Topical cannabidiol may safely improve the healing of digital ulcers and boost quality of life, while also easing pain in people with systemic sclerosis (SSc), a study in Italy suggests.
Benefits were also seen in increasing the amount of sleep per night for those given the treatment.
The study, “Topical Cannabidiol in the Treatment of Digital Ulcers in Patients with Scleroderma: Comparative Analysis and Literature Review,” was published in the journal Advances in Skin & Wound Care.
Topical cannabidiol contains non-psychoactive component of cannabis plant
Digital ulcers in people with SSc can be extremely painful and hard to heal, and often reduce quality of life.
Pain relief provided by standard therapy, such as nonsteroidal anti-inflammatory medications and opioids, is often inadequate or limited by side effects. A large range of topically applied agents have been studied in SSc patients. However, their efficacy remains unclear.
In this study, researchers at the University Hospital of Modena investigated the effect of topical cannabidiol (CBD) to treat digital ulcers in patients with SSc. CBD is a non-psychoactive component of the cannabis plant that has gained increased scientific interest in recent years.
The team evaluated 45 patients with SSc (40 were women), with a mean age of 53 years and a mean disease duration of 10.68 years. The majority of patients (35) had limited scleroderma, while 10 had a diffuse form of the disease.
The enrolled patients had painful digital ulcers resistant to opioid therapy at the maximum tolerated dose. All took local and body-wide therapies, including Ventavis (iloprost), calcium-channel blockers, Revatio (sildenafil), and/or Tracleer (bosentan), or Opsumit (macitentan), according to the patient’s clinical condition and co-existing disorders (e.g. pulmonary arterial hypertension).
Surgical debridement, a procedure to treat wounds that involves removing thickened skin, as well as infected and dead tissue, was also performed regularly, and advanced dressings were applied.
The participants were randomly assigned to the CBD group (25) or control group (20). In the CBD group, the wound and the skin around it were treated with Cannabis sativa seed oil, obtained from high-quality pharmaceutical preparations. Four drops of oil were applied daily for up to two months over the clean wound, and covered with nonadhesive gauze.
the results of this preliminary report encourage further exploration of CBD oil as a potentially helpful topical treatment in the management of SSc [digital ulcers], having no major adverse effects and few minor adverse effects
Pain decreased significantly in group treated with topical cannabidiol
Results showed significantly lower wound-related pain scores, as assessed by a numeric rating scale, from 8.4 to 6 after one month of treatment. Volitional incident pain, the pain caused by voluntary actions (such as dressing and cleaning) or treatment procedures, decreased from 9.32 to 6.8. Over the same period, patients in the control group reported a decrease in wound pain from 8.44 to 7.88, which was not considered statistically significant, whereas volitional incident pain remained stable.
In the CBD group, 12 participants required additional analgesics to manage pain, namely acetaminophen (four participants), acetaminophen plus codeine (two participants), oxycodone (four), and morphine (two). In the control group, all participants needed additional analgesics.
For the participants receiving CBD, the mean hours of sleep per night increased significantly from 2.56 to 5.67. The Health Assessment Questionnaire Disability Index, a self-measure of the ability to perform daily life activities, decreased from 2.19 to 0.79 by the end of follow-up, reflecting improved quality of life. For the control group, these parameters did not change significantly.
More participants in CBD group experienced wound healing
By the end of the study, digital ulcers healed completely in 18 participants (72%) receiving CBD, a higher proportion than the six participants (30%) in the control group with such benefit. Importantly, no infection occurred in the CBD group, while six patients in the control group required antibiotics to treat wound infections.
No significant adverse events were reported. Likewise, no patient experienced treatment-related severe side effects. Seven patients on CBD (28%) reported mild effects, such as itch and redness of skin around the wound. No participant discontinued CBD therapy.
“The present study is the first to report the effectiveness of local CBD treatment in the management of SSc-DUs [digital ulcers],” the researchers wrote, adding that “the results of this preliminary report encourage further exploration of CBD oil as a potentially helpful topical treatment in the management of SSc-DUs, having no major adverse effects and few minor adverse effects.”