold of THC, hemp is not regulated in consumer products. 21 Therefore, consumers have no guarantee the cannabis products purchased contain the labeled content. ...
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... Also, these products deliver calming, hydrating, antioxidant effects, decrease inflammation, and have a soothing effect on the (Tóth et al. 2019;. Skin CBD balms relieve sore muscles, stiffness and provide intense hydration to the skin (Palmieri et al. 2019). CBD/hemp exfoliating cleanser cleanses and soothes the skin (Zagórska-Dziok et al. 2021). ...
... Also, these products deliver calming, hydrating, antioxidant effects, decrease inflammation, and have a soothing effect on the (Tóth et al. 2019;. Skin CBD balms relieve sore muscles, stiffness and provide intense hydration to the skin (Palmieri et al. 2019). CBD/hemp exfoliating cleanser cleanses and soothes the skin (Zagórska-Dziok et al. 2021). ...
Chapter
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... The skin parameters, the symptoms and the PASI index score were significantly improved. No irritant or allergic reactions were documented during the period treatment [108]. ...
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... Maida and Corban showed that topical combined CBD-THC appears to be effective for pain relief in patients with pyoderma gangrenosum; in fact, three patients achieved symptomatic relief of pain (p < 0.05) with an overall pain reduction of 30% [112]. Two studies reported first data about a total of six psoriasis patients that were treated with topical CBD or THC: all patients had a good response to treatment with a resolution of psoriasis plaques [113,114]. Numerous studies are underway to test the efficacy of new cannabinoids and to evaluate their clinical efficacy in known and still unknown skin diseases. The data obtained to date give us hope in their use as future therapeutic agents. ...
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Medical case reports suggest that cannabinoids extracted from Cannabis sativa have therapeutic effects; however, the therapeutic employment is limited due to the psychotropic effect of its major component, Δ9-tetrahydrocannabinol (THC). The new scientific discoveries related to the endocannabinoid system, including new receptors, ligands, and mediators, allowed the development of new therapeutic targets for the treatment of several pathological disorders minimizing the undesirable psychotropic effects of some constituents of this plant. Today, FDA-approved drugs, such as nabiximols (a mixture of THC and non-psychoactive cannabidiol (CBD)), are employed in alleviating pain and spasticity in multiple sclerosis. Dronabinol and nabilone are used for the treatment of chemotherapy-induced nausea and vomiting in cancer patients. Dronabinol was approved for the treatment of anorexia in patients with AIDS (acquired immune deficiency syndrome). In this review, we highlighted the potential therapeutic efficacy of natural and synthetic cannabinoids and their clinical relevance in cancer, neurodegenerative and dermatological diseases, and viral infections.
Chapter
The development of medications or cosmetics from botanicals such as the cannabis plant is the current major topic of interest in the pharmaceutical and cosmetic industry. Currently, several countries have legalized the use and dispensing of cannabis products. Cannabis is one of the most commonly abused or used addictive natural products after alcohol and tobacco. Concerning the cosmetic world, cannabis-based products are used extensively in various formulations. The most common personal care products are the skin, hair, eye, nails, or face formulations which are generally used to improve the appearance and prevent aging or risk of other diseases. This chapter deals with various cannabis-based cosmetic products and their uses.
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Atopic dermatitis (AD) and psoriasis represent contrasting poles of the T(H)1 versus T(H)2 paradigm. Both diseases have been associated with increased numbers of dendritic cells (DCs) in the skin, but the similarities and differences in DC populations need to be established. We aimed to characterize the specific DC subsets, as well as chemokine and cytokine environment in chronic AD compared with psoriasis. Skin biopsies were obtained from patients with acute exacerbation of chronic AD (n = 18), psoriasis (n = 15), and healthy volunteers (n = 15) for microarray analysis, RT-PCR, immunohistochemistry, and double-label immunofluorescence. Myeloid DCs upregulate CCL17 and CCL18 in AD, as opposed to TNF-alpha and inducible nitric oxide synthase (iNOS) in psoriasis. In our study, we identified cells phenotypically identical to the inflammatory dendritic epidermal cells in the dermis in both diseases, although to a lesser extent in psoriasis. We found substantially higher numbers of dermal CCL22 producing plasmacytoid DCs in AD. The thymic stromal lymphopoietin receptor showed significantly higher expression in AD, whereas the thymic stromal lymphopoietin ligand was upregulated more in psoriasis. There are major differences in myeloid and plasmacytoid subsets of cutaneous DCs and the chemokine/cytokine environment between AD and psoriasis. Distinct subsets within the CD11c(+) population may influence polarization through the production of regulatory mediators, including iNOS, TNF, CCL17, and CCL18. Plasmacytoid DCs may also influence T(H)2 polarization, having a more important role in AD than previously appreciated. Dermal inflammatory dendritic cells in AD and TNF and iNOS-producing DCs in psoriasis, and/or their regulatory products, may be potential targets for future therapeutic interventions.
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Introduction: Skin lesions can be defined as lesions that result in loss of tissues and their joints, and often this cutaneous skin process is a primary or secondary consequence of the structural changes in the skin itself. Subjects with peripheral arteripathies that develop chronic skin lesions in the lower extremities of the Western world are constantly increasing. We conducted a study on the etiologic incidence of chronic skin lesions in peripheral arterial disease CSLpa subjects in the lower limbs compared to subjects with chronic skin lesions CSL (controls). Materials and methods: 30 subjects with peripheral atheropathies PA (22 F - 8 M mean age 74,5 ± 4,9) and with chronic skin lesions (CSLpa) in the lower limbs "A" group were admitted to our study according to a randomized and compared to 30 no peripheral atheropathies subjects (19 F-11 M, mean age 81,5 ± 7,3 - controls) group B with chronic skin lesions (CSL). These two groups "A" and "B" have been studied and compared on the basis of infectious etiology responsible for the infectious skin process. Results: In the subjects of the "A" group we found a 12 positive assay of 40.0% of the examinations, while in the group "B" we achieved a total cultured positivity of 9 cases corresponding to 30.0% of the examinations . For the number of bacterial species identified for "A" group we obtained 3 mono microbial and 6 poly microbial bacteriological tests and for group "B" we observed 7 mono microbial and 2 poly microbial tests. All bacteriological isolates showed "in vitro" sensitivity to satisfactory ciprofloxacin with MICs range of 0.78-1.56mg/L. The data observed after 4 weeks after the amniotic membrane (MA) in the two study groups A and B were respectively the following: and for group A 50% scarring, 46.6% partial resolution and in one case worsening for the B-healing group in 63.3%, the partial resolution in the remaining 36.6. Conclusions: The data from this study show a different etiology between subjects with CSLpa than subjects with CSL. This phenomenon confirms an alteration of the skin microbioma of subjects with peripheral arteriopathy and chronic skin lesions with modification of the opportunistic role of some species of cutaneous bacterial flora.
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Inflammation of the skin is the pathological base of contact dermatitis (CD), and cytokines are very important in its pathogenesis. Recently it has been shown that interferon (IFN)-γ, and the IFN-γ dependent chemokines, monokine induced by IFN-γ (MIG), IFN-γ-induced protein 10 (IP-10), and IFN-inducible T cell alpha chemoattractant (I-TAC), play an important role in CD. Allergic CD (ACD) is a T-cell-mediated disease in which expression of a distinct repertoire of chemokines results in the recruitment of effector T cells into the skin. An increased expression of MIG, IP-10 and I-TAC in the skin has been observed by many studies in ACD, but not in irritant CD. The IFN-γ dependent chemokines are produced by keratinocytes, mainly during the clinically inflammatory phase of ACD. Also chemokine (C-X-C motif) receptor (CXCR) 3, the common receptor of the three IFN-γ dependent chemokines, is upregulated in chemical-induced allergic skin responses when compared with irritant skin responses. However, other studies have shown a low level increase of IP-10 in irritant sodium dodecyl sulphate dermatitis. The above mentioned results show that although skin inflammation contact sensitizer-induced is similar to irritant-induced, the regulation of allergic inflammation-related gene MIG and IP-10, could help to discriminate skin sensitization from chemically irritation.
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Psoriasis vulgaris, affecting the skin, is one of the most common organspecific autoimmune diseases in humans. Until recently, psoriasis was treated by agents or approaches discovered largely through serendipity. Many of the available drugs were inherently quite toxic when used as continuous treatment for many years in this chronic disease. However, an increasing understanding of disease-specific immune pathways has spurred development of pathway-targeted therapeutics during the past decade. Psoriasis is now the most effectively treated human autoimmune disease, with high-level clinical improvements possible in ∼90% of patients using a new generation of drugs that selectively target the IL-23/Type 17 T cell axis. Thus, psoriasis is a model for the success of a translational-medicine approach based on cellular and molecular dissection of disease pathogenesis in humans. Expected final online publication date for the Annual Review of Medicine Volume 68 is January 14, 2017. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Introduction: Psoriasis produces functional and aesthetic damages which cause psychosocial discomfort and require new adjustment factors. Aims: We describe the correlation among discomfort and personality factors as traits, coping, defense mechanism (DM) and resilience in Ps (skin psoriasis) and PsA (psoriatic arthritis) patients. Materials and methods: A random sample, age between 45-60, with 1:1 female/male, includes 3 groups each of 90 subjects: - single psoriasis (Ps, average 50.11, SD 4.9928) - Ps and psoriatic arthritis (PsA, average 50.61, SD 4.8765) - controls (C, average 50.0 and SD 4.8019). We evaluated traits by the 16PF-5, coping by Cope Scale, defence mechanism (DM) by DMRS, dysmorphophobia by BDDE and resilience by CR-RISC scales. Statistical analysis was performed by SPSS 14 version, p < 0.05 and t, F, W and P tests and clinical analysis. Results: We recorded a reduction in traits and coping and an increase in DM, dysmorphophobia and resilience. PsA patients showed a greater distress and adjustment factors than Ps alone. Tests showed a valid significance (p < 0.00001), an effect size from 0.30 to > 0.50 in comparison patients-C and η2 = 1.4 in comparison Ps-PsA. In all patients- controls OR, PAR and NNT registered very high values. Discussion: Reduction in autonomy and imperfections cause an internal damage. The adaptation process searches coping factors (to integrate traits) when lesions appear. It selects DM when stressful dynamics require a further adaptation. Finally it results in adequate resilience when damages and dysmorphophobia are offset by traits, coping and DM. Conclusions: Clinical signs increase more then traits in severity, coping decrease in resources, resilience and DM grow in use and dismorphophobia just increases in intensity.
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The understanding of the pathogenesis of psoriasis vulgaris has advanced significantly since the therapeutic efficacy of immunosuppressive drugs has drawn attention to the role of immune mechanisms in psoriasis manifestation. Today the results of many experimental studies provide evidence that psoriasis is largely a T cell mediated disorder. It may result from antigen-specific activation of T cells in the skin of genetically predisposed individuals. These T cells apparently have a particular functional differentiation and promote the psoriatic skin changes by secreting a certain set of cytokines. Based on the fact that streptococcal throat infections are trigger of guttate psoriasis, the putative psoriatic antigens are assumed in keratinocyte proteins that share structural homologies with streptococcal proteins and thus induce cross-reactive responses of antibacterial T cells against skin components. Together with the particular phenotype of psoriatic skin lesions these findings suggest that psoriasis represents a sterile antibacterial tissue reaction, which is mediated by streptococci-specific T cells that cross-react against epidermal autoantigens.
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It has been demonstrated that second opinion (SO) in medicine and surgery may influence the diagnosis, as well as treatment and prognosis; in fact, the patient may achieve treatment optimization and avoid unnecessary risks and costs. Most of the studies reviewed in this editorial evaluated the benefits of second opinions and the reasons on which the patients seek a medical SO in oncology. SOs are, in fact, pretty common in cancer care with most patients motivated by the need for improved communication, additional information and reassurance. Also theWeb has become a relevant partner in this procedure, but to avoid the unpleasant "Web Babel Syndrome", it is necessary an easy access to SO consulting medical offices.
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Background: Atopic dermatitis (AD) is generally considered to be the initial step of the so-called atopic march, which following steps are allergic rhinitis (AR) and asthma. There are few data about the progression of AD, including factors associated with the remission of AD in Asians and further research is needed. Objective: To study the progression and factors associated with the remission of childhood AD diagnosed by pediatric dermatologists. Methods: This study included 303 AD patients who visited the pediatric dermatology unit at King Chulalongkorn Memorial Hospital, Thailand, between 2002 and 2010. An interview, performed by a physician via telephone using a preformed questionnaire, was completed for 205 children. Results: A total of 205 children were observed, with a median observation time of 5.2 (3.5-8.0) years, and an initial AD severity score of mild (61.0%), moderate (29.3%) and severe (9.7%). The prevalence of AD during the first two years of life was 64.4%. AD completely disappeared in 102 cases (49.8%) by the median age of 3.5 (1.5-7.8) years. Early onset and severity of AD were major determinant of prognosis. The prevalence of AR and asthma was 36.6%, and 9.3%, respectively. The risk factors associated with respiratory allergy were the onset of AD after aged two years, a family history of atopy, increased serum IgE level, and sensitization to inhalant allergens. Conclusions: Half of AD had completely disappeared at preschool age. Good prognosis was mostly determined by early onset AD and mild severity. Late onset, family history of atopy and increased serum IgE level are associated with respiratory allergy. © 2015, Allergy and Immunology Society of Thailand. All rights reserved.