Cannabis Cream Safely Reduces Itch in Patients with CKD-Associated Pruritus

Credit: Adobe Stock/ Yevhenii

Topical cream containing cannabis significantly reduced the severity of itching symptoms compared with placebo in patients with chronic kidney disease (CKD)-associated pruritus, a recent study found.¹

Previous research has suggested the potential of cannabinoid-containing products for dermatology conditions, including acne vulgaris, allergic dermatitis, psoriasis, and pruritus.² Studies have observed cannabidiol’s antipruritic effect, which is mediated by neuronal activation and mast cell modulation.³

Cannabinoid binding to CB1 and CB2 receptors stops mast cell differentiation, aggregation, and histone release.¹ Additionally, when cannabis interacts with TRP-iron receptors, this diminishes peripheral nerve activation.

“In the context of CKD-associated pruritus, characterized by histamine release, inflammation, dry skin, and peripheral nervous system stimulation, cannabinoids present potential therapeutic benefits,” wrote investigators, led by Suthiya Anumas, MD, from Chulabhorn International College of Medicine at Thammasat University in Thailand.

The study sought to compare the efficacy of a cannabis cream and placebo in the treatment of chronic kidney disease (CKD)-associated pruritus. The team conducted a double-blind randomized controlled study of 60 hemodialysis patients who had the worst itching intensity on the numerical rating rate (WI-NRS) (≥ 3). The primary endpoint was the WI-NRS score at week 4, and secondary endpoints included the WI-NRS at week 2, the Skindex-10 score at weeks 2 and 4, and the mean difference score between baseline and week 4 for the WI-NRS and the Skindex-10 score.

Among the sample, the mean age was 61.6±14.4 years and the mean baseline WI-NRS was 6.7±1.7. Participants had a median hemodialysis duration of 4 months and a mean duration of itch of 12 months. None of the participants had a history of THC or marijuana use.

Participants were randomized 1:1 to receive their cannabis cream or placebo. At baseline, the cannabis cream and placebo arms were similar, however, more participants on the placebo had diabetes.

At week 4, the WI-NRS reduced to 2.6 in the cannabis group and 3.6 in the placebo group (mean difference after adjustment for baseline scores, -1.1; 95% confidence interval [CI], -2.1 to -0.2; P = .02). They observed no significant differences in the WI-NS between participants on cannabis cream and placebo at week 2 (-0.6; 95% CI, -1.5 to 0.4; P = .23) and the change at weeks 2 (-0.3; 95% CI, -1.2 to 0.7; P = .57) and 4 (-0.8; 95% CI, -1.19 to 0.3; P = .13).

Skindex-10 scores were also lower in the cannabis group at weeks 2 (P = .04) and 4 (P = .03), but the statistical significance did not stay after adjusting for baseline scores (-1.6; 95% CI, -5.3 to 2.1; P = .38 and -1.6; 95% CI, -7.1 to 2.9; P = .48, respectively).

“However, the observed reduction in Skindex-10 scores suggests a trend toward a positive impact of the cannabis cream on itch-related quality of life, and there was a significant reduction in scores when not adjusted,” investigators wrote. “Confirming the efficacy on itch-related quality of life may prompt considerations regarding the duration of exposure to the cannabis cream.”

Investigators tested for irritant and allergic reactions in the cannabis cream during a preliminary test with 30 healthy volunteers. During the randomized trial, participants did not experience adverse events in either arm.

Investigators wrote the study was limited by its small sample size, variations in participants’ diabetes statuses, the lack of a cannabinoid level assessment in blood, and only having a 4-week follow-up period which does not adequately capture long-term effects.

“…this study demonstrated that a cannabis-containing cream might be an effective treatment for CKD-associated pruritus in hemodialysis patients with limited adverse side effects,” investigators wrote. “Further studies with larger sample sizes and longer durations of follow-up are suggested to ensure the reliability of the results, especially regarding itch-related quality of life.”

References

1. ^{Anumas, S, Kuropakornpong, P, Chakkavittumong, P, et al. Cannabis-Containing Cream for CKD-Associated Pruritus: A Double-Blind, Placebo Controlled Trial. Kidney Medicine. 2024.}
2. ^{Sivesind TE, Maghfour J, Rietcheck H, Kamel K, Malik AS, Dellavalle RP. Cannabinoids for the Treatment of Dermatologic Conditions. JID Innov. 2022;2(2):100095. Published 2022 Jan 13. doi:10.1016/j.xjidi.2022.100095}
3. ^{Ferreira, B.P., Costa, G., Mascarenhas-Melo, F. et al. Skin applications of cannabidiol: sources, effects, delivery systems, marketed formulations and safety. Phytochem Rev 22, 781–828 (2023). https://doi.org/10.1007/s11101-023-09860-5}