When eczema causes your skin to be dry, itchy, and red or purplish, your doctor may recommend a rub-on treatment like a steroid. Topical steroids bring down inflammation and help soothe eczema itch. These medicines work very well, but they can cause problems such as thinning skin.
If the side effects worry you, or your insurance won't cover topical steroids and the cost is too high, you might look for other options. Topical cannabinoids are an alternative treatment made from plants.
Cannabinoids have shown promise for eczema. "Evidence suggests they may provide a modest reduction in itch. That is encouraging," says Marisa Ponzo, MD, PhD, a board-certified dermatologist with North York Board Dermatology Clinic in Ontario, Canada.
But there isn't enough research to confirm that topical cannabinoids can fix the damaged skin barrier or stop the inflammation that causes redness and itch. Plus, there are no recommendations on the best type of product and dose to use.
If you want to try topical cannabinoids, Ponzo suggests using them as an add-on to the treatment your doctor prescribed. They shouldn't replace more proven topical nonsteroidal medicines such as calcineurin inhibitors, PDE-4 inhibitors, and JAK inhibitors.
What Are Topical Cannabinoids?
Products containing cannabinoids are everywhere these days — in gummies, oils, capsules, and creams. They're marketed with a range of claims, including that they can reduce pain, ease anxiety, help you sleep better, and improve your skin.
Cannabinoids are active substances found in marijuana and hemp plants. But unlike the tetrahydrocannabinol (THC) in marijuana, they won't get you high.
There are three types of cannabinoids:
- Ecocannabinoids that your body makes
- Phytocannabinoids such as cannabidiol from plants
- Synthetic cannabinoids made in labs
Cannabidiol (CBD) from the Cannabis sativa plant family is usually the type you'll find in topical products sold for eczema.
How Do Topical Cannabinoids Work for Eczema?
Researchers have good reasons to study cannabinoids for eczema. Your body has its own endocannabinoid system. It's made up of endocannabinoids and the receptors they attach to. Receptors are special proteins on or inside cells. An endocannabinoid attaches to its receptor like a key fits into a lock. Then it sends a message that tells the cell what to do.
Endocannabinoid receptors are involved in:
- Immune signals. In eczema, your immune system overreacts to germs and other things in your environment.
- Inflammation. A faulty immune system in eczema makes the skin inflamed and red.
- Skin cell activity. Eczema changes how skin cells fit together in the outer layer of skin. It leaves gaps that allow water to leak out of the skin.
- Sensory nerve signals. A healthy skin barrier covers and protects the nerves that help you feel things. The damaged skin barrier in eczema exposes those nerves and makes them more sensitive. Immune system chemicals then irritate the exposed nerves and cause itching.
"The skin contains cannabinoid receptors," says Hayley Goldbach, MD, a dermatologist and Mohs surgeon at Brown University in Providence, Rhode Island. "There is some promising research to suggest that binding to these receptors can help with inflammation and itch."
There are two main receptors, CB1 and CB2, in your skin cells and nerve fibers. When CBD attaches to these receptors, it may help with inflammation, skin cell growth, and pain and itch signals.
Topical cannabinoids also work on PPAR and TRPV receptors, which are involved in inflammation and itching. "Cannabinoids may be able to influence the [nerve] pathways involved in the sensation of itch," Ponzo says.
Cannabinoids for Eczema: Latest Research
"Overall, there's not enough research to say definitively that [topical cannabinoids] are effective for eczema. However, some small studies definitely show promise," Goldbach says.
The best evidence for topical cannabinoids is that they may help with eczema itch. That's a big deal, because 86% of people with eczema itch every day. Some say it's the most bothersome eczema symptom.
Researchers reviewed 17 studies on topical cannabinoids for skin conditions. They found that cannabinoid treatments improved itch in eczema, psoriasis, and dry skin. But these treatments didn't help with skin redness or dryness.
There's no proof that topical cannabinoids ease inflammation or repair the damaged skin barrier in eczema. Researchers say larger and better studies are needed to confirm that.
Also, it's hard to know whether the cannabinoid products you buy at a store or online will work as well as the ones used in studies. "The studies included different cannabinoid compounds and formulations," Ponzo says. "We cannot assume that every CBD cream will produce the same result."
Benefits
Topical cannabinoids seem to help the most with itching. Some people who used them in studies saw improvements in their eczema symptoms and quality of life. Like other topicals, they're easy to use because you just rub them on your skin. And they don't cause thin skin and other side effects like topical steroids do.
Risks
The government doesn't regulate topical cannabinoids. You can't be sure that a product you buy online or over the counter contains the ingredients listed on the label. And even though some topical cannabinoids helped people with eczema in studies, the ones you buy may not have been tested in the same way.
Cannabinoid products can vary widely in ingredients and amounts, making it hard to know how much gets into your skin or how well they work.
Cannabinoid cream comes with risks, too. It may contain allergens or irritants that aren't listed on the label. Eczema damages your skin barrier and makes you more sensitive to fragrances, preservatives, and other allergens that may be present in these products.
The risks are greater if you're allergic to cannabis. "Although cannabinoids may potentially reduce itch in some circumstances, a topical product can also cause an itchy reaction in someone who is sensitive to an ingredient," Ponzo says.
Though topical cannabinoid products may be less expensive than prescription creams, they still cost money. Cannabinoid creams can cost about $30 to $135.
Signs That Nonsteroidal Medicines Might Not Be Enough
Steroid creams and ointments are the main topical treatment for eczema. These medicines calm inflammation in your skin, reduce itch, and prevent symptom relapses. If you can't use steroids or you worry about side effects, you can try a nonsteroid alternative, such as a:
- Topical calcineurin inhibitor such as pimecrolimus (Elidel) or tacrolimus (Protopic)
- Anti-inflammatory pill like cyclosporine, methotrexate, or prednisone, or Rinvoq or Cibinqo
- Injected biologic such as dupilumab (Dupixent), tralokinumab (Adbry), or Nemluvio
These medicines should control your eczema symptoms. New or worsening symptoms, including inflamed, flaky, dry, or itchy patches of skin, are signs that your current treatment may not be enough on its own. A doctor can adjust your medicine to find one that better manages your symptoms.
What to Look for in Topicals
Talk to your dermatologist before you try any topical cannabinoid. "There are plenty of unregulated products claiming to be cannabinoids," Goldbach says. Make sure you understand what active and inactive ingredients the product contains, and how they might affect your skin.
Read the label of any topical medicine you buy over the counter. Be cautious about products that say they offer "fast-acting relief" or "healing." These claims aren't backed up by evidence.
Look for a product that is:
- Labeled "Good Manufacturing Practice," or "GMP," which means it meets the FDA's safety standards
- Certified organic, which means it does not contain any pesticides or heavy metals
- Made by a company that reports side effects
