Top 5 Epidermolysis bullosa (EB) refers to a group of rare, potentially-lethal inherited conditions characterized by extremely fragile skin, which blisters and forms sores easily in response to minor trauma. EB shares similarities with other skin conditions such as dermatitis and psoriasis, which cannabis is known to benefit.
1. Analgesic – Pain reducing
Due to the rarity of EB, there is little existing research into the potential for cannabis to improve its symptoms. However, substantial anecdotal evidence in recent years has led to increasing interest within the medical community. One almost-universal symptom of EB that cannabis may help to improve is chronic pain due to blistered and broken skin (as well as later complications such as loss, deformity, or fusion of fingers or toes). Various patient reports online testify as to cannabis’ effectiveness in managing EB-related pain, and numerous physicians and dispensaries list EB pain as treatable with cannabis.
U.S. medical cannabis patient Miguel Garcia, who suffers from EB, has documented his use of cannabis to manage his symptoms, and in a video uploaded to YouTube remarked that cannabis helped him to “physically numb the pain” and meant that he did not need to use opioid painkillers such as hydrocodone or oxycodone.
2. Antipruritic or anti-itch
Pruritus (itching) is another almost universal symptom of EB. There is a relatively wide selection of articles and papers available that attest to the fact that cannabis and certain synthetic cannabinoid analogues can act as antipruritics in cases of EB and several related conditions.
In 2002, the synthetic agonist HU210 was shown to improve histamine-induced pruritus in atopic dermatitis; in 2012, a team of Japanese researchers (Odan et al.) discovered a synthetic CB2-receptor agonist that they named S-777469, and a dual CB1/CB2 agonist named S-444823, both of which significantly inhibited scratching without inducing psychoactivity.
In 2005, it was demonstrated that CB1- and CB2-receptors are present in the sensory nerve fibres and adnexal structures (appendages such as hair follicles and sebaceous glands) of the skin, and that they have an important role to play in the management of both itching and inflammation.
It is thought that inflammatory immune responses are the cause of blistering in many cases of EB. Cannabis has been shown to be effective against inflammation of the skin in numerous related conditions, and there are plenty of anecdotal reports of its effectiveness to be found online. The presence of dermal cannabinoid receptors is now thought to be crucial to the regulation of various immune responses, including regulation of oxidative stress and programmed cell death as well as itching and inflammation.
The mechanism via which cannabis exerts its anti-inflammatory effects is complex and not fully understood. It is thought that both THC and CBD have anti-inflammatory properties, and that while the cannabinoid receptors are involved in the process, other mechanisms independent of the CB-receptors also have a part to play.
A 2013 study conducted by researchers at the University of Bonn in Germany demonstrated that both wild-type mice and CB-receptor knockout mice experienced improved dermatitis symptoms when administered topically-applied THC, indicating that the mechanism is CB-receptor independent. However, there is also evidence that CB-receptor agonists such as THC or the endogenous agonist 2-AG may induce dermal inflammation, which may be mediated by application of antagonists such as CBD–and conversely, there is also evidence that 2-AG can inhibit inflammation via the CB2-receptor.
Thus, the precise relationship between endocannabinoids, the CB-receptors, and immune inflammatory responses in the skin is unclear, and gaining a clearer understanding of the mechanisms at work will allow us to develop targeted therapies to treat EB and numerous related conditions.
A common complication of EB is infection due to exposure of broken skin to pathogens present in the natural environment. As well as causing pain to the patient, infected wounds prevent healing, may become necrotic, and ultimately contribute to all-round ill-health (as well as causing failure to thrive in children). The most common wound-colonizing bacteria in individuals with EB are staphylococcus, streptococcus, diptheroids, pseudomonas, and candida.
Again, no specific research has been conducted on the ability of cannabis to combat bacterial infections in EB patients, but there is abundant evidence indicating that it can exert a significant antibacterial effect in vitro and in vivo against various common bacteria and in the treatment of several important diseases.
Cannabis medications have been used as antimicrobials since the days of antiquity. In the late 19th and early 20th centuries, modern researchers began to document traditional folk uses of cannabis, and in many cases, demonstrate their veracity with new empirical methods. In 1960, a landmark paper was published demonstrating the ability of cannabis extract to destroy several species of staphylococcus and streptococcus bacteria; since then, various other papers have found that cannabis can also kill pseudomonas and candida bacteria.
Some forms of EB dramatically increase the risk of skin cancer in affected individuals, particularly a rare form of cancer known as squamous cell carcinoma (SCC). Again, no specific research into the potential for cannabinoids to treat EB-related SCC exists, but there are various anecdotal reports of individuals afflicted with SCC who have successfully treated their condition with high doses of cannabis oil.
An American medical cannabis patient, Michael McShane was diagnosed with HIV in the late 1980s, and a few years later developed SCC, perhaps as a complication of his HIV. After undergoing several surgical procedures to remove tumour growth that repeatedly grew back, he began to use cannabis oil and rapidly experienced improvements, ultimately becoming cancer-free after around four months. According to his website, he remains cancer-free.
It is clear that much work remains before we will have a complete understanding of the various ways in which cannabis can help this understudied disease. However, the existing evidence strongly suggests that cannabis treatments could improve the symptoms of EB in several key ways, and that further research is needed.
Research into CBD does however back up the therapeutic benefits of CBD products. These can be safely used to contribute to a healthy lifestyle, without the high effects of THC.