Topical cannabidiol can safely promote healing of fingertip ulcers and improve patients' quality of life, while also relieving pain in patients with systemic sclerosis (SSc), an Italian study suggests.

Patients who received the treatment also saw an increase in the number of hours of sleep per night.

The study, called "Topical application of cannabidiol for the treatment of fingertip ulcers in patients with scleroderma: a comparative analysis and review of the literature," was published in the journal Advances in Skin & Wound Care.

Finger tip ulcers are extremely painful for people with SSc, and their wounds are difficult to heal, often reducing the patient's quality of life.

Standard therapies (e.g., nonsteroidal anti-inflammatory drugs, opioids, etc.) are often insufficient to relieve pain or are limited by side effects. Studies of topical medications for SSc patients have been conducted on a large scale, but the efficacy of these therapies is unknown.


In this study, a team of researchers at Modena University Hospital investigated the effectiveness of topical cannabidiol (CBD) in treating finger ulcers in SSc patients.

CBD contains a non-psychoactive component of the cannabis plant and has attracted increasing interest in the scientific community in recent years.

The research team evaluated 45 patients with SSc (40 of whom were female). The mean age of the patients was 53 years and the mean duration of the disease was 10.68 years. The majority of patients (35) had limited scleroderma, while the remaining 10 were patients with diffuse scleroderma.

These subjects suffering from fingertip ulcers were resistant to opioid therapy at the maximum tolerated dose. Depending on the patients' clinical status and co-morbidities (e.g., pulmonary arterial hypertension), all patients received topical and systemic treatments, including Ventavis (generic: iloprost), calcium channel blockers, Revatio (generic: sildenafil), and/or Tracleer (generic: bosentan) or Opsumit (generic: macitentan).

Debridement is a surgical method of wound cleaning that involves the removal of thickened skin, as well as infected and necrotic tissue. In this trial, debridement is also performed regularly and advanced dressings are used.

Subjects were randomly assigned to the cannabidiol group (25 cases) and the control group (20 cases). In the cannabidiol group, the subjects' wounds and their surrounding skin were treated with cannabis seed oil. The said cannabis seed oil was obtained from a high quality pharmaceutical preparation. Four drops of cannabis seed oil were applied daily to the clean wound and covered with non-stick gauze for a period of 2 months.

Preliminary reported results further confirm that cannabis seed oil as a potential therapy helps in the topical treatment of SSc fingertip ulcers with no serious adverse effects and a few minor adverse effects. Subjects in the cannabidiol group experienced a significant reduction in pain.

The results of the study showed a significant decrease in wound-related pain scores from 8.4 to 6 after 1 month of treatment. Spontaneous pain (i.e., pain caused by autonomous behaviours (e.g., dressing and cleaning) or treatment procedures) scores, decreased from 9.32 to 6.8. During the same period, control subjects reported a decrease in wound pain scores from 8.44 to 7.88, but there was no statistically significant difference, while spontaneous pain scores remained stable.

In the cannabidiol group, 12 subjects required additional analgesics for pain control, i.e. acetaminophen (4), acetaminophen + codeine (2), oxycodone (4) and morphine (2). In the control group, all subjects required additional analgesics.

For subjects taking cannabidiol, there was a significant increase in the average number of hours of sleep per night from 2.56 to 5.67. The Health Assessment Questionnaire Disability Index (a self-measure of ability to perform activities of daily living) decreased from 2.19 to 0.79 by the end of follow-up, reflecting an improvement in quality of life. In the control group, there were no significant changes in these parameters.

By the end of the study, 18 subjects in the cannabidiol group (72 per cent) had fully healed finger-end ulcers, a higher proportion than the six participants in the control group (30 per cent). Importantly, no infections occurred in the cannabidiol group, while six patients in the control group required antibiotics to treat wound infections.

No serious adverse events were reported. Similarly, no patients experienced treatment-related serious adverse reactions. 7 (28%) subjects taking cannabidiol reported minor adverse reactions such as itching and redness of the skin around the wound. No subjects discontinued cannabidiol treatment.

"The current study reports for the first time the effectiveness of topical cannabidiol treatment against SSc-DUs (scleroderma finger tip ulcers)," the researchers wrote, adding, "This preliminary result further confirms the potential of cannabis seed oil as a helpful topical treatment for SSc-DUs therapy with no serious adverse effects, except for a few minor adverse effects."