cannabidiol and Epidermolysis-Bullosa

Since the federal ban on hemp products was lifted in December 2018, cannabidiol (CBD), a nonpsychoactive cannabinoid derived from hemp, has become increasingly popular and accessible. CBD is sold in the form of oils, tablets, and foods in locations including gas stations, cafés, and drug stores. Despite a lack of reliable evidence, many parents praise its purported therapeutic effects on a variety of childhood ailments.. Epidiolex was the first CBD-based medication to be approved by the US Food and Drug Administration in 2018 for the treatment of two rare and severe forms of epilepsy, known as Lennox-Gastaut and Dravet syndrome, in patients of at least 2 years of age. Its efficacy was assessed through three randomized, double blind, and placebo-controlled trials in a sample of 516 patients with either Lennox-Gastaut syndrome or Dravet syndrome. Despite this development, there are few or no large-scale, rigorous studies concerning the effects of CBD on any other pediatric conditions that parents have tried to alleviate with CBD. The purpose of this review is to explore recent literature regarding the efficacy and safety of CBD in treating various health conditions in children; the risks of consuming CBD products, and the role of pediatricians in helping parents navigate often-confusing information about CBD.. Although CBD use has dramatically increased in recent years, both its potential to treat conditions and its risks have not yet been subjected to rigorous study. Pediatricians should be aware of the risks posed by poor-quality standards and labeling practices for cannabinoid products. Due to the confusing nature of the numerous sources of information about CBD, pediatricians are in a position to provide and clarify information about CBD to parents and understand the risks it poses to children.

Topics: Cannabidiol; Child; Child, Preschool; Communication; Epidermolysis Bullosa; Humans; Mental Disorders; Nervous System Diseases; Physician-Patient Relations; Risk Assessment; Risk Factors

Patients with the genetic blistering skin condition epidermolysis bullosa (EB) report severe pain as a consequence of skin and mucous membrane lesions including blisters, wounds, and scars. Adequate symptom alleviation is not often achieved using conventional pharmacologic interventions. Finding novel approaches to pain care in EB is imperative to improve the quality of life of patients living with EB. There are several anecdotal reports on the use of cannabinoid-based medicines (CBMs) by EB patients to reduce the burden of symptoms. However, controlled clinical investigations assessing these reported effects are lacking. As the pain quality "unpleasantness" delineates EB pain, we hypothesize the modulation of affective pain processing in the brain by way of intervention with CBMs comprising the cannabinoids Δ-9-tetrahydrocannabinol and cannabidiol-objectified by functional magnetic resonance imaging (fMRI). The C4EB study is an investigator-initiated, single-centre, randomized, double-blind, placebo-controlled and crossover trial. Adult patients with the diagnosis epidermolysis bullosa, reporting chronic pain will be eligible to participate. Following baseline measurements, participants will be randomized to receive the sublingually administered interventions placebo and Transvamix® in forward or reversed orders, each for two weeks and separated by a washout. The primary outcome is the difference in numeric rating scale pain scores between grouped interventions, using affective descriptors within the Short-form McGill Pain Questionnaire-2. Secondary outcomes include pain self-efficacy, concomitant analgesic medication-use and adverse events. Additionally, fMRI will be employed to assess brain connectivity related to neuroanatomic pain circuits at baseline, placebo and Transvamix® interventions. The study was approved by the ethical committee at the University Medical Center of Groningen in the Netherlands. Results will be submitted for publication in a peer-reviewed journal. Trial registration number: Netherlands Trial Register: NL9347 (Acronym: C4EB).

Topics: Adult; Cannabidiol; Chronic Pain; Cross-Over Studies; Double-Blind Method; Dronabinol; Epidermolysis Bullosa; Humans; Quality of Life; Randomized Controlled Trials as Topic

Epidermolysis bullosa (EB) is a genetic blistering disorder characterized by intense pain related to disease pathology and care-based interventions. Opioid-based therapies underpin pain care in EB; however, they are unable to provide adequate analgesia in a significant proportion of patients. Cannabinoid-based medicines (CBMs) have been studied increasingly for pain conditions of various aetiologies and pose as a novel dimension for pain care in EB. We present three patients with EB who were prescribed pharmaceutical-grade sublingually administered CBMs comprising tetrahydrocannabinol and cannabidiol. All three patients reported improved pain scores, reduced pruritus and reduction in overall analgesic drug intake.

Topics: Administration, Sublingual; Adult; Analgesics, Opioid; Cannabidiol; Cannabis; Dronabinol; Drug Combinations; Drug Therapy, Combination; Epidermolysis Bullosa; Female; Humans; Male; Middle Aged; Netherlands; Pain; Pain Measurement; Plant Oils; Treatment Outcome

Topics: Cannabidiol; Cannabinoids; Dronabinol; Epidermolysis Bullosa; Humans; Pain

Epidermolysis bullosa is a rare blistering skin disorder that is challenging to manage because skin fragility and repeated wound healing cause itching, pain, limited mobility, and recurrent infections. Cannabidiol, an active cannabinoid found in cannabis, is postulated to have antiinflammatory and analgesic effects. We report 3 cases of self-initiated topical cannabidiol use in patients with epidermolysis bullosa in an observational study. One patient was weaned completely off oral opioid analgesics. All 3 reported faster wound healing, less blistering, and amelioration of pain with cannabidiol use. Although these results demonstrate promise, further randomized, double-blind clinical trials are necessary to provide scientific evidence of our observed benefits of cannabidiol for the treatment of epidermolysis bullosa.

Topics: Administration, Topical; Cannabidiol; Child; Child, Preschool; Epidermolysis Bullosa; Female; Humans; Infant; Male; Pain; Skin; Wound Healing