Combined tetrahydrocannabinol and cannabidiol to treat pain in epidermolysis bullosa: a report of three cases

N H B Schräder, J C Duipmans, B Molenbuur, A P Wolff, M F Jonkman, N H B Schräder, J C Duipmans, B Molenbuur, A P Wolff, M F Jonkman

Abstract

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.

© 2018 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.

References

    1. Fine JD, Johnson LB, Weiner M, Suchindran C. Assessment of mobility, activities and pain in different subtypes of epidermolysis bullosa. Clin Exp Dermatol 2004; 29:122–7.
    1. Goldschneider KR, Good J, Harrop E et al Pain care for patients with epidermolysis bullosa: best care practice guidelines. BMC Med 2014; 12:178.
    1. de Hoop B, Heerdink ER, Hazekamp A. Medicinal cannabis on prescription in the Netherlands: statistics for 2003–2016. Cannabis Cannabinoid Res 2018; 3:54–5.
    1. Chelliah MP, Zinn Z, Khuu P, Teng JMC. Self‐initiated use of topical cannabidiol oil for epidermolysis bullosa. Pediatr Dermatol 2018; 35:e224–7.
    1. Yuen WY, Frew JW, Veerman K et al Health‐related quality of life in epidermolysis bullosa: validation of the Dutch QOLEB questionnaire and assessment in the Dutch population. Acta Derm Venereol 2014; 94:442–7.
    1. Von Bischhoffshausen S, Ivulic D, Alvarez P et al Recessive dystrophic epidermolysis bullosa results in painful small fibre neuropathy. Brain 2017; 140:1238–51.
    1. Schräder N, Yuen W, Jonkman M. Pain quality assessment scale for epidermolysis bullosa. Acta Derm Venereol 2017; 98:346–9.
    1. Finnerup NB, Attal N, Haroutounian S et al Pharmacotherapy for neuropathic pain in adults: a systematic review and meta‐analysis. Lancet Neurol 2015; 14:162–73.
    1. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain 2011; 152 (Suppl. 3):S2–15.
    1. Whiting PF, Wolff RF, Deshpande S et al Cannabinoids for medical use a systematic review and meta‐analysis. JAMA 2015; 313:2456–73.
    1. Thomas BF, Pollard GT. Preparation and distribution of cannabis and cannabis‐derived dosage formulations for investigational and therapeutic use in the United States. Front Pharmacol 2016; 7:285.
    1. Castillo PE, Younts TJ, Chávez AE et al Endocannabinoid signaling and synaptic function. Neuron 2012; 76:70–81.
    1. Russo EB. Cannabinoids in the management of difficult to treat pain. Ther Clin Risk Manag 2008; 4:245–59.
    1. Mounessa JS, Siegel JA, Dunnick CA, Dellavalle RP. The role of cannabinoids in dermatology. J Am Acad Dermatology 2017; 77:188–90.
    1. Pertwee RG. The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: delta9‐tetrahydrocannabinol, cannabidiol and delta9‐tetrahydrocannabivarin. Br J Pharmacol 2008; 153:199–215.

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