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Does cannabis produce acne and oily skin? 

28 Jun 2021

  • A cross sectional study 

By Dr. Anuradha Ellepola    The term cannabis is used to denote psychoactive preparations of the plant Cannabis sativa. Its main psychoactive constituent is Delta-9 tetrahydrocannabinol (THC). Cannabinoids are the compounds with a structural similarity to THC. Terms such as marijuana, hashish, weed, madana modaka, ganja, kansa and joint are used in different cultures to refer to cannabis or its derivatives.  Cannabis consumption in different forms is a global behaviour. Some countries have a strictly controlled legal provision to produce, sell and consume defined concentrations of THC. However, it is, as per P. Palihawadana’s “Cannabis and Health”, the most widely cultivated, trafficked and abused illicit drug. About 147 million people (2.5% of the world population) consume cannabis according to Palihawadana’s report. Also, according to Palihawadana, the age of initiation of cannabis is lower when compared to other substances and its relatively low price and free availability leads to the high prevalence of its use. Using the substance as a gateway drug is not uncommon.  Cannabis abuse has been prevalent in Sri Lanka for centuries. According to V. De Silva, N. Jayasekera and R. Hanwella’s “Cannabis use among Navy personnel in Sri Lanka: a cross sectional study”, the prevalence of cannabis use was 5.22% among a cohort of Navy personnel, and the prevalence was significantly higher among the unmarried 18 to 24-year-old category with a lower level of education. The same study concluded that among Navy personnel exposed to combat, cannabis use was significantly associated with hazardous alcohol use but not smoking.  A number of short and long term adversities have been found to be associated with THC use. According to N.D. Volkow, R.D. Baler, W.M. Compton and S.R.B. Weiss’s “Adverse Health Effects of Marijuana Use”, the short term effects include cognitive impairments, the impairment of motor coordination, altered judgment, increased sexual behaviour and psychosis while chronic heavy use is associated with dependence, altered cerebral development, poor educational attainment, cognitive impairment, poor life satisfaction, respiratory difficulties and psychosis. In addition, according to D. Tennstedt and A. Saint-Remy’s “Cannabis and skin diseases”, weed smoking is found to cause dermatological ailments such as Raynaud’s phenomenon (a condition where there is reduced blood flow to the extremities, especially to the fingers) and arteritis (inflammation of the arteries, causing damage to the blood vessels) and since the conditions could be extremely severe, the patients were advised about the necessity to completely stop cannabis consumption. However, a number of research (L.R.M. Eagleston, N.K. Kalani, R.R. Patel, H.K. Flaten, C.A. Dunnick and R.P. Dellavalle’s “Cannabinoids in dermatology: a scoping review”) have published some initial promise of cannabis as therapy for a variety of skin diseases including acne vulgaris (dermatological condition where there is the inflammation of hair follicles and associated glands), allergic contact dermatitis (a skin rash caused by an allergic reaction to a contact), asteatotic dermatitis (a common skin lesion with dryness, itching and peeling of the skin), atopic dermatitis (a skin condition where the affected area becomes red and itchy), hidradenitis suppurativa (chronic skin condition which is painful and causes abscesses and the scarring of the skin), Kaposi’s sarcoma (a malignant condition in the lining of the blood and lymphatic systems), pruritus (a sensation causing the urge to scratch), psoriasis (dermatological condition with red, itchy, scaly patches seen commonly on the knees, elbows, the scalp and the torso), skin cancer, and the cutaneous manifestations of systemic sclerosis (a skin condition that is the result of an autoimmune disorder), but the majority of such available research is pre-clinical and lacks the properties such as controlling and randomisation.  Acne is a widely prevalent disturbing dermatological condition, especially affecting the youth. There are controversial, mixed literature findings as to whether cannabis is beneficial or not for acne. Few of the very preliminary studies (G. Dhadwal and M.G. Kirchhof’s “The Risks and Benefits of Cannabis in the Dermatology Clinic”) have suggested that cannabis and its derivatives might have a benefit in acne. Other studies have indicated that marijuana aggravates oily skin and causes acne. THC is thought to increase the testosterone level, which in turn, according to A. Börve’s “Marijuana and Your Skin: The Good, the Bad, and the Ugly” increases oil secretion all over the body, particularly in the face and in turn hormonal acne is often triggered by high levels of testosterone, while in addition, the smoke exhaled when smoking weed, like tobacco, can irritate and exacerbate acne.  The bottom line is that there is no ample worldwide scientific evidence available to establish an association between smoking marijuana and skin health. Sri Lankan research up to date is inadequate to establish links between cannabis and skin conditions.  Therefore, a preliminary cross sectional study was carried out to find an association between weed and oily skin and acne among 27 consenting patients who presented for treatment to the psychiatry out-patient clinic at the Anuradhapura Teaching Hospital, from 1 September 2018 to 30 November 2018. Patients with a history of cannabis consumption (at least once over the previous one month) were included in the study. Patient data were collected using clinic records. Patients were referred to the dermatologist when there were doubts about the skin condition, and when the skin was severely affected by lesions. In addition, skin referrals were done on patient request.  The majority of the THC users (16) were within the age range of 20 to 29 years. The commonest form of THC was called Kerala (India) Ganja or KG. A total of eight of them smoked cannabis daily, and four used it one to three times per week. A high proportion of this age category also smoked nicotine (20) while five consumed other substances. Acne and oily skin were present in 12 and 11 individuals, respectively. The majority had both the conditions. A total of five patients were between the ages of 30 to 39 years and three of them smoked THC more than once a week while three habitually smoked cigarettes. Six others were within the age groups of 16 to 19 years (two), 40-49 years (three) and less than 50 years (one). Patients in this cohort were on mono-therapy or a combination treatment of antidepressants (15), antipsychotics (15), mood stabilisers (six), anxiolytics [anxiety relieving] (10) and other medicines (four). Overall, the sample showed that the 20 to 39 age group consumed cannabis more often, and that they had a high prevalence of acne and oily skin. Three patients needed dermatology referrals due to the severity of the skin condition.  The studied sample consisted of patients taking treatment for psychiatric disorders from the said out-patient clinic. Similar to other available studies such as Palihawadana’s, the majority of the frequent drug users were young, and smoked nicotine. However, a previous Sri Lankan study (De Silva et al.,) concluded that nicotine smoking was not significantly associated with cannabis use among Naval personnel.  Acne and oily skin were present in around 70% of these young cannabis users. As per Borve, it may be due to the property of cannabis to increase testosterone levels in the body. It is also possible that young people have a higher incidence of this skin condition due to the age per se. Nicotine smoking, as per Borve, could be another highly possible confounder to this result. Patients within other age categories had a lower prevalence of nicotine smoking, acne and oily skin.  Young individuals consuming cannabis showed a high incidence of acne and oily skin. However, this brief study, done at a psychiatry out-patient clinic, was a preliminary cross sectional study which had no capacity to establish a possible quantitative association between cannabinoids and acne and oily skin. Due to its small sample size and probable confounding factors such as nicotine smoking, other substances, age factor and medications, statistical significance could not be found. Well designed case control or cohort studies with adequate power will be necessary to statistically determine the association between cannabis use and acne and oily skin in the Sri Lankan population. If a significant association is established, it will be helpful to observe for acne and oily skin during the mental state examination for diagnostic purposes, and for patient education on the benefits of abstaining from cannabis.  (The writer is a Consultant Psychiatrist at the Anuradhapura Teaching Hospital)

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