A new treatment paradigm for sickle cell disease leg ulcers: Topical cannabis‐based medicines

Maida, Vincent; Shi, Runjie Bill; Fazzari, Francesco; Zomparelli, Lydia-Marie

doi:10.1111/exd.14256

Cited by 6 publications

(11 citation statements)

References 15 publications

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“…We regret that we were not able to catch this editorial error earlier and the confusion that it caused.We also read with much interest the reports on the use of topical cannabis-based medicines on wound closure and healing. 3,4 This was also pointed out by Abdalla et al 5 in their recent commentary. Based on the available preliminary data, we agree that topical cannabis-based medicines hold much potential and eagerly await the results of larger randomized trials in multiple types of wounds.We wholeheartedly agree that both CBD and non-CBD cannabinoids hold significant promise for the treatment of dermatologic conditions, although for the purposes of our review, we focused primarily on implications for dermatologic surgery.…”

supporting

confidence: 59%

“…We also read with much interest the reports on the use of topical cannabis-based medicines on wound closure and healing. 3,4 This was also pointed out by Abdalla et al 5 in their recent commentary. Based on the available preliminary data, we agree that topical cannabis-based medicines hold much potential and eagerly await the results of larger randomized trials in multiple types of wounds.…”

supporting

confidence: 59%

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Response to “Comment on ‘Cannabinoids in dermatologic surgery’”

Kong

Blalock

2021

Journal of the American Academy of Dermatology

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Response to ''Comment on 'Cannabinoids in dermatologic surgery'''To the Editor: We thank Fazzari et al 1 for their interest in our article 2 and for their comments. We agree that we were not able to fully discuss the extensive scope of all cannabinoids and their effects and we therefore appreciate that in their comments they emphasized the diversity of the cannabinoids and some of the distinguished effects of non-cannabidiol (CBD) cannabinoids.We are grateful to Fazarri et al 1 for alerting us to a typographical error in the manuscript, where ''cannabinoids'' was unfortunately incorrectly replaced by ''CBD.'' The paragraph, ''Therapeutic applications of CBD'' should have been entitled ''Therapeutic applications of cannabinoids'' and the term ''CBD'' in that paragraph, in Fig 1, as well as in the sentence, ''Further studies would be necessary to characterize the impact of the drug interactions of CBD on patient outcomes'' should have been replaced by the word ''cannabinoids.'' We regret that we were not able to catch this editorial error earlier and the confusion that it caused.We also read with much interest the reports on the use of topical cannabis-based medicines on wound closure and healing. 3,4 This was also pointed out by Abdalla et al 5 in their recent commentary. Based on the available preliminary data, we agree that topical cannabis-based medicines hold much potential and eagerly await the results of larger randomized trials in multiple types of wounds.We wholeheartedly agree that both CBD and non-CBD cannabinoids hold significant promise for the treatment of dermatologic conditions, although for the purposes of our review, we focused primarily on implications for dermatologic surgery. At a minimum, we are excited about continued dialogue regarding this thrilling field of research and discovery and its impact on the field.

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supporting

confidence: 59%

supporting

confidence: 59%

Response to “Comment on ‘Cannabinoids in dermatologic surgery’”

Kong

Blalock

2021

Journal of the American Academy of Dermatology

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“…56 One patient with chronic leg ulcers associated with sickle cell disease achieved complete closure of multiple wounds within a mean of 43 days when treated with topical Cannabis-Based Medicines, VS-21 and VS-22, which are chemically related to VS-12 and VS-14 but augmented with the addition of tetrahydrocannabinolic acid (THCA). 57 Although it is theorized that the positive results observed were due to local absorption and associated activities within the tissues of the wound bed and peri-wound, it is not known if systemic absorption of the various components of TCBM contributed to the outcomes. Nonetheless, we postulate that the positive outcomes reported are the result of a potentiation and synergy between cannabinoids, terpenes and flavonoids, acting on both wound bed and peri-wound tissues.…”

Section: Discussionmentioning

confidence: 99%

Topical cannabis‐based medicines – A novel adjuvant treatment for venous leg ulcers: An open‐label trial

Maida

Shi

Fazzari

et al. 2021

Experimental Dermatology

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Venous leg ulcers are highly prevalent lower limb integumentary wounds that remain challenging to heal despite the use of evidence-based compression therapies. A multitude of adjuvant treatments has been studied but none have demonstrated enough efficacy to gain adoption into treatment guidelines. Global attention on Cannabis-Based Therapies is increasing and has been driven by quantum scientific advancements in the understanding of the endocannabinoid signalling system. Topical Cannabis-Based Medicines represent a novel treatment paradigm for venous leg ulcers in terms of promoting wound closure. Fourteen complex patients with sixteen recalcitrant leg ulcers were treated with Topical Cannabis-Based Medicines in conjunction with compression bandaging, every second day, to both wound bed and peri-wound tissues.The cohort had a mean age of 75.8 years and was medically complex as reflected by a mean M3 multimorbidity index score of 2.94 and a mean Palliative Performance Scale score of 67.1%. Complete wound closure, defined as being fully epithelialized, was achieved among 11 patients (79%) and 13 wounds (81%) within a median of 34 days.All three remaining patients demonstrated progressive healing trends but were lost to follow-up. The treatments were well tolerated, and no significant adverse reactions were experienced. The rapid wound closure of previously non-healing venous leg ulcers among elderly and highly complex patients suggests that Topical Cannabis-Based Medicines may become effective adjuvants in conjunction with compression therapy. This may also indicate that they may have an even broader role within integumentary and wound management. Therefore, this treatment paradigm warrants being subjected to controlled trials.

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“…Within the field of dermatology, the combined use of cannabinoids, terpenes, and flavonoids from cannabis, instead of CBD alone, is garnering attention due to their potentiated effects in chronic pain and wound healing as a result of the entourage effect. 1,4,5 The use of topical CBD in epidermolysis bullosa highlighted by the authors is one published example of the benefit of cannabinoids in dermatologic conditions. However, there are more recently published data on successful outcomes in similarly challenging integumentary wounds caused by calciphylaxis and sickle cell disease using topical cannabis-based medicines (TCBM).…”

mentioning

confidence: 99%

“…4 A case report involving 3 recalcitrant leg wounds in a complex patient with sickle cell disease showed complete wound closure within a mean of 1.4 months after TCBM application. 5 These reports highlight the greater potential within the cannabis plant as a tool for the healing of integumentary conditions.…”

mentioning

confidence: 99%