Pharmaceutical grade cannabinoid-based medications (CBMs) could improve the treatment of epidermolysis bullosa (EB), a severe and debilitating genetic skin disease, according to research published in the British Journal of Dermatology.

The research, by doctors in the Netherlands, highlights the lack of effective pain relief options for people with EB, and demonstrates the effectiveness of CBMs as an alternative in a sample of EB patients.

EB is blistering condition, in which even minor knocks and friction can cause the skin to blister or ulcer. Children with EB are often know as butterfly children due to the fragility of their skin.

There are three main types reflecting the severity and location on the body of the blistering, EB simplex, junctional EB, and dystrophic EB. It is estimated that approximately 5,000 people in the UK are currently living with EB.

Cannabinoids are chemical compounds which occur naturally in the cannabis plant. Cannabis contains over 100 cannabinoids, the two most abundant being tetrahydrocannabinol (THC) and cannabidiol (CBD). CBD, unlike THC, does not possess psychoactive properties, meaning it does not alter mood, perception and behaviour in the ways often associated with recreational use of cannabis. The CBM used in this case was a mixture of CBD and THC in an oil base, which seemed to avoid unwanted side effects such as sedation and intoxication. The treatment was administered under the tongue.

Pain is an extremely debilitating symptom of all the sub-types of EB. Daily use of opioids, a class of drug which includes powerful painkillers such as morphine, is the current mainstay of EB pain relief. Opioids often fail to effectively manage this pain and are associated with development of tolerance, meaning that with repeated use, it takes a higher dose to get the initial benefits, and addiction.

Three adult EB patients with chronic, severe pain were treated with CBM oil as part of this study. All three participants reported a significant reduction in pain levels experienced whilst undergoing CBM oil treatment relative to their previous drug regime. An additional benefit was reduction in itching.

Before this study, all three participants had a complicated daily pain treatment regimen made up of paracetamol, ibuprofen and multiple opioids including topical morphine.

Mr. Nicholas Schräder of the University Medical Center Groningen and the study’s lead author said “Pain management and itch control in EB are two symptoms that underpin the burden of suffering. The complex nature of this disease probably means no single treatment is able to address the pain and itch alleviation needs of all patients.

“The cases reported in this study indicate that there is a possibility that patients with EB may be able to respond to treatment with a CBM oil, and call for in-depth controlled scientific studies to understand the true effect and impact this type of treatment may have on patient with EB, especially with regard to pain and itch.”

Holly Barber of the British Association of Dermatologists said: “The last year has seen some really exciting developments in EB research, however, we are still lacking really effective pain and itch management which works over the long-term, and which has minimal side effects. Hopefully, further research on this topic will reveal if cannabinoid oils are the answer. If they are, this could provide a long sought-after source of relief for EB patients.”

Home Secretary Sajid Javid announced in July 2018 that specialist doctors in the UK will be able to legally prescribe cannabis-based medicinal products, however, few have been approved by the Medicines and Healthcare products Regulatory Agency (MHRA). Sativex, a cannabis-based spray combining equal parts THC and CBD, is one of the few which been approved for use in the UK, as a treatment for multiple sclerosis. The European Medicines Agency (EMEA) has also approved two safety and efficacy studies of Sativex as adjunctive therapy to opiates in children with cancer-related pain.

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Study details:

Combined tetrahydrocannabinol and cannabidiol to treat pain in epidermolysis bullosa: a report of three cases
N.H.B. Schräder,1 J.C. Duipmans,1 B. Molenbuur,2 A.P. Wolff3 and M.F. Jonkman1

Departments of 1Dermatology, 2Anaesthesiology and 3Anaesthesiology Pain Center; University of Groningen, University Medical Center Groningen, Groningen, the Netherlands

Citation: N.H.B. Schräder, J.C. Duipmans, B. Molenbuur, A.P. Wolff and M.F. Jonkman (2018), Combined tetrahydrocannabinol and cannabidiol to treat pain in epidermolysis bullosa: a report of three cases. Br J Dermatol. DOI 10.1111/bjd.17341

Link to full study: https://onlinelibrary.wiley.com/doi/10.1111/bjd.17341

For more information please contact the media team: comms@bad.org.uk, 0207 391 6084. Website: www.bad.org.uk

About us:

The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. For further information about the charity, visit www.bad.org.uk

The British Association of Dermatologists publishes two world-renowned dermatology journals, both published by Wiley-Blackwell. The British Journal of Dermatology is one of the top dermatology journals in the world, and publishes papers on all aspects of the biology and pathology of the skin. http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2133