Acne can quickly become problematic and distressing for some individuals: pimples, redness... Depending on the severity and persistence of the acne, various medicinal treatments can be considered and offered to alleviate acne and limit flare-ups. However, their effectiveness and safety are often questioned by patients. Yet, numerous studies have highlighted the positive effects of CBD in managing acne, positioning it as a natural alternative without undesirable and severe side effects. Could CBD truly be a solution for effective action in individuals suffering from acne?
Why does acne appear?
As the eighth most common disease (affecting approximately 9.4% of the global population), acne is one of the most frequently observed skin conditions in humans in dermatology, evolving in flare-ups. Associated with discomfort, permanent skin scarring, and negative self-perception and self-esteem, it is characterized by a mixed eruption of inflammatory skin lesions (papules, pustules, nodules, and cysts) and non-inflammatory/retentional lesions due to hyperkeratinization (open and closed comedones), primarily affecting the face, back, and chest. Although acne is primarily a disorder of adolescence, current research indicates that the prevalence of acne in adults, particularly women, is on the rise.
It is well known that acne is a multifactorial disease: the accumulation of acne-causing strains of Cutibacterium acnes at the level of the pilosebaceous unit, the increase in sebum production (hyperseborrhea) and the alteration of its consistency (dyseborrhea), defective keratinization and clogging of hair follicles, and inflammation of the sebaceous glands are elements commonly cited in the pathophysiology of acne. To date, guidelines recommend a combination of ingredients and conventional treatments (topical retinoids, benzoyl peroxide, oral antibiotics, isotretinoin, etc.) aimed at targeting the different stages of pathogenesis by acting through independent mechanisms.
However, most available acne treatments induce potential side effects (drying, itching, burning, etc.), not to mention the risk of antibiotic resistance, which remains a limitation. These effects can lead to a premature discontinuation of treatment by the patient. That's why, over the last decade, the growing interest in natural ingredients derived from plants as an alternative or adjunct to conventional treatments has led to the discovery and development of new therapies that offer good efficacy with a minimal risk of side effects.
How does CBD act on acne?
Given the significant role of the endocannabinoid system in the skin, current research has focused on the role of phytocannabinoids as potential therapeutic options for various skin disorders, such as acne. Recently, cannabidiol (CBD) has been suggested as a new treatment option for acne. In addition to its known anti-inflammatory activity, it would simultaneously target the various pathological pathways underlying acne physiology, all with a notable side effect profile.
CBD, a Sebostatic Agent: CBD has the ability to "normalize" the pathologically high sebum production from sebaceous glands seen in acne-prone skin. A study revealed that CBD administered to cultured human sebocytes and human skin organ cultures reduced the cellular proliferation of sebocytes through the activation of TRPV4 (Transient Receptor Potential Vanilloid-4) ion channels, without compromising viability, and thus significantly reducing sebum production due to the holocrine mechanism. It is also capable of inhibiting the lipogenic actions of various compounds, including arachidonic acid, linoleic acid, and testosterone.
The Complex Anti-Inflammatory Effect of CBD: CBD also exerts anti-inflammatory actions in keratinocytes, which are mediated by the increase of TRIB3 and the inactivation of NF-κB and MAPK signaling pathways. This is illustrated by a decrease in the expression levels of inflammatory mediators in skin cells, including TNF-α, IL-6, IL-8, and IL-1β. In the case of acne, it thus helps to modulate the inflammation of the sebaceous glands induced by C. acnes. Therefore, it helps to soothe and fade acne inflammation without presenting unpleasant effects. This anti-inflammatory action of CBD extends to the prevention of symptoms related to acne outbreaks such as redness.
CBD and its Bactericidal Mechanism: CBD also exhibits antibacterial and antifungal actions. This phytocannabinoid can reduce the growth of several bacteria, including the Staphylococcus aureus highly resistant, the Streptococcus pneumoniae and the Clostridioides difficile, by altering the membrane.
CBD in the face of hyperkeratinization: Finally, it has also been demonstrated that CBD inhibits the proliferation of hyperproliferative keratinocytes. These findings thus show that CBD can help prevent the buildup of epidermal cells that lead to sebum retention and pore obstruction.
In close correlation with the results in vitro and ex vivo, several placebo-controlled clinical evaluations have been conducted and have shown that the topical application of a CBD-based formula statistically reduces the number of acne lesions (primarily inflammatory lesions), sebum production, and the onset of erythema. Collectively, the obtained results suggest that, thanks to its properties of regulating sebum overproduction, its anti-sebocyte, antibacterial, anti-proliferative, and anti-inflammatory effects combined, CBD has the potential to be a promising universal therapeutic agent in the fight against acne by thus influencing all aspects of this skin pathology.
Guidelines for using CBD to alleviate acne lesions.
CBD can be applied directly and locally to the affected skin areas. To promote its percutaneous penetration and distribution, CBD oils, balms, and creams are among the most effective means to benefit from its effects against acne, due to its lipophilic nature.
In order to optimize effectiveness, CBD is often combined with other active ingredients used in acne treatments, such as vitamins or other anti-inflammatory compounds (Centella asiatica, salicylic acid, etc.). Various clinical studies show that concentrations of 2.5 to 10 μg/mL of CBD are sufficient to observe a reduction in acne lesions and improve tolerance with reduced local side effects, and this for an application of twice a day for an average of one and a half months.
It is important to clarify that CBD currently serves as a therapeutic supplement against acne and it is recommended to discuss the subject in advance with your doctor, especially if you are concurrently taking any medication.
WILIAMSON E. M. & al. Cannabinoids inhibit human keratinocyte proliferation through a non-CB1/CB2 mechanism and have a potential therapeutic value in the treatment of psoriasis. Journal of Dermatological Science (2007).
BIRO T. & al. Cannabidiol exerts sebostatic and antiinflammatory effects on human sebocytes. Journal of Clinical Investigation (2014).
AKHTAR N. & al. The safety and efficacy of 3% Cannabis seeds extract cream for reduction of human cheek skin sebum and erythema content. Pakistan Journal of Pharmaceutical Sciences (2015).
BIRO T. & al. Differential effectiveness of selected non-psychotropic phytocannabinoids on human sebocyte functions implicates their introduction in dry/seborrhoeic skin and acne treatment. Experimental Dermatology (2016).
JIMENEZ J. J. & al. The anti-inflammatory effects of cannabidiol (CBD) on acne. Journal of Inflammation Research (2022).
XIANG L. & al. Cannabidiol inhibits inflammation induced by Cutibacterium acnes-derived extracellular vesicles via activation of CB2 receptor in keratinocytes. Journal of Inflammation Research (2022).
FERNANDES J. & al. Cannabidiol and cannabigerol exert antimicrobial activity without compromising skin microbiota. International Journal of Molecular Sciences (2023).
ROZENBLAT S. & al. Development of an effective acne treatment based on CBD and herbal extracts: preliminary in vitro, ex vivo, and clinical evaluation. Evidence-Based Complementary and Alternative Medicine (2023).