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Cannabidiol, or CBD, is one of the two well-known chemical compounds or cannabinoids found in marijuana or hemp. But unlike tetrahydrocannabinol (THC), it doesn’t give you a “high.” Instead, it has a mellowing effect with pain relief. Lately, CBD has been gaining popularity and trending in the health wellness sector with a wide variety of creams, lotions, oils, vape pens, or edibles like gummies or candies.
The internet is littered with information that claim CBD as a natural treatment option for a host of conditions including skin-related disorders like psoriasis or psoriatic arthritis.
Reported health benefits include relief for:
But does it work as well as claimed? Jim Snedden says that for him, it did.
Snedden, 55, was living in Connecticut in 2005 when he first noticed his legs were very dry and itchy. Soon, the itch migrated to his hands.
“I was waking up all bloody because I was digging at it,” recalls Snedden who now lives in Goshen, NY.
In 2007, after he moved to upstate New York, he had another severe flare-up. Initially, he chalked it up to change in water, but it was confirmed as psoriasis. By 2012, he had developed psoriatic arthritis (PsA). Knowing it was a “destructive disease,” Snedden asked his doctor to put him on a biologic, a powerful, genetically engineered drug that’s designed to lower or stop inflammation in your body. It kept his psoriasis symptoms at bay. But the deep, bone-aching pain from the arthritis lingered.
“I have days where I can’t pick things up. I’m dropping things all day because my fingers hurt really bad,” Snedden says.
For years, he took prescription opiates to manage the pain, but they stopped working. In 2018, his daughter, who has fibromyalgia, a condition that causes pain all over the body, urged Snedden to look into cannabidiol (or CBD) as an option for pain relief.
He did. “It did a lot of good,” Snedden says. He’s cut out all the opiates from his treatment regimen.
Does CBD Really Work for Psoriasis and Psoriatic Arthritis?
Doctors and other experts who are keeping a close eye on the growing demand for CBD say it’s hard to know for sure.
“While there are some theories to suggest CBD may have benefits for psoriasis, there is a complete absence of rigorous trials in people to prove their safety and efficacy for treatment of psoriasis,” says Joel Gelfand, MD, in an email to WebMD. Gelfand is a professor of dermatology and director of the Psoriasis and Phototherapy Treatment Center at University of Pennsylvania Perelman School of Medicine.
However, Adam Friedman, MD, professor and chair of dermatology at George Washington School of Medicine and Health Sciences in Washington, DC, says there’s “enough mechanistic data” to argue the potential benefits of CBD for psoriasis or PsA.
Friedman explains that when CBD enters your body, it binds with several receptors including receptors called endocannabinoids that affect pain, itch, and inflammation. There are two types of receptors in the endocannabinoid system: cannabinoid type 1 and 2 (CB1 and CB2). THC binds with CB1 located in the central nervous system, which gives you the fuzzy feels when you take marijuana, and CBD binds with CB2.
When CBD binds with the CB2 receptor found on immune cells throughout the body, it has effects on the body’s immune function.
“When CBD binds to various receptors, CB2 and others, from an immune perspective, what it does is it induces inflammation resolution,” Friedman says. Meaning it activates signals in your body that makes the cells that cause inflammation to change and subside.
In terms of psoriasis, according to Friedman, CBD can reportedly stimulate the secretion and recruitment of cells that are important to remove skin cell debris and to allow your skin to mature and heal properly.
In a 2019 study, 20 participants with psoriasis or atopic dermatitis, another skin-related disorder, were asked to apply a CBD ointment on affected skin twice daily for three months. The CBD ointment, without any THC, was able to improve skin hydration and elasticity. It also improved participants’ quality-of-life when it was measured against the Psoriasis Area Severity Index.
In a recent 2020 study, 50 people with scalp psoriasis or seborrheic dermatitis, a type of condition that causes dry, flaky skin mostly on the scalp, were asked to use a shampoo with CBD for 2 weeks. The shampoo was able to reduce itching, burning, the severity of the inflammation in the scalp.
But Friedman notes that there’s a lot more research to be done to see the full extent of CBD’s impact on your body. “Our understanding of the endocannabinoid system is incomplete.”
Moreover, Friedman says when it comes to cannabinoids like CBD and THC, if you’re buying over-the-counter creams and other topics products infused with it, it may not be getting absorbed properly through the skin barrier. This is because “cannabinoids are lipophilic.” This means they are likely to stay in a fatty environment — something your top layer of skin has plenty of. So if you apply a cream on your skin, only “a fraction of it” may actually get through.
“Purposeful delivery [of CBD] is what you have to think about versus asking ‘do cannabinoids work?’” Friedman says.
CBD and Potential Risk
Studies done on CBD to date are not conclusive. The lack of tests on safety and effectiveness is also because of the confusion around government regulations around CBD. It’s made it hard to study the plant and its potential use, risks, and benefits. Laws for legal access to CBD differ from state to state. So there are a lot of CBD-infused products on the market that are not regulated by the FDA.
“Due to current lack of FDA regulation for CBD, retailers may not adequately disclose the amount of THC in their products, potentially resulting in a positive drug screen. Also, CBD products are available for purchase online with little consumer safety oversight and can contain unknown and potentially dangerous elements,” says James Ralston, MD, a dermatologist at Dermatology Center of McKinney in Texas.
In fact, the FDA has served citations to several companies selling CBD-infused products or food supplements over safety concerns.
In 2017, one study looked at 84 CBD products manufactured by 31 companies and sold online in 2016, to see how accurate the labels were about the ingredients. Turns out, nearly 43% of the products were under-labeled, meaning they had 10% more CBD that advertised. Around 26% of the products were over-labeled, meaning they had 10% less CBD than advertised. Only about 31% of the products were accurately labeled.
Cynthia Covert, 52, from Moreno Valley, CA has been living with PsA since 2003. Covert has tried both THC and CBD products. Both have helped her manage her pain to a certain degree. But CBD products, she says, have too much hype surrounding it. She blames the market that’s flooded with CBD products to meet the growing demands.
“When it comes to CBD alone, I think it’s way too much hype, and it really does disappoint me. Because I know everyone just wants to make money off it, whether it’s the person who’s affiliated with it, or a salesman for it.”
Besides inaccurate ingredients on CBD products, research shows that there may be potential side effects to CBD use. It can:
- Cause liver injury
- Interact with other medications that can cause serious side effects
- Lead to physical injuries if mixed with alcohol or other drugs that can alter your brain activity
- Affect fertility in men or male offspring of women exposed to CBD as seen in some animal studies
There are also a lot of unanswered questions that scientists are trying to figure out when it comes to CBD use. This includes:
- What happens if you take CBD daily for a long period of time?
- How much is too much CBD?
- Can different methods or types of CBD such as creams, gummies, oils, etc., affect you differently?
- What effect does CBD have on the developing brain of children?
- How does CBD affect a fetus or a breastfed newborn?
Things You Should Be Aware of Before You Try CBD
If you’re thinking of trying CBD for relief from psoriasis or PsA, there are a few things you should keep in mind.
Before you try, talk to your doctor about it. Snedden spoke to his neurologist, a doctor who specializes in nerves, brain, and the spinal cord before he decided to try CBD. He also gets frequent migraines and has three herniated discs. He was worried about some of his prescription drugs mixing with CBD.
“Talk to your doctor first because anything can interact with anything,” Snedden says.
Do your research beforehand. Friedman says he urges anyone who wants to try CBD to first do their “due diligence” in researching all they can about CBD and the different brands and methods.
“I think the easiest is to go on Google or whatever search engine and type in Department of Health medical cannabis program,” Friedman says especially if cannabis is legalized in your state.
If you’re going to buy CBD products online or over the counter at your local drugstore, research and write down a few things to check on the labels before you buy it. Once you buy it, Friedman says it’s always a good idea to test it out.
“I typically tell patients to start by doing a test site on a small area for a couple days to make sure that it doesn’t cause irritation or allergic reaction. If they tolerate it, then they can apply to affected areas twice a day, ongoing,” Friedman says.
Start low and slow. When Snedden first started using CBD, it was a bit of a learning curve, especially with what type to use and how much. He researched online on what types or brands would work best. He tried three different types before he found that worked best for him — a tincture, an alcohol-based liquid extract that you put under your tongue.
“I started with one drop and I wasn’t really noticing anything. So I decided to take two drops and it was fine. I started to sleep through the night, I was able to relax. A lot of the pain was gone,” Snedden says.
It’s important to remember that each person reacts different to CBD so it’s always good to start small and see how it goes.
Manage your expectations. CBD isn’t the same as THC. It won’t deliver quick results and it’s definitely not a “cure all.” You may have to continue your regular treatments for psoriasis and PsA and compliment it with approved CBD products to help with the pain.
“If you’re going to use CBD, you can’t go in with the expectation that it’s going to relieve all your pain. And that it’s not going to relieve your pain as soon as possible like an opiate would or smoking a joint. What you are going to get though is a wonderful muscle relaxation,” Covert says. “You’re going to sleep better [and] you’re going to be less stressed. All those things over time will lead to a decrease in pain.”
However, if you notice any allergic reaction or side effects on your skin after CBD use, tell your doctor about it.
National Psoriasis Foundation: “CBD for Psoriasis and PsA.”
FDA: “What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD,” “FDA warns 15 companies for illegally selling various products containing cannabidiol as agency details safety concerns,” “FDA Warns Companies Illegally Selling Over-the-Counter CBD Products for Pain Relief.”
Karger Journals: “Efficacy and Tolerability of a Shampoo Containing Broad-Spectrum Cannabidiol in the Treatment of Scalp Inflammation in Patients with Mild to Moderate Scalp Psoriasis or Seborrheic Dermatitis.”
La Clinica Therapeutica: “Anandamide Suppresses Proinflammatory T Cell Responses In Vitro through Type-1 Cannabinoid Receptor-Mediated mTOR Inhibition in Human Keratinocytes.”
JAMA: “Labeling Accuracy of Cannabidiol Extracts Sold Online.”
Cedars Sinai: “CBD: What You Need to Know Before You Try.”
Adam Friedman, MD, professor and chair of dermatology, George Washington School of Medicine and Health Sciences.
Joel Gelfand, MD, professor of dermatology and of epidemiology; vice chair of clinical research and medical director, Dermatology Clinical Studies Unit; director, Psoriasis and Phototherapy Treatment Center, University of Pennsylvania Perelman School of Medicine.
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