Medical Cannabis and Eczema and Psoriasis

Eczema (dermatitis) and psoriasis are both skin conditions. Eczema and psoriasis are often grouped, but the conditions differ in many ways. Endocannabinoid disruption and changes in cannabinoid receptor expression in the skin are part of the etiology of both conditions. Medical cannabis could help regulate the endocannabinoid system (ECS) in those with eczema or psoriasis.

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What Are Eczema and Psoriasis?

Although the two conditions are often mentioned together, there are significant differences between eczema and psoriasis. Psoriasis is an autoimmune condition that results in itchy and scaly skin. Psoriasis is often associated with conditions such as arthritis (psoriatic arthritis), Crohn’s disease, depression, and cardiovascular diseases (CVDs). Plaque-type psoriasis is the most common type of psoriasis. Plaque psoriasis causes dry, itchy, raised skin patches (plaques) covered with scales. Other types of psoriasis include:

Nail psoriasis: psoriasis affects the nails, causing them to loosen.
Guttate psoriasis: primarily affects young children and is usually triggered by a bacterial infection.
Inverse psoriasis: affects the skin folds of the groin, buttocks, and breasts and is usually triggered by a fungal infection.
Pustular psoriasis: a rare type of psoriasis that can cause pus-filled blisters in widespread patches or on areas of the palms or soles of the feet.
Erythrodermic psoriasis: a type of chronic or acute psoriasis that can cover the entire body with a peeling rash that can itch or burn intensely.

In psoriasis, skins called “keratinocytes” are overproduced, leading to flaky, scaly excess skin.

Eczema (aka “dermatitis”), meanwhile, is a condition that is usually triggered by allergens (contact dermatitis), skin irritation, stress, hot or cold weather, and poor blood flow from the veins. Atopic eczema (atopic dermatitis) is the most common form of eczema. Eczema is a common condition that usually starts in childhood and, in some, continues into adulthood. An estimated 245 million people worldwide suffer from dermatitis (as of 2015). In the U.S., dermatitis affects 10% and 30% of people. Other types of eczema include:

Neurodermatitis
Dyshidrotic eczema
Nummular eczema
Seborrheic dermatitis
Stasis dermatitis

It is possible to have more than one type of eczema simultaneously.

arms showing red and itchy skin

Brief Summary of Current Treatments

Psoriasis treatment often includes vitamin D3 topical creams, ultraviolet light treatment, and immunosuppressants such as methotrexate. NSAIDs like aspirin may be prescribed for pain relief and inflammation associated with psoriasis. Beta-blockers can make psoriasis worse.

Antihistamines, oatmeal baths, coconut oil, moisturizers, manuka honey, and capsaicin cream may treat eczema.

How Might Medical Cannabis Help?

Cannabis may help eczema and psoriasis, as the skin contains endocannabinoid receptors, which interact with phytocannabinoids and possibly help prevent itching.

Cannabinoids also have an immune system modulating effect, which could help prevent the release of cytokines and therefore prevent inflammation. Some suggest that THC may suppress allergic reactions by activating CB1 receptors. The cannabis plant also contains several cannabinoids and terpenoids that have antimicrobial properties.

Cannabinoids

THC can help reduce pain.
CBD has anti-inflammatory properties.
CBG can calm inflammation.
THCV could help block CB1 receptors in low doses, helping reduce plaque formation in psoriasis.

Cannabinoid Ratios

There is little information on what THC:CBD ratios might be effective for eczema or psoriasis. Some may benefit from a more CBD-rich product like THC:CBD 1:2 or above, whereas others may require the opposite.

Terpenes and Terpenoids

Pinene has antimicrobial properties that could help prevent skin infections.
Beta-caryophyllene has stress-busting, painkilling (analgesic), and anxiolytic (anti-anxiety) effects.
Myrcene: has relaxing and sedative effects that could aid sleep.
Linalool: has relaxing and anti-inflammatory effects that could help reduce swelling.

Flavonoids

Evidence suggests that “flavonoids (plant molecules) can help to rebalance the immune system and be beneficial for people with eczema.” Quercetin may be particularly effective “through anti-inflammatory and antioxidant activities along with its acceleration of wound healing via ERK1/2 MAPK and NF-κB pathways.”

Effective Ways of Taking Medical Cannabis for Eczema and Psoriasis

Routes of Administration

Topical
Sublingual

Special Formulations

As the skin is the main target of phytocannabinoid treatment, using a topical or salve is unlikely to have an intoxicating effect. Using a THC-rich transdermal patch does have intoxicating and psychoactive effects, however.

Dosing Methods

Topical cream or salve
Oil-based tincture
Transdermal patch

What are the Pros and Cons of Taking Medical Cannabis for Eczema and Psoriasis?

Potential Pros

Cannabinoid-based medications – particularly topical creams – could be an adjunct or alternative to steroid-based creams and moisturizers and work well alongside treatments such as coconut oil.
Pinene has significant antibacterial and anti-inflammatory properties, so it can help prevent skin infections in those with eczema or psoriasis.
Alternatives to NSAID-based anti-inflammatories are needed for many.
THC applied to the skin may help prevent contact dermatitis.
CBD may help manage joint pain and inflammation associated with psoriatic arthritis.

Potential Cons

Some people may be allergic to cannabis (or, at least, one or more of the terpenes or other compounds in cannabis), meaning that contact dermatitis is possible with cannabis as well.
So far, most studies are on animals and tissue samples in labs, not people.

Useful Anecdotal Information

Forand, Rebecca L. “Patients with eczema open to OTC cannabinoid products.” Healio, April 15, 2022

Downey, Andrea. “HIGH HOPES Medical CANNABIS could help ease the agony of psoriasis and eczema.” April 18, 2017

Scientific Data Overview and Studies

Total Studies = 10 (eczema)
Positive Studies = 9
Inconclusive Studies = None
Negative Studies = 1
4 Meta-Analyses (3 positive, 1 negative); 1 Animal Study (positive); 2 Human Trials (both positive); 3 Lab Studies (all positive)
3 studies include CBD (all positive)
Possible Overall Efficacy: Moderate
Total Studies = 18 (psoriasis)
Positive Studies = 17
Inconclusive Studies = 1
Negative Studies = None
11 Meta-Analyses (10 positive, 1 inconclusive); 3 Animal Studies (all positive); 4 Lab Studies (all positive)
6 studies include CBD (all positive); 2 studies include THC (both positive); 2 studies include CBG (both positive); 1 study includes THCV (positive)
Possible Overall Efficacy: Moderate

Quotes from Studies

“Phytocannabinoids are promising drugs in the treatment of psoriasis due to their effects of inhibiting the proliferation of keratinocytes while also modulating the associated inflammatory component [123]. In human skin cultures, synthetic CB1 agonist arachidonoyl-chloro-ethanolamide (ACEA) inhibited keratinocyte cell proliferation in situ, while decreasing K6 and K16 expression in organ cultured human skin samples [81]. The beneficial effects of phytocannabinoids THC and CBD in psoriasis are the conversion of the pro-inflammatory Th1 profile to an anti-inflammatory Th2 type expression, and the anti-proliferative properties on keratinocytes; however, these effects seem predominantly mediated through PPARγ, independent of CBs, demonstrated by sustained results in CB1 and CB2 blockades on human papilloma virus (HPV)-16 E6/E7 transformed human skin keratinocytes cultures [124].”

Source: Scheau, Cristian et al. “Cannabinoids in the Pathophysiology of Skin Inflammation.” Molecules (Basel, Switzerland) vol. 25,3 652. 4 Feb. 2020, doi:10.3390/molecules25030652

“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.”

Source: Palmieri B, Laurino C, Vadalà M. “A therapeutic effect of cbd-enriched ointment in inflammatory skin diseases and cutaneous scars.” Clin Ter. 2019 Mar-Apr;170(2):e93-e99. doi: 10.7417/CT.2019.2116. PMID: 30993303.

Conclusion

Although there is promising evidence that medical cannabis could help manage skin conditions like eczema and psoriasis, there is little beyond lab studies, a small number of human trials, and a theoretical understanding of the ECS and its function in the skin to prove its efficacy. More research is needed.

Does CBD Provide Any Benefits for Skin?

Allergic Contact Dermatitis and Medical Cannabis

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Systemic Scleroderma and Medical Cannabis

Xeroderma Pigmentosum (XP) and Medical Cannabis

Disorders of the Skin and Subcutaneous Tissue

Skin Cancer (Non-Melanoma) and Medical Cannabis

Melanoma and Medical Cannabis

Please note that the information in this article does not constitute medical advice.