Topical Cannabidiol in the Treatment of Digital Ulcers in Patients with Scleroderma: Comparative Analysis and Literature Review.
Amelia Spinella, Marco de Pinto, Carlo Baraldi and 7 others
PMID 36537770WHAT IT FOUND
In 45 patients with painful scleroderma digital ulcers, adding topical CBD oil to standard systemic and local wound care was associated with lower pain and more complete healing than standard care alone.
All patients received multiple treatments, so CBD alone cannot be credited.
Key findings
01All 45 patients received a bundle of standard scleroderma ulcer care: periodic iloprost infusions, calcium-channel blockers or sildenafil or bosentan or macitentan as clinically indicated, regular surgical debridement, and advanced dressings; 25 were randomized to add topical CBD oil and 20 to control.
02Wound-related pain scores decreased from 8.4 to 6.0 in the CBD group and from 8.44 to 7.88 in the control group; volitional incident pain scores decreased from 9.32 to 6.8 in the CBD group but remained stable in controls, and between-group pain differences after 1 month were reported as significant.
03Complete ulcer healing was reported in 18 of 25 CBD patients versus 6 of 20 controls; no severe adverse events were recorded, 7 of 25 CBD patients had mild itch or perilesional erythema, and 6 control patients required antibiotics for infection.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The paper is a preliminary report and review, and it does not name a primary outcome, so it is unclear which result was the main question. All patients received multiple treatments at the same time: iloprost infusions, calcium-channel blockers or sildenafil or bosentan or macitentan as clinically indicated, surgical debridement and advanced dressings. The study cannot show what CBD alone did. The study is small and retrospective. It states randomisation but does not describe allocation concealment, blinding of patients, clinicians or assessors, or how dropouts were handled. The paper gives inconsistent numbers for quality of life: the text says CBD HAQ-DI scores decreased from 2.19 to 0.79, while Table 1 lists 1.61 for the CBD group at the end. The paper says CBD was applied daily for a 2-month follow-up but also reports mean CBD administration of 1.20 months. The literature review found no prior CBD studies in scleroderma digital ulcers and only small case reports, case series or open-label studies for other wounds, with no randomized controlled trials.
Declared interests
The authors disclosed no financial relationships related to the article.
The easy way to misread this
Do not conclude that topical CBD oil alone caused the pain reduction or healing. Every patient received iloprost infusions, systemic vascular drugs as clinically indicated, surgical debridement and advanced dressings, and the study does not separate CBD from those treatments. The paper also does not name a primary outcome.