Cannabidiol (CBD) and Skin Care: 102

                                              Cannabidiol (CBD) and Skin Care:  102

Cannabidiol has been known for thousands of years and reportedly used by ancient civilizations as a remedy for soothing muscle aches, itchiness, and wound care.  Cannabinoids represent a diverse group of compounds that can be divided into three groups: 1) endogenous cannabinoids that are naturally occurring and produced in humans, 2) cannabinoids that are found only in the Cannabis plant, and 3) synthetic cannabinoids that are produced by industry.  They are believed to share common structures and biologic characteristics.  CBD, one of the cannabinoids of the Cannabis plant, is believed to regulate physiologic processes, including cutaneous growth and differentiation, and purported to have benefits of being anti-inflammatory, analgesic, hydrating, moisturizing, and wrinkle-reducing.  Today, we are still learning about the trendy benefits of topical CBD, supplemented in personal skin care products, that are being marketed for everything from acne, wrinkles and aging skin in oils, creams, lotions, soaps, sunscreens, masks, lip balms, moisturizers and even in dog food.  In general, manufacturers add CBD to their products to give them a more powered boost.  If you are using CBD products in your aesthetic routines, they will probably not harm you.  However, their purported intuitive benefits of reducing pain and inflammation have yet to be studied with high-quality randomized trials.  Unfortunately, the claims for CBD-containing skin care products may have outpaced our current scientific understanding, especially regarding safety and efficacy standards.  Currently, there may be more effective cosmeceuticals and evidence-based drugs available that treat the same problems as claimed to be improved by CBD usage.  It has been reported that 70% of tested CBD products do not match the claims on their labels.

Basics 102.

CBD is the abbreviation for cannabidiol that is found in cannabis plants such as hemp (cannabis sativa) and marijuana (cannabis sativa indica).  CBD is extracted as a powder from the flowers and leaves of the hemp plant, and usually mixed with an oil from olives, hemps, or coconuts.  This CBD “oil” enhances its application and possibly aids in its penetration through the skin’s lipid barrier.  It is important to know that CBD oil is not the same as hemp seed oil.  Hemp seed oil is produced by cold pressing the seeds of the cannabis plant which is rich in several vitamins and Omega fatty acids.  While CBD oil is richly concentrated with cannabidiol, hemp see oil only contains trace amounts of cannabidiol.  The two may be marketed interchangeably.   

CBD oil for skin care does not contain measurable amounts of marijuana’s tetrahydrocannabinol (THC), which can get you high as a psychoactive ingredient.  Hemp was legalized as an agricultural crop in 2018 and is reported to contain no more than 0.3% THC.  If THC levels are found to be higher than 0.3%, they are found in marijuana plants.  Few studies report that there may be trace levels of THC in your skin care products, which is allowable, but no more than 0.3%.  A Denver-based laboratory found that 45% of the 250 top-selling CBD products contain THC that is absorbed slowly and not expected to cause any psychoactive effects.

Purported Mechanism (s) of Action

There exists a paucity of evidence-base studies in humans to fully understand the potential ways that CBD works in skin care products.  For instance, scientists still are uncertain what the ideal dose should be for skin conditions or general health.  In addition, investigators do not know whether synergistic or antagonistic effects may occur when combining its usage with other skin cosmeceuticals or drugs.  Consumers, manufacturers, and physicians should be requesting that high-quality Investigational Review Board (IRB) studies be done in larger human populations with longer follow up to determine the efficacy and safety of CBD products.  That being said, the following are reports of how and what CBD is presumed to benefit skin.

• Controlling Inflammation and pain (eczema, psoriasis, itching, sunburns)

             CBD interacts with two CBD receptors, CB1 and CB2, to decrease the inflammatory response             through suppression of specific inflammatory interleukins released from cells. 

• Skin Hydration (moisturization of dry skin)

             CBD ointment improved skin hydration by preventing water loss.

• Acne Treatment

             CBD potentially reacts with CB2 receptors in sebaceous gland to influences sebum production.

•  Anti-bacterial Action

             Topical CBD may help kill a range of gram-positive bacteria that plays a role in acne infections.

Regulatory Concerns

Although CBD skin products are readily available for consumer purchase, the status of their regulation and legality remains controversial at the state and federal levels.  In states that have comprehensive public medical Cannabis programs for recreational and medical marijuana, or permit extraction from hemp, CBD are considered legal for usage (2017, District of Columbia, Guam, Puerto Rico, and 29 states).  At the Federal level, however, the Drug Enforcement Administration (DEA) and the Controlled Substances Act regulate psychoactive substances with potential abuse.  The DEA has recently offered clarification that the presence of CBD in products does not in and of itself make them illegal under the Controlled Substance Act.  In addition, the Department of Agriculture and the Farm Bill state that CBD extracted from hemp is, in their view, considered to be legal.  The conflict amongst state, federal, and skin care companies has created confusion for patients, consumers, and clinicians alike.  Products may differ in purity, strength, and source of the CBD, such consumers should be aware of these various formulations. 

Call to Action Steps

• CBD skin care products are safe in general, but much more evidence-based research is needed.
• Make sure the ingredient list states “cannabidiol” as an FDA-regulated labelling under the International Nomenclature of Cosmetic Ingredients (INCI). You may always ask the company for their product’s specification of their assay tests.  Remember that CBD extracted from hemp seed oil contains miniscule amounts of CBD.
• Many brand companies list the total cannabidiol content in milligrams, as an indicator. Currently, there is no consensus on how much CBD the skin requires per application for results.
• Inquire from the brand company or check to see if there is evidence of a third-party certification on the purity and stated amount of CBD that is on the label.
• Look for CBD skin care in stable packaging. Jars and clear bottles that exposes this delicate plant ingredient to a lot of light or air may cause it be become less effective.
• Some brand may advertise their CBD as being “isolate”, “full spectrum”, or “broad spectrum”. None of these terms are regulated. 

     ▪ CBD isolate means pure CBD, no other cannabinoids or other naturally occurring substances

        like flavonoids or terpenes.

      ▪ Full spectrum CBD means everything that occurs in hemp plant alongside the CBD, including trace

         amounts of HC and other cannabinoids such as CBG (cannabigerol) and antioxidant compounds.

      ▪ Broad spectrum CBD means no THC is detectable.  Trace amounts of THC can be detected in full

         spectrum CBD, but must fall below 0.3% in order to be not considered active.

• Depending on the laws in your state, there may be licensed dispensaries in your area who are knowledgeable on product testing, third party verification, and quality brands that they would recommend.
• Shop smart as this is a “buyer beware’s unregulated situation.
• Consult with your plastic surgeon, dermatologist, or other skin care specialist on its isolated or combined application with other skin care cosmeceuticals and topical drugs you may be using.

References for this information:

Journal of Pharmacology and Experimental Therapies, June 2018, pages 652-663.

Journal of American Academy of Dermatology, July 2017, Pages 188-190.

Cannabis and Cannabinoid Research, June 2017, pages 139-154.

Journal of Clinical Investigation, September 2014, pages 3,713-3,724.

U.S. Department of Justice, Drug Enforcement Administration, e-publication

Jhawar N, Schoenberg E, Wand JV, and Saedi N.  The growing trend of cannabidiol in skincare products.  Clin in Dermatology. 2019;37:279-281.