Marijuana and Wound Healing in Dermatologic Surgery: A Literature Review

Introduction: With the increasing legality and availability of cannabis, it is important to understand the impacts of cannabis on all aspects of dermatologic care. There are several different methods available to ingest marijuana, including inhalation, edible, and topical formulations. There is preliminary evidence that topical CBD is beneficial for wound healing and inflammation. At the same time, the effects of smoking marijuana on wound healing are unclear. Thus, a literature review was conducted to understand the connection between marijuana consumption and wound healing in dermatology.Methods:A focused review of the literature was conducted to understand the connection between cannabis and wound healing.Results:There is preclinical evidence that suggests cannabinoids play a role in wound healing, potentially through action on CB1 and CB2 receptors. For example, agonism of CB2R has been demonstrated to attenuate inflammation, accelerate re-epithelialization, and affect fibrogenesis in mouse models. Topical cannabis extract has also been shown to inhibit skin inflammation and mediators of wound injury in vitro. There is some clinical evidence suggesting that topical CBD works to improve wound healing in skin conditions. For example, topical CBD used in combination with compression dressing demonstrated a rapid closure of wounds in an open-label trial of recalcitrant venous leg ulcers. Topical CBD has also been shown to improve wound healing in epidermolysis bullosa and sickle cell leg ulcers in case reports.   Beyond topical CBD, there is more limited evidence regarding the effects of inhaled or edible marijuana consumption on wound healing. It is well documented that smoking cigarettes has a negative impact on wound healing, and marijuana consumed in combination with nicotine may also have detrimental effects. Consuming marijuana is also associated with side effects, including arteritis, increased risk for cardiovascular events, increased postoperative complications, and drug-drug interactions.Discussion: There is some initial preclinical and clinical evidence that suggests cannabinoids have a positive impact on wound healing, though additional research is needed to fully elucidate the effects. In addition, the impact of smoking marijuana on wound healing remains largely unexplored. Given the rise in marijuana use across states, it is becoming increasingly relevant to understand its impact on wound healing to best advise patients.References:1. Du Y, Ren P, Wang Q, et al. Cannabinoid 2 receptor attenuates inflammation during skin wound healing by inhibiting M1 macrophages rather than activating M2 macrophages. J Inflamm (Lond) 2018; 15: 25. 2. Wang LL, Zhao R, Li JY, et al. Pharmacological activation of cannabinoid 2 receptor attenuates inflammation, fibrogenesis, and promotes re-epithelialization during skin wound healing. Eur J Pharmacol 2016; 786: 128-36. 3. Weigelt MA, Sivamani R, Lev-Tov H. The therapeutic potential of cannabinoids for integumentary wound management. Exp Dermatol 2021; 30(2): 201-11. 4. Makhakhe L. Topical cannabidiol (CBD) in skin pathology - A comprehensive review and prospects for new therapeutic opportunities. S Afr Fam Pract (2004) 2022; 64(1): e1-e4. 5. Kong HE, Pollack BP, Blalock TW. Cannabinoids in dermatologic surgery. J Am Acad Dermatol 2021; 85(6): 1565-70. 6. Sangiovanni E, Fumagalli M, Pacchetti B, et al. Cannabis sativa L. extract and cannabidiol inhibit in vitro mediators of skin inflammation and wound injury. Phytother Res 2019; 33(8): 2083-93. 7. Maida V, Shi RB, Fazzari FGT, Zomparelli L. Topical cannabis-based medicines - A novel adjuvant treatment for venous leg ulcers: An open-label trial. Exp Dermatol 2021; 30(9): 1258-67. 8. Chelliah MP, Zinn Z, Khuu P, Teng JMC. Self-initiated use of topical cannabidiol oil for epidermolysis bullosa. Pediatr Dermatol 2018; 35(4): e224-e7. 9. Maida V, Shi RB, Fazzari FGT, Zomparelli LM. A new treatment paradigm for sickle cell disease leg ulcers: Topical cannabis-based medicines. Exp Dermatol 2021; 30(2): 291-3. 10. Dakour-Aridi H, Arora M, Nejim B, Locham S, Malas MB. Association between Drug Use and In-hospital Outcomes after Infrainguinal Bypass for Peripheral Arterial Occlusive Disease. Ann Vasc Surg 2019; 58: 122-33.e4. 11. Thomas G, Kloner RA, Rezkalla S. Adverse cardiovascular, cerebrovascular, and peripheral vascular effects of marijuana inhalation: what cardiologists need to know. Am J Cardiol 2014; 113(1): 187-90.