Source: Aesthetic Authority | Author: Katie Hobbins | Sep 17, 2020
CBD is said to hold anti-inflammatory and analgesic properties, and may help to treat dry skin, psoriasis, eczema, and acne.
Seen everywhere from Sephora and Target to the local supermarket and gas station, cannabidiol (CBD) has the potential to be the next blockbuster ingredient in supplements and skincare.
And if your patients haven’t asked about it yet, they will soon.
While more information is needed to truly understand its potential benefits, the general public is driving significant growth of the global CBD skincare market—predicted to grow by nearly 25% over a six-year period.1
“The global CBD skin care market size was valued at $633.6 million in 2018 and is anticipated to reach $3,484.00 million by 2026, with a CAGR of 24.80% during the forecast period,” according to Allied Market Research. “The CBD skin care market exhibits an incremental revenue opportunity of $2,747.4 million from 2019 to 2026.”1
The normalization and popularity of CBD in recent years is in part due to loosening laws surrounding cannabis, but its suggested wellness benefits have given the notorious plant legitimacy.
According to Matthew Zirwas, MD, FAAD, who spoke at last year’s Cosmetic Surgery Forum in Nashville, Tenn., CBD products can be made from hemp or marijuana, both of which are derived from the same plant family, Cannabis. Tetrahydrocannabinol (THC) is the principal psychoactive, or high-inducing, constituent. The plant can be bred with high levels of THC, which is classified as marijuana, or to have little to no THC, thereby classified as hemp.2
CBD is one of more than 80 cannabinoids taken from the flowers, stems, and leaves of the cannabis sativa plant. If CBD is extracted from the hemp plant, it has little to no THC. For areas where THC-containing products are still prohibited, CBD derived from hemp is considered legal.2
“There’s no official cutoff [for THC in CBD],” Dr. Zirwas says. “The closest thing to an official cutoff is 0.3%. If it has 0.3% or less of THC, it is considered hemp, but if it has 0.3% or more THC, the plant is considered marijuana.”
Marijuana meant to induce a high has a THC content of around 20%, he says.
CBD may be legal, but it is not regulated, and as a result, Dr. Zirwas says, almost all CBD products can be contaminated with enough THC to cause positive drug tests.
Also problematic, he says, is that some commercially available supplements and ingestables marketed as CBD actually contain hemp seed oil, which contains no CBD.2
Oral vs Topical CBD
Extracted in the form of a powder, CBD is usually mixed with various types of oils, including olive oil, coconut oil, or hemp oil, to work as a carrier to dissolve the compounds of the hemp plant. According to the CBD industry, CBD is a fat-soluble substance and the carrier oil signals the rest of the body to prepare for fat absorption. This increases the amount of CBD the body can absorb.3
While evidence says that it is theoretically possible for CBD products to offer benefits topically, Dr. Zirwas says that this information is often based on reasoning that there are cannabinoid receptors in the skin.
“Let’s clear the air,” says Dr. Zirwas. “There are cannabinoid receptors in the skin, and it has been proven that cannabidiol does not activate them.”
However, other non-cannabinoid receptor mechanisms have been proposed in a study in the Molecule journal by MDPI.
“… receptor mechanisms of CBD have been proposed, among them its agonism at serotonin 1A receptor (or 5-TH1A), vanilloid receptor 1 (TRPV1) and adenosine A2A receptors,” study authors write. “These data may help explain some of the observed CBD effects including analgesic, anti-inflammatory, anti-anxiety and anti-psychotic activity.”4
According to the same MDPI study, in vitro studies of topical CBD suggest sebostatic and anti-inflammatory effects. When applied topically, “It’s high lipophilicity means that CBD is expected to preferentially enter the skin via the transfollicular route and to accumulate in the sebaceous gland.”4
CBD shows promise, and may offer skin benefits, but scientific evidence is needed.
Examining CBD Skin Benefits
Before the legalization of cannabis in most of the United States, studies researching related skin benefits were almost nonexistent.
Now, its newfound mainstream popularity boasts anti-inflammatory and analgesic properties. In addition, scientists are finding more evidence for its use in treating dry skin, psoriasis, eczema, and acne.5
In a recent 2019 study, “A therapeutic effect of cbd-enriched ointment in inflammatory skin diseases and cutaneous scars,” researchers examined 20 patients suffering from psoriasis (n=5), atopic dermatitis (n=5), and resulting outcome scars (n=10) to whom they administered topical CBD-enriched ointment to lesioned skin twice daily for three months.5
After three months, researchers saw improved skin and inflammatory symptoms in study participants.
“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 significantly improved the skin parameters, the symptoms and also the PASI index score,” according to the study. “No irritant or allergic reactions were documented during the period treatment.”
A 2014 study in the Journal of Drugs in Dermatology also found that CBD could help to suppress acne breakouts by regulating oil production of the sebaceous glands.6
Still, while Dr. Zirwas says CBD shows promise, nothing has been scientifically proven. CBD products may very well work, he says, but he emphasizes that there is no evidence that they do.
Even so, not all CBD is considered equal.
When discussing CBD with patients, Dr. Zirwas explains that while there is no scientific evidence that CBD works, topical CBD is unlikely to cause problems. Furthermore, it’s hard to know which products have quality CBD.
He suggests referencing ConsumerLab.com for insightful reviews of CBD supplements.
As for the need for concrete evidence in this area, Dr. Zirwas says, “A small, double-blinded study would be needed at minimum to establish the credibility of CBD products. Nothing anecdotal, no case report, no case series, nor any open label study could make it credible.”
References:
- Bhandalkar, S., & Deshmukh, R. (2020, January). CBD Skin Care Market Size, Share & Trends | Research Report by 2026. Allied Market Research. https://www.alliedmarketresearch.com/cbd-skin-care-market
- Zirwas, M. (2020, August 3). CBD and Cosmetics: Does CBD really work? Cosmetic Surgery Forum. https://www.cosmeticsurgeryforum.com/is-cbd-oil-in-beauty-products-worth-the-hype/
- Oleinik, G. (2020, August 9). What’s in Your CBD Oil? Why Carrier Oil Matters. Daily CBD. https://dailycbd.com/en/carrier-oils/
- Bruni N, Della pepa C, Oliaro-bosso S, Pessione E, Gastaldi D, Dosio F. Cannabinoid Delivery Systems for Pain and Inflammation Treatment. Molecules. 2018;23(10)
- Palmieri B, Laurino C, Vadalà M. A therapeutic effect of cbd-enriched ointment in inflammatory skin diseases and cutaneous scars. Clin Ter. 2019;170(2):e93-e99.
- Barbieri JS, Choi JK, Mitra N, Margolis DJ. Frequency of Treatment Switching for Spironolactone Compared to Oral Tetracycline-Class Antibiotics for Women With Acne: A Retrospective Cohort Study 2010-2016. J Drugs Dermatol. 2018;17(6):632-638.