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

Abstract

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.

Topical Cannabidiol in the Treatment of Digital Ulcers in Patients with Scleroderma: Comparative Analysis and Literature Review

“…The results showed rapid wound closure of the previously nonhealing venous leg ulcers. This evidence suggests that TCBM may be an effective adjuvant in conjunction with compression therapy 23 . No randomized controlled trials have been carried out though, and further research is needed.…”

“…Despite an extensive literature search, the authors did not find any research investigating the use of CBD in SSc-DU treatment. Only seven published reports have investigated CBD treatment of skin ulcers (Table 3 ): 6 , 18 – 23 a single case report, 6 two case series, 19 , 20 and one prospective open-label trial with different reports from the same study. 18 , 21 – 23 Generally, the studies reported small patient series (between 3 and 33 patients) with varied dosages and modalities of CBD administration.…”

“…Only seven published reports have investigated CBD treatment of skin ulcers (Table 3 ): 6 , 18 – 23 a single case report, 6 two case series, 19 , 20 and one prospective open-label trial with different reports from the same study. 18 , 21 – 23 Generally, the studies reported small patient series (between 3 and 33 patients) with varied dosages and modalities of CBD administration. The indications for CBD treatment were skin ulcers, pain, and wound healing.…”

Cannabinoid Compounds as a Pharmacotherapeutic Option for the Treatment of Non-Cancer Skin Diseases

“…Thus, a CBD-containing hydrogel dressing based on the ion-crosslinked interaction between Zn 2+ ions and the alginate polymer was recently reported to accelerate wound healing in vivo [ 125 ]. Based on the promising preclinical results, corresponding cannabinoid effects have meanwhile been investigated in patients with venous leg ulcers [ 126 ]. Here, liposomal formulations with a mixture of CBD, THC and other substances proved to be beneficial.…”

“…Finally, data from a recent small open-label trial suggest that cannabinoids are a therapeutic option for rapid wound closure of previously non-healing venous leg ulcers [ 126 ]. This study tested the wound healing properties of cannabinoids in 14 patients with ulcers due to chronic venous hypertension and existing venous insufficiency.…”