Updated Research on CBD and Psoriasis
January 07, 2021
We just wrapped our massive review of CBD and autoimmune pathways.
It's now time to get specific.
Our first trip is to the skin and psoriasis.
The same general principles hold from our autoimmune review:
- Gut barrier breakdown
- Heightened immune response and inflammation
- Misreading skin cells as foreign
We'll even look at the newest research which speaks to why certain areas of the body are targeted (such as keratocytes in our skin).
Protein mimicry to its fullest.
Most importantly, we'll look at research on CBD and psoriasis pathways.
Here are the topics we'll cover:
- A quick (updated) lay of the land for psoriasis
- The avenues of autoimmune tied to psoriasis (gut, mimicry, and inflammation)
- How CBD affects the pathways of psoriasis
- How much CBD to take for psoriasis
- What's the best CBD for psoriasis
Let's get started!
A quick (updated) lay of the land for psoriasis
Yes, we all know the end result...painful and red scaling patches of skin (makeup 90% of psoriasis cases - called psoriasis Vulgaris).
What's going on below the surface?
Essentially, our immune system is mistakenly responding to proteins in our skin.
This causes a steady flow of inflammation (our immune system's main weapon) in our skin and an imbalance in the birth/death cycle of the cells there.
Most people don't realize that our immune system governs the delicate balance of cell formation and removal.
In psoriasis, the production of a specific type of skin cell, keratinocytes, can be increased by 10's!
This leads to the scaly, raised growth that characterizes the disease.
How do we know that psoriasis is an autoimmune disease?
There's a well-established link between dendritic cells and progression.
What are dendritic cells?
Dendritic cells are professional antigen-presenting cells.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6471628/
This is the cornerstone of autoimmune and antigens are the little signals to train the immune system where to attack (hopefully bad bacteria or virus and not our cells).
And come it does!
The immune system responds with a host of inflammatory agents at the site of the target:
The activation of the adaptive immune response via the distinct T cell subsets drives the maintenance phase of psoriatic inflammation [62 ]. Th17 cytokines, namely IL-17, IL-21, and IL-22 activate keratinocyte proliferation in the epidermis.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6471628/
We'll get into all those players later with CBD.
They're called cytokines and they have different roles in our body...generally as assassins for foreign invaders but like all things in the body, with dual roles.
IL-17, 21, and 22 directly drive more keratinocyte production!
The heart of psoriasis.
The question is why...how does this whole ball get started rolling? We have to go to the gut (and even throat) for that.
Psoriasis is just one example of a system gone awry. The root is more systemic as we'll find out.
The avenues of autoimmune tied to psoriasis (gut, mimicry, and inflammation)
Autoimmune diseases in general are on the rise.
Just looking at the presence of potentially damaging antibodies:
In samples taken in the period 1988 to 1991, ANA prevalence was 11%. It rose slightly to 11.5% for the 1999–2004 time period, and to 15.9% in the 2011–2012 period.
That's over a 50% increase!
We're talking about millions of people in the US.
There are common threads to the many different autoimmune diseases now.
Let's focus on three with psoriasis:
- Gut imbalance and permeability
- Protein mimicry with bacteria
- Inflammatory response
We'll then jump into how CBD affects these pathways.
First, all roads lead to the gut!
Gut imbalance and psoriasis
You wouldn't think what goes on in the gut would affect your skin but the links are increasing strong.
Simply put…
The gut microbiome affects skin homeostasis through its influence on the signaling pathways that coordinate epidermal differentiation
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6881942/
That review points to a virtual chemical soup of interactions with an emphasis on immune response elements.
Ones critical to psoriasis!
Even more fascinating is this:
For instance, intestinal bacteria DNA has been isolated successfully from the plasma of psoriatic patients.
We covered this world at our CBD and microbiome review.
The real story is about breaks in the gut barrier...so-called leaky gut.
There's a massive review on CBD and gut barrier here.
In fact, there is evidence of gut bacteria and their chemical products ending up in the skin of people with psoriasis.
Newer studies have even studied positive effects on skin by adding certain strains of gut bacteria such as:
Another study showed improved recovery of skin barrier function with decreased signs of reactive skin inflammation—including mast cell degranulation, vasodilation, edema, and tumor necrosis factor-alpha (TNF-α) release—following the administration of L. paracasei CNCM I- 2116 (ST11).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6881942/
Goodness….let's break this down.
By orally taking a strain of gut bacteria, there effects in the skin across the gamut of inflammatory response.
Speaking of oral, it's not just the gut with psoriasis and in fact, the (or a) culprit may be directly tied to strep throat.
Psoriasis patients' tonsils had a higher frequency of skin-homing [cutaneous lymphocyte-associated antigen (CLA+)] CD4+ and CD8+ T cells, and this correlated significantly with their frequency of blood CLA+ T cells.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3784221/
People with psoriasis have a poor response in the throat to streptococcus bacteria.
What's fascinating is why strep bacteria would lead to autoimmune of the skin...as opposed to the brain.
That's where protein mimicry comes in.
Protein mimicry and psoriasis
It turns out that the mechanism in our immune response that controls the ramp-up of T cells to strep bacteria also governs the increase of building blocks in our skin (of keratin).
Just so you don't think we're making this up…
The streptococcal association might reflect the concurrence of superantigen production promoting skin-homing of tonsil T cells, M-protein mimicking keratin determinants, and adjuvant effects of the peptidoglycan.
https://linkinghub.elsevier.com/retrieve/pii/S1471490609001537
In fact, look at the effect of tonsillectomies on psoriasis:
Thirteen patients (86%) showed sustained improvement after tonsillectomy ranging from 30 to 90% reduction in disease severity.
https://pubmed.ncbi.nlm.nih.gov/22491250/
So barriers….gut or mouth are critical. Our mouth has its own microbiome as well and now, all the dental floss is lined with PFOA's (the forever chemical) to slide more easily.
Finally, the net result of this imbalance is...inflammation.
Inflammation and psoriasis
Inflammation is just one leg of our immune response.
It's a very complicated and complex system governing response to damage, attack, and even cell birth/death balance.
We saw above how psoriasis is marked by an increase in cytokines that are known to spur the growth of skin tissue (the birth side).
In addition, we have the effect of T cells:
In addition, an earlier in vitro study showing that activated CD4+ T cells from psoriatic lesions could enhance keratinocyte proliferation via secretion of interferon-γ (IFN-γ)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4132586/
So...a particular type of T cell...CD4+.
Again, this quickly gets very complicated but it's safe to say the following:
Psoriasis is one of the most common immune-mediated chronic, inflammatory skin diseases characterized by hyperproliferative keratinocytes and infiltration of T cells, dendritic cells, macrophages, and neutrophils.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4132586/
The keyword there is "hyperproliferative". Too much activity. Those all are all inflammatory agents.
Let's turn our attention to CBD finally.
How CBD affects the pathways of psoriasis
We've sketched out the modern research on psoriasis.
Let's look at CBD and everything we've covered:
- CBD and gut barrier for psoriasis
- CBD and inflammatory response for psoriasis
- CBD and psoriasis directly
- CBD and TH17, 22, 23
- CBD and T cells
- CBD and skin apoptosis (reduction in excess skin)
Let's get started!
First, we'll start in the gut barrier (since this is likely where psoriasis starts).
CBD and gut barrier for psoriasis
Our gut barrier is under assault from roughly 100,000 chemicals ingested and in contact with us that our gut was not designed to deal with.
We did a whole review on CBD and leaky gut here but some highlights are in order.
A fascinating study looked at CBD's effect after exposure to c diff, the bacteria at the heart of antibiotic resistance in our hospitals.
The net effect:
Cannabidiol restores intestinal barrier dysfunction and inhibits the apoptotic process induced by Clostridium difficile toxin A in Caco-2 cells
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721977/
Let's translate.
Essentially, CBD offset the destructive effects of c diff and slowed the "cell death" in the barrier that usually results.
We have more extensive studies for CBD and the blood-brain barrier but what about the mouth?
Here's a study on CBD's effect on harmful bacteria in the mouth:
Cannabinoids have the potential to be used as an effective antibacterial agent against dental plaque-associated bacteria.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6991146/
Interestingly, occasionally CBD will accompany a "burn" right behind the tonsils which we can only interpret as a reaction to infection. It's rare but definitely there. We looked at it here.
As for our skin barrier, the endocannabinoid system is deeply integrated.
Anandamide actually makes our melanin!
We'll focus down on CBD and psoriasis directly below but let's turn to the immune system.
CBD and inflammatory response for psoriasis
Once the signal has gone out for rogue bacteria (or keratinocytes in disguise), the immune system is the next shoe to drop with psoriasis.
We have to introduce two key immune settings...TH1 and TH2.
TH1 is inflammatory and TH2 then comes into to "resolve" inflammation and re-establish balance.
This is critical with psoriasis where the inflammatory response is a runaway train.
Look at CBD's effect here:
The beneficial effects of phytocannabinoid CBD in psoriasis are the conversion of the pro-inflammatory Th1 profile to an anti-inflammatory Th2 type expression, and the anti-proliferative properties on keratinocytes
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7037408/
IL17 (part of the TH1 grouping) is a known player with psoriasis.
CBD's effect there:
CBD decreased the activities of T and B-cells-mediated response, inhibited the release of interleukins 6, 8, and 17, TNF-α, and interferon (IFN)-γ, and modulated the immune response decreasing the activity of T helper 17 cells
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7037408/
Goodness...we just showed all our inflammatory cards.
Let's jump into studies on psoriasis directly.
CBD and psoriasis directly
First, some of the direct pathways affected.
Overgrowth of skin (too much keratinocyte activity) is a key aspect of psoriasis.
The effect of CBD on this:
The cannabinoids tested all inhibited keratinocyte proliferation in a concentration-dependent manner.
https://pubmed.ncbi.nlm.nih.gov/17157480/
Remember, the endocannabinoid system governs cell birth/death balance. Too little or too much is a bad thing.
Psoriasis is too much (remember how the immune system gets tricked into overproducing to keep up with strep bacteria in the throat?).
A quick note...we don't want to just suppress cell growth or even immune response in one direction (like THC does).
That's the beauty of CBD!
Its effect depends on the state of the system.
For example, with keratinocyte activity after listing off a range of beneficial actions in psoriatic skin:
Interestingly, these changes are largely in the opposite direction to the case of keratinocytes from healthy subjects.
https://pubmed.ncbi.nlm.nih.gov/32121131/
Watch this fascinating little trick:
We conclude that CBD partially reduces oxidative stress in the keratinocytes of healthy individuals, while showing a tendency to increase the oxidative and inflammatory state in the keratinocytes of patients with psoriasis, especially following UV-irradiation.
Essentially, CBD had three different response:
- Health individuals, CBD calmed oxidative stress (inflammation) in keratinocytes
- Psoriatic individuals, CBD increased inflammation in keratinocytes
- Psoriatic individuals with UV radiation, CBD ramped up inflammation!
What gives? This is very fascinating and piggybacks what we see with cancerous cells.
It doesn't make sense until you understand that oxidative stress is the natural way our immune system kills off cells.
A culling of excess keratinocytes if you will!
The "apoptosis" or cell death mechanism that's so important.
Radiation and chemo are essentially giant doses of oxidative stress to kill cancer cells (along with everything else).
Okay...back to our original program but that responsive ability of CBD is so important!
Most autoimmune drugs for psoriasis suppress immune response in one direction...hence the nasty side effects!
A study looked at CBD isolate applied topically:
Based on skin evaluations (hydration, TEWL, elasticity), clinical questionnaires (SCORAD, ADI, PASI), and supported by photographic data and investigators' clinical assessment, the results showed that topical treatment with CBD-enriched ointment significantly improved the skin parameters, the symptoms and also the PASI index score.
https://pubmed.ncbi.nlm.nih.gov/30993303/
By the way, our CBD isolate oil has two ingredients only (CBD isolate and MCT oil from organic coconut) so there's no downside to applying it topically.
Just recently, there was a patent filed for treatment of psoriasis based on the following results:
In 2019, a patent has been filed for the treatment of psoriasis with topical application of cannabidiol and cannabigerol, which showed dose-dependent effectiveness in the trial subjects, apparently via the inhibition of inflammatory cytokines and angiogenic growth factors while restoring the Th1/Th2 balance
https://www.freepatentsonline.com/y2019/0060250.html
There are finally double-blind trials underway for CBD and psoriasis.
Let's turn to the crux of psoriasis...excessive skin production in the keratinocytes and the removal of this skin (called apoptosis).
Finally…
CBD and skin apoptosis (reduction in excess skin)
The cannabinoid system, in general, appears to be tasked with balancing the cellular birth/death cycle:
The cannabinoids tested all inhibited keratinocyte proliferation in a concentration-dependent manner.
CBD was one of the cannabinoids tested with the ability to slow skin growth when excessive.
We look forward to result of current trials which we'll add here as they come online in the next few years.
On to some practical questions.
How much CBD to take for psoriasis
We don't have good guidance yet on dosage for psoriasis yet.
Generally, 30-50 mg is a good test dosage (very low) and it can go up from there.
Max neurogenesis peaks at 300 mg so that's generally our top-level with average doses around 100 mg.
Obviously, everyone is different and it's important to test your response.
Studies on social anxiety and addiction have looked at levels between 600-800 mg daily with a strong safety profile so we have a good range.
CBD can be applied topically and/or orally. Remember, the gut barrier is critical to the whole process. Holding under your tongue up to 60 seconds can boost bioavailability.
What about the type of CBD.
What's the best CBD for psoriasis
There are basic requirements for any CBD:
- Organically grown in the US at FDA registered farms
- 3rd party tested
- CO2 processed
- No THC - THC normalizes and reduces long term anandamide function
- No pesticides
- No heavy metals
- No solvents
- No bacteria
- No mold
We test our oil twice since our whole family takes it.
That's just the start however.
Then there's the question of CBD isolate versus full spectrum.
We focus on isolate since all the research is on CBD by itself. We further explain the difference between CBD isolate versus full spectrum here.
The bigger issue is histamine or allergic issues.
Roughly 40-60% of the population has histamine issues (goes up for women and as we get older).
Autoimmune hits women at an 80% clip and progesterone fleeting (drops 50% by age 40) is a huge calming agent for immune response. Go figure!
We see an array of side effects from full spectrum go away with isolate. That's how we found it to begin with after 3-4 of the biggest brands (with side effects).
Then there's the question of cost.
The key there is cost per mg of CBD. We price our 6000 bottles at 2-3 cents per mg before discounts up to 30%.
What the research does show is that higher amounts are needed than the standard bottles of 250 mg that companies are pushing for ridiculous pricing.
That's another review!
Check out the full autoimmune review as it's very comprehensive.
Be well. Take care of each other. Take care of yourself.
Check out Related Topics:
CBD and Autoimmune Guide
CBD and Asthma Guide
CBD and Histamine
Always work with a doctor or naturopath with any supplement!
The information provided here is not intended to treat an illness or substitute for professional medical advice, diagnosis, or treatment from a qualified healthcare provider.