Treatment of chronic pruritus with medical marijuana
Chronic itching – known clinically as chronic pruritus – is characterized by an incessant and sometimes even debilitating sensation of itching, and often decreases the quality of life of those who have it. Treatment for this condition is difficult because there are few therapies approved by the Food and Drug Administration. A recent case study by researchers at Johns Hopkins Medicine shows that there may already be a promising option for patients with chronic itching: medical marijuana (cannabis).
Chronic pruritus is associated with many dermatological diseases
Chronic pruritus is a debilitating symptom associated with many dermatological, neurological and systemic diseases. It is often resistant to treatment and can lead to a severe reduction in quality of life. Currently, to our knowledge, there is a lack of US Food and Drug Administration approved therapies for pruritus, so treatment can be difficult and relies on off-label therapies. In this article, we report a case of successful medical marijuana use to treat chronic pruritus.
Johns Hopkins Medical School team tests medical marijuana as possible treatment for chronic itching
A report on the team’s findings was published on April 9, 2021 in JAMA Dermatology.
“Chronic itching can be a particularly difficult condition to treat, as unauthorized treatments are often used,” says Shawn Kwatra, physician, assistant professor of dermatology at Johns Hopkins University School of Medicine. “With the increased use of medical marijuana and our understanding of the role of the endocannabinoid system [un système complexe de signalisation cellulaire qui régule une variété de fonctions dans le corps] in chronic itching, we decided to try medical marijuana in a patient who had failed multiple therapies and had few options. “
Kwatra and her colleagues examined an African-American woman in her 60s with a 10-year history of chronic itching. The patient first presented to the Johns Hopkins Itch Center complaining of extreme itching on her arms, legs and stomach. Examination of the skin revealed numerous hyperpigmented and raised skin lesions. Several treatments were offered to the patient – including several systemic therapies, centrally acting nasal sprays, steroid creams and phototherapy – but they were all unsuccessful.
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Kwatra claims that the use of medical marijuana – either by smoking it or in liquid form – gave the woman almost instant improvement.
“We asked the patient to rate her symptoms using a numerical rating scale, where 10 is worst itch and zero is no itch,” says Kwatra. “It started at 10 but dropped to 4 within 10 minutes of the initial administration of medical marijuana. By continuing to use the cannabis, the patient’s itching completely subsided. “
Researchers believe that one of the active ingredients in medical marijuana, tetrahydrocannabinol binds to receptors in the brain that influence the nervous system. When this happens, the inflammation and activity of the nervous system decreases, which could also lead to a reduction in skin sensations such as itching.
Mr Kwatra says that while conclusive studies have yet to be done to validate medical marijuana as an effective measure to relieve previously unmanageable itching, he believes this warrants further clinical trials.
“Controlled studies are needed to determine the dosage, effectiveness and safety of medical marijuana in the treatment of various subtypes of itching in humans, and once these studies are completed we will better understand which patients are most likely to benefit from this therapy, ”he says.
Additionally, human studies, although limited due to differences in cannabinoids used, disease patterns, and method of administration, have consistently shown significant reductions in both scratching and symptoms of chronic pruritus. . Clinical studies have shown a reduction in pruritus in several dermatological diseases (atopic dermatitis, psoriasis, asteatotic eczema, prurigo nodularis and allergic contact dermatitis) and systemic (uremic pruritus and cholestatic pruritus). These preliminary studies in humans justify controlled trials to confirm the benefit of cannabinoids for the treatment of pruritus and to standardize treatment regimens and indications. In patients who have refractory chronic pruritus after standard therapies, cannabinoid formulations may be considered as adjuvant therapy where legal.