Jul 17

Psoriasis and Eczema (Atopic Dermatitis) and Their Connection with the Endocannabinoid System

A recent survey conducted in the EU shows that 85% of patients suffering from Atopic Dermatitis are highly dissatisfied with their current treatments. Patients are constantly looking for information (70%) on new and more efficient treatments that would help them live better lives. This study is a breakthrough in revealing the extremely high social and financial impacts that skin disease such as Atopic Dermatitis and Psoriasis have on society. 1

Psoriasis is a chronic autoimmune condition that results in the overproduction of skin cells. The dead cells build up into silvery-white scales. The skin becomes inflamed and red, causing serious itching. Like most skin conditions, Psoriasis can become widespread and very irritating. For instance, plaque Psoriasis may cover almost the entire surface of the body. In extreme cases, inflammation can become so severe that it appears and feels like burns. This type of psoriasis can be life threatening. Other forms simply require treatment and attention. Although Psoriasis comes and goes over time, it’s a lifelong debilitating condition.

Psoriasis is associated with increased risk for co-morbidities, including, psoriatic arthritis, cardiovascular disease, diabetes, obesity, inflammatory bowel disease and non‐alcoholic fatty liver disease compared with the general population. According to the Mayo Clinic, people with psoriasis have double the risk of developing CVD and Psoriasis increases the chance of getting high blood pressure. 2 It has also been found that that people with Psoriasis may be at a higher risk to develop Parkinson’s disease due to the chronic inflammation on the neuronal tissue. 3

Atopic Dermatitis or Eczema may also be a long-term condition affecting the skin. Best known as a sensitivity to certain external triggers. Atopic Dermatitis affects up to 18% of children and can be very common in infants, it has been reported as effecting 7% of adults. As a chronic, relapsing disease, severe AD has a profound impact on the quality of life of patients and their families. Recent studies reveal patients with severe cases report high itch frequency of up to 18 hours a day, sleep disturbance and borderline or abnormal quality of life scores. 4

AD was also seen to put patients at 36 percent higher risk for making a suicide attempt. Researchers have explained this fact by indicating that inflammatory cytokines such as interleukin-4 (IL-4) and

interleukin-13 (IL-13) drive both the physical and psychosocial aspects of the disease. High levels of these molecules are characteristic of AD, and they’re also seen in the spinal fluid of patients who have attempted suicide. 5

A new study has concluded that new targeted systemic drugs (Biologics) can be safer than conventional treatments to treat Psoriasis. Biologics are medicines made from living cells. The cells are genetically changed in the lab to make certain proteins. Unlike drugs that work on your whole immune system, Biologics block only the parts that are responsible for the overgrowth of skin cells. This study done in 2019 shows that patients using Biologics for their Atopic Dermatitis had a significantly lower risk for infection compared to those taking the other drugs. 6 Systemic treatments are taken orally or through injection. They work inside the body and attack the physiological processes that cause psoriasis. Biologics such as Infliximab (Remicade), Adalimumab (Humira), and Etanercept (Enbrel) and oral treatments such as Methotrexate and Apremilast (Otezla) are all examples of systemic drugs.

These newer drugs were shown to be more effective at clearing symptoms and likely safer since they specifically treat the overactive immune response that causes the disease rather than suppressing the whole body’s immune system.

However, there is a need for a better understanding of the comparative safety of systemic medications used in these treatments. Each type of systemic treatment comes with a unique set of risks. 7

As the survey shows only 15% of the patients today are satisfied with their treatments. These patients and their families are demanding more investment in research to develop better treatments to break the cycles and flare-ups that dominate their lives every day.

The study of the endocannabinoid system reveals the role the system plays in maintaining several important functions of the skin and explains why natural cannabinoids in hemp and other plants have therapeutic effects on skin diseases such as Atopic Dermatitis and Psoriasis.

Understanding the anti-proliferative and anti-inflammatory properties of various endocannabinoids, such as those involved in the CB1 and CB2 pathways in the skin, reveals that by targeting these pathways this signaling could treat diseases such as psoriasis, atopic dermatitis, melanoma, systemic sclerosis, wound healing processes, non-melanoma skin cancers and much more.

CBD, just one type of cannabinoid binds to receptors in the endocannabinoid system and stimulates all kind of changes in the body. There exists a very long history of topical use of CBD for dermatological conditions. Although our understanding of the endocannabinoid system of the skin has made great advances, a lot more research and clinical data is required on the use of cannabis in dermatological practice. Nonetheless CBD shows a promising potential in the treatment of inflammatory skin diseases and provides hope that new treatments from CBD and other cannabinoids, will fill the void that patients and their families require to transform their lives.

1. https://www.euractiv.com/section/health-consumers/news/biggest-ever-study-on-eczema-in-
europe-urges-need-for-further-research/
2. https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4817438/
4. https://www.sciencedaily.com/releases/2019/01/190115132801.html
5. https://nationaleczema.org/atopic-dermatitis-suicide/
6. https://jamanetwork.com/journals/jamadermatology/article-abstract/2733383
7. https://www.healthline.com/health/psoriasis/complications-psa-anxiety#reducing-your-risk