The Role of CBD In Treating Rosacea

Rosacea is a challenging skin condition that is associated with distressing symptoms such as excessive flushing, redness, blood vessel enlargement, pustules, skin burning and itching.

Cannabidiol or CBD that is derived from the Cannabis sativa plant has immense potential as a safe and highly effective treatment for rosacea.

What is rosacea?

Rosacea is a type of skin condition characterized by chronic inflammation. In the earlier stage of the condition, there may only be intermittent flushing of the central area of the face. The later stage symptoms include papules, acne, pustules, erythema (redness) and telangiectasias (red lines or patterns formed by enlarged blood vessels).

The condition can persist for weeks to months and then go into remission for some time.

There are some known triggers of rosacea, including:

  • Hot drinks/food
  • Sunlight exposure
  • Spicy foods
  • Red wine or other alcoholic beverages
  • Extreme temperature
  • Emotions
  • Wind
  • Intense exercise
  • Certain cosmetic products
  • Drugs such as blood pressure medications that can dilate blood vessels
  • Foods such as chocolate, tomatoes, citrus fruits and others that contain a compound called cinnamaldehyde

The conventional treatment options include:

  • Avoiding known triggers such as hot food/drinks, alcohol and spicy food
  • Using sunscreen and avoiding harsh sunlight
  • Prescription topical antibiotic creams
  • Anti-inflammatories and antibiotics
  • Retinoid treatment
  • Steroid creams
  • Cosmetic surgery using laser or intense pulsed light in severe cases.

However, long-term antibiotic, steroid or retinoid therapy is associated with severe side effects, including nausea, stomach pain, antibiotic resistance and liver damage.

Prevalence

Although the precise numbers are not yet available, a study conducted by researchers at the University of Copenhagen estimated the prevalence to be 415 million. The researchers gathered data from 32 studies across the world, covering 26.5 million patients.

The general population prevalence ranged between 0.09 percent and 22.41 percent, while the overall prevalence is about 5.46 percent. Extrapolating the overall prevalence to a global population estimate of 7.6 billion would mean there are 414,960,000 rosacea sufferers across the world.

The NRS (National Rosacea Society) in the U.S. estimates that 16 million Americans are suffering from rosacea while many more are in temporary remission.

A Sweden based study showed that rosacea affects one out of ten workers. Although the condition more commonly affects fair-skinned people of Celtic and European origin, it also affects darker skinned people.

 Causes of rosacea

 Although the precise causative factors of rosacea are not yet known, scientists have found these factors to be linked to a higher risk of rosacea:

  • Family history-Many people with rosacea have one or more family members with mild to severe rosacea. The genes responsible for rosacea can be inherited.
  • The role of the immune system – Scientists have found that many people with rosacea are highly sensitive to a bacterium known as bacillus oleronius. When exposed to this bacterium, the immune system of these hypersensitive individuals tends to overreact. Helicobacter pylori is another common type of bacteria that live in the gastrointestinal tract of some people and cause infection, stomach ulcer and even cancer. Although there is no conclusive evidence, H pylori is thought to play a role in causing rosacea.

Rosacea patients also have higher levels of a type of mite called Demodex folliculorum, which is normally present in sebaceous glands. Scientists propose that Demodex mites’ cell membrane components activate pro-inflammatory responses.

  • Pro-inflammatory proteins –Cathelicidin is a type of protein that has antimicrobial properties and protects the skin against infection. In people with rosacea, there are abnormal levels of cathelicidin, while there is excessive production of certain enzymes that degrade cathelicidin. Higher levels of cathelicidin, along with excessive serine protease activity, is linked to the pro-inflammatory action of the antimicrobial peptide, leading to rosacea.

Researchers are also looking into the roles played by many other inflammatory agents, including interferon, mast cells and cytokines.

Complications

  • Facial redness – Some people with rosacea can experience persistent redness despite topical or antibiotic treatment. Small blood vessels become visible as they enlarge and form lines or patterns.
  • Red bumps- Pimples and pustules that resemble acne sometimes contain pus and can be painful, itchy or cause a burning sensation.
  • Skin feels tender and hot.
  • Eye problems -Many people who have rosacea experience swollen, red, irritated and dry eyelids.
  • Enlarged nose -The skin can thicken on the nose over time, causing a bulbous (rhinophyma) appearance, typically in men.

Apart from the physical signs and symptoms and aesthetic concerns, rosacea can affect the quality of life and mental health of sufferers. In a study, 90 percent of people with rosacea said their working life was impacted due to rosacea. Over 50 percent of patients said their daily life was significantly impacted by the disease, while one out of two sufferers had moderate-to-severe anxiety and depression.

CBD and anti-inflammatory mechanism

 The key characteristic of rosacea is chronic inflammation. Whenever an injury or infection occurs, the immune system responds towards it. This helps the body initiate the healing process and repair any damaged body tissue.

As a defense mechanism, inflammation also helps fight harmful invaders such as viruses and bacteria. While inflammation is a necessary component of the body’s defense system and is generally short-lived, at times, it can persist for a long time even in the absence of triggering factors. This can occur when the immune system gets into overdrive and attacks healthy body cells, mistaking them to be invaders. Chronic inflammation can also be a response to pollutants or industrial irritants.

Cytokine modulation

 Certain signaling proteins known as cytokines are produced and released by the immune cells when there is an infection or injury, which leads to inflammation. Cytokines are also involved in chronic inflammation when there is no injury or infection, such as inflammatory skin conditions. Cytokine regulation is one of the treatment modalities for chronic inflammatory conditions such as rosacea.

 Many studies have shown that CBD controls inflammation by regulating cytokine production and release in the immune cells. A 2018 study showed that cannabinoids such as CBD have powerful anti-inflammatory effects. CBD was found to control the immune system response by regulating the production of cytokines in experimental inflammation models.

Action on other proinflammatory agents

CBD also exerts an anti-inflammatory effect by regulating other proinflammatory agents, such as interleukin-6 (IL-6), IL-8 and tumor necrosis factor ((TNF) and monocyte chemotactic protein-2 (MCP-2). These agents activate inflammatory pathways and reducing their levels is an effective way of addressing chronic inflammation.

Researchers hypothesize that CBD activates the CB2 receptors (cannabinoid receptor) to reduce MCP-2 and other inflammatory agents. This results in alleviation of symptoms in chronic inflammatory conditions such as rosacea, psoriasis and other skin conditions.

 Costa et al studied the efficacy of CBD in reducing acute inflammation in rats and found that the cannabinoid is a viable pharmacological alternative for treating acute inflammation and pain.

Action on reactive oxygen species

Reactive oxygen species (ROS) or free radicals are highly unstable oxygen atoms that are released as a by-product of metabolism. These can also accumulate in the body as a result of toxic heavy metals such as lead and mercury, asbestos, pollutants and cigarette smoke. The body’s natural antioxidant system is able to neutralize the ROS. But when there are excessive free radicals or deficiency of natural antioxidants (such as in illness, injury or other health conditions), free radicals build up and initiate a cycle of destruction of healthy cells in the body. ROS is linked to chronic inflammation and the onset of many diseases associated with chronic inflammation such as Alzheimer’s, heart disease, diabetes, arthritis and rosacea.

Researchers have shown that CBD neutralizes reactive oxygen species as a powerful antioxidant. In fact, CBD’s antioxidant activity has been shown to be many times more potent than that of the most powerful natural antioxidants such as vitamin C and E.

CBD and skin inflammation

 A retrospective study conducted by Palmeri et al in 2019 had the objective to study CBD’s therapeutic effects on common skin disorders such as atopic dermatitis and psoriasis. The study participants applied topical CBD enriched skin ointment on the affected areas two times a day for three months. At the end of the study period, the researchers found that CBD-enriched cream improved all the parameters of skin health, the PASI (Psoriasis Area and Severity Index) score, as well as other symptoms. Researchers concluded that CBD was an effective and non-invasive treatment option for inflammatory skin conditions.

Other researchers have found that CBD has a ‘triple anti-acne’ effect on acne and inflammatory skin conditions. It acts on multiple receptors and pathways, including anandamide, fatty acid amide hydrolase, reactive oxygen species and nuclear factor NF-κB, which plays a major role in immunity and inflammation.

 Other mechanisms

The endocannabinoid system or ECS is a complex cell signaling network that scientists discovered in 1992. The ECS is made up of three components – endocannabinoids (that closely resemble cannabinoids), enzymes and cannabinoid receptors (CB1 and CB2). The receptors are distributed in the nervous system, immune system, peripheral tissues, and gastrointestinal system. The natural endocannabinoids are of two types – anandamide and 2-arachidonoylglycerol (2 AG).

The endocannabinoids act as ligands and bind to the cannabinoid receptors to initiate physiological and neurological responses. CB1 receptors are predominantly located in the brain and CB2 receptors are concentrated in the immune system but are also present in peripheral tissues and gastrointestinal systems.

CBD, as it is similar to the natural endocannabinoids, has a similar action on the CB receptors. It has been shown to influence many physiological and neurological processes through the endocannabinoid system by activation of CB receptors, including pain, pleasure, sleep, immune activity, mood, relaxation, fertility, and metabolism.

Scientists suggest CBD may also indirectly activate cannabinoid receptors, which may play a role in controlling inflammation and pain. Researchers believe CBD activates other types of receptors such as vanilloid receptor, serotonin 1A receptor and adenosine A2A receptor to reduce inflammation.

A deficiency of endocannabinoids, as well as CB1/CB2 receptors, is also believed to be the cause behind disease conditions. This theory explains health conditions associated with chronic inflammation, including rosacea, arthritis, fibromyalgia and irritable bowel syndrome.

Efficacy of CBD in treating rosacea

Researchers at the University of Bonn in Germany conducted a study on the efficacy of cannabinoids in treating inflammation due to skin allergies. They found that topical cannabinoids were effective in reducing symptoms of inflammation. The researchers concluded that this has important implications as far as using cannabinoids such as CBD for treating inflammatory skin diseases, including rosacea.

The topical cannabinoid acts by decreasing pro-inflammatory agents such as IFNγ produced by T cells and chemokines such as CCL2 and CCL8.

In another study that tested the effect of cannabidiol on acne vulgaris, researchers observed that CBD had immense potential to be a promising therapeutic agent in treating inflammatory conditions. The beneficial effect of CBD is due to its anti-inflammatory and antiproliferative effects.

The researchers focused on CBD’s effects on the sebaceous gland that is one of the aspects regulated by the endocannabinoid system. The ECS regulates many physiological processes, such as growth and differentiation of skin cells.

How to use CBD to treat rosacea

The best way to address the distressing symptoms of rosacea is to use topical CBD products on the affected skin. It is important for you to consult a medical professional to confirm the diagnosis of rosacea and to ascertain the possible triggers such as bacterial infection or family history.

While topical CBD application is recommended, combining it with oral CBD medication can be beneficial.

Reputed manufacturers of CBD use sophisticated extraction techniques where they derive the purest forms of CBD isolate or distillate from Cannabis sativa plants rich in CBD. The CBD, which is in the powder form, is then mixed with therapeutic skin health ingredients such as olive oil, almond oil, coconut oil and other herbal derivatives. These are then incorporated into topical products such as

  • Pain-relief spray
  • Pain-relief roll on
  • Pain-relief cream
  • Facial serum
  • Face cream
  • Face oil
  • Sleeping mask
  • Eye serum
  • Recovery lotion
  • Body oil
  • Anti-aging facial serum
  • Facial cream

To alleviate the symptoms of rosacea, CBD can be directly applied to the affected area to calm the skin. You can sprinkle a few drops of high-quality CBD oil on your face and gently massage it into the skin.

Alternatively, you can use a reputed manufacturer’s topical CBD cream, serum or face mask and apply it as directed on affected areas. CBD Plus and CBD Must are good choices.

CBD oil can also be taken orally in the sublingual method. Here, you can place CBD oil under your tongue to allow it to get absorbed or take them in the form of CBD oil containing capsules.

When selecting a topical CBD product for treating rosacea, one of the most important things that you need to check is the amount of active ingredient in the product. The active ingredient in CBD isolate or distillate containing products is CBD (Cannabidiol) itself. Some products, while claiming to contain CBD, may actually have hemp oil as the active ingredient.

While both CBD and hemp oil are derived from the Cannabis sativa plant, they are not the same when it comes to their therapeutic effects. CBD is extracted from the leaves, stalks and flowers of the Cannabis sativa plant that is exclusively grown for CBD cultivation. These plants have minimal (less than 0.3 percent) to zero THC, the psychoactive compound in cannabis plants. Hemp oil, on the other hand, is made from hemp seeds of cannabis plants. While hemp oil is used in cooking and for certain cosmetic products, it has trace to zero amounts of CBD and does not bring about the same therapeutic benefits.

A full-spectrum CBD product contains all compounds in the cannabis plant, including CBD and low levels of THC. A broad-spectrum CBD cream can contain CBD and other compounds of the cannabis plant, excluding THC. CBD isolate or distillate contains only CBD and is the most potent topical product.

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