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CBD for Venous Leg Ulcers: Complete Wound Closure in 81% Chronic Cases

In journalism and media industry for more than twenty years, worked for a number of media companies. Business editing, research and PR specialist. Covering industry and science news for Ilesol Pharmaceuticals.

CBD for Venous Leg Ulcers: Complete Wound Closure in 81% Chronic Cases

A new study shows that a combination of CBD, terpenes, and flavonoids improves the results of compression therapy in venous leg ulcers. With the application of the topical solution containing molecules naturally present in cannabis, the wounds rapidly healed in patients with chronic conditions. The scientists believe in the efficiency of CBD for venous leg ulcers as a promising novel supportive therapy.

Venous leg ulcers are a chronic problem in many countries, especially in Northern Europe and the US. The overall prevalence of this condition is 1% rising to 3% in patients over 65 years of age. The venous leg ulcers are formed in the skin over the ankles and often are painful. Their treatment includes standardized care, which relies on a reliable diagnosis, compression, and local wound care. The healing of these wounds is variable, with common recurrence.

A recent analysis of 1323 patients reported that the proportion of patients who achieved complete closure using compression therapy at three and six months was 42.2% and 48.6%, respectively.

A new study published in May 2021 in Experimental Dermatology shows that a combination of cannabidiol, terpenes, and flavonoids leads to rapid wound closure of previously non-healing venous leg ulcers among elderly and highly complex patients.

This prospective open-label cohort trial recruited 14 patients with 16 chronic and non-healing leg ulcers referred to a regional consultative wound management clinic in Toronto, Canada.

The median age of the patients was 75.8 years, all with chronic wounds. One 81-year old patient with a surgically fused ankle was affected by his wound for 12.2 years. More than half of the patients had moderate to severe lipodermatosclerosis, edema, and peripheral arterial disease, all of which are significant factors against wound closure.

All patients had venous leg ulcers for longer than six months that failed to close despite at least four weeks of compression therapy. All patients underwent duplex venous dopplers that confirmed the presence of venous incompetency, and wound biopsies were carried out to rule out neoplasm, vasculitis, and rare vasculopathy. All patients provided informed consent for treatment using cannabis-based medicines – VS-12 and VS-14.

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The cannabis-based medicines in this trial were composed of mixtures of cannabinoids, terpenes, and flavonoids applied topically to the wound beds and peri-wound tissues. VS-12 and VS-14 were chemically equivalent but compounded in separate vehicles. Formula VS-12, applied to wound bed consisted of CBD 3.8 mg/ml, THC

CBD for venous leg ulcers: The treatment

Great results obtained in this study on CBD for venous leg ulcers resulted with the following methodology:

Treatments were carried out every second day and continued until complete wound closure,
defined as the wound bed being 100% epithelialized. On their initial visits, all patients’ degrees of global medical complexity was calculated using both the M3 multimorbidity index tool and the Palliative Performance Scale score (PPS). Qualitative clinical assessments of their degrees of lipodermatosclerosis, edema, and peripheral arterial disease were also scored and documented. Following gentle cleansing with sterile normal saline, each patient underwent application of evenly applied thin layers of VS-12 to the wound beds, and VS-14 to a 4-6 cm radial cuff of peri-wound integument every second day. Tissues were then covered with one layer each of Jelonet and Mesorb. This was followed by the application of inelastic compression bandages, chosen based upon patient preferences, using a spiral technique, between the level of the metatarsal phalangeal joints and the infra-popliteal space.

Two-dimensional wound measurements, namely, widest width and longest length, were documented at each visit after debridement was carried out. Given the irregular and eclectic wound bed contours, the wound area calculations were approximated by matching them to various geometric shapes and applying their respective mathematical formulae. Data was also fitted to a linear regression model to report the general trend and the estimated time to complete wound closure. The observed time to complete wound closure, defined as the number of days since treatment onset to observe complete wound closure since the start of treatment, was calculated. The wound area data points were also fitted using a least-squares linear regression model. The slope was extracted to report both the absolute (cm² per 30 days) and relative (% of original wound area per 30 days) rates of wound healing. The estimated time to achieve wound healing, defined as the number of days since treatment onset for the linear fit line to reach zero was reported.

Rapid wound closure in 34 days

Complete wound closure, defined as being fully epithelialized, was achieved among 11 patients (79%) and 13 wounds (81%) within a median of 34 days. The three remaining patients were unavailable for follow-up because one of them moved out of the country, and two died of unrelated reasons. However, those three wounds also demonstrated progressive healing when last seen. There were no significant adverse reactions in any patients.

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These positive outcomes are the result of potentiation and synergy between cannabinoids, terpenes, and flavonoids, the scientists conclude.

The rapid wound closure of previously non-healing venous leg ulcers among elderly and highly complex patients suggests that topical cannabis-based medicines may become effective adjuvants in conjunction with compression therapy. It may also indicate that they may have an even broader role within the skin and wound management.

Reviewed by Sasha Bajilo, founder of ILESOL Pharmaceuticals, an industrial scale producer of CBD products and formulations. Expert on Hemp/Cannabis policy, member of the Croatian Ministry of Health regulatory commission for medical cannabis.

Can Cannabis Oil Help Heal Wounds?

A middle-age man in Canada with oral cancer found that medical cannabis oil may have helped to slightly reduce the size of a wound that his cancer caused on his cheek, according to a new report of his case.

The cannabis oil treatment also reduced the man’s pain after the cancer created a hole in his right cheek, according to the report published in the January issue of the Journal of Pain and Symptom Management. Studies have suggested that marijuana may work to treat cancer patients’ pain.

Much more research is needed to know whether medical cannabis oil may have a wound-healing effect. But the man’s case “really validates what has been known for thousands of years about the utility of cannabinoids in so many different areas,” said Dr. Vincent Maida, an associate professor in the Division of Palliative Care at the University of Toronto, who treated the man. [25 Odd Facts About Marijuana]

“Ancient cultures used cannabis extracts on wounds,” Maida said.

The 44-year-old man went to see Maida at a palliative-care clinic in Toronto in the spring of 2016 for the treatment of pain caused by a malignant wound in his right cheek. The man had been diagnosed with oral cancer three years earlier, and despite having the tumor surgically removed as well as undergoing radiation and chemotherapy for his condition, the cancer returned. The man had chosen, two years before his visit to Maida’s clinic, to forgo any further treatments for his cancer, according to the report. (Palliative care generally involves only treatments to reduce pain.)

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The man had tried taking opioid medications, but was still having severe pain in his cheek. In addition, he was experiencing side effects from those medicines, such as drowsiness and constipation, the man told Maida. He asked Maida to prescribe medical marijuana to treat his pain.

The doctor prescribed vaporized medical marijuana for the man, which the man then used for the next few months. The marijuana seemed to help alleviate the pain significantly, and allowed the man to reduce the doses of opioids he was taking. However, the wound in his cheek grew and the cancer eventually eroded through his cheek, creating a hole, which prevented the man from continuing to use vaporized marijuana.

The man then asked Maida for a prescription for medical cannabis oil, which he could apply directly to his wound. The man used the oil four times daily for about a month.

He found that his wound stopped growing, and shrank by a small amount, about 5 percent, over the next month. The man said he experienced pain relief starting about 10 to 15 minutes after he applied the oil to the wound, which lasted for about 2 hours after application.

However, about a month after the man started using the oil, he was admitted to a hospital because his overall condition had deteriorated. He died from cancer three weeks later, according to the report.

The new report showing that the cannabis oil seemed to work for treating the man’s wound “is really interesting,” said Dr. Anita Gupta, the vice chair of the Division of Pain Medicine at Drexel College of Medicine in Philadelphia, who was not involved in the report. [Mixing the Pot? 7 Ways Marijuana Interacts with Medicines]

So far, no actual studies have looked at using cannabis oil for wound treatment in people. One study, done on human intestine cells growing in lab dishes, suggested that cannabinoids may enhance the closure of wounds.

Though it is not clear why cannabis oil may have had a wound-healing effect in this case, one possible reason might be that the oil reduced inflammation, Gupta said.

However, she noted that more research is needed to examine whether cannabis oil may have any robust benefit in large numbers of patients with significant wounds.