Over the past decade, Madison Adams has seen a number of dermatologists about her acne. Some suggested prescription medications, but Adams, now 28, was wary of taking anything too serious for sporadic breakouts. She went the DIY route instead, trying acne washes and scrubs from drugstore and boutique brands alike. Some products helped more than others, but her skin never fully cleared up. Then, during a routine visit in February to get some moles checked, a dermatologist suggested something new for Adams’s acne: CBD oil. 

“I had heard about CBD products for stress and anxiety, but never for skincare,” she says. “I was surprised that my doctor suggested a natural product instead of a stronger prescription. I was willing to try it because nothing else had worked that well for me.”

Adams was hesitant to put oil on her already oily skin, until she read up on the “oil fights oil” theory. That convinced her to purchase small tubs of CBD-infused balm and CBD-infused salve. She began applying a dab of both products on her acne each night after washing her face.

Two weeks went by without a new breakout, Adams says. Within a month, most of the older acne on her face had cleared up too. Even her acne scars seemed to be fading. Now, five months later, she estimates that 90 percent of her acne is gone. “I still get random pimples here and there,” Adams says, “but I don’t ever get major breakouts anymore, which is incredible.”

Go online and it’s easy to find similarly promising anecdotes about the skin-clearing powers of CBD-infused oils, serums, creams, balms and other skincare products. Satisfied customers cite improvements with not only acne, but an array of other conditions, including psoriasis and eczema. Many CBD-infused skincare products also claim to help with dryness, redness and wrinkles.

The thing is, the research doesn’t back up the hype. But the hype is more enticing than the science, and many patients are taking it upon themselves to bring up cannabis during dermatology appointments. In one December 2018 survey of more than 500 dermatologists, 55 percent reported having at least one patient-initiated discussion about cannabinoids in the previous year. There’s no question that CBD is having a cultural moment; still, it’s worth asking questions about its proven therapeutic benefits. 

What is CBD?

In case you need a refresher, CBD stands for cannabidiol. It’s one of more than 100 chemical compounds found in plants of the cannabis genus, which includes hemp and marijuana. Unlike THC, the psychoactive compound in weed that makes you feel high, CBD doesn’t have psychoactive properties. That said, proponents claim it can do a lot for our health, including improve sleep, reduce anxiety in both humans and pets, prevent epileptic seizures, hydrate skin and reduce redness and acne. Within the past two years, CBD has made its way into everything from morning lattes to post-workout muscle balms to bedtime elixirs. Experts predict that the CBD market, which includes food, drinks, beauty products and vapors, could grow to more than $20 billion in the next five years.

Why exactly made CBD so popular? Well, marijuana is a Schedule I substance, meaning it’s considered to have a high potential for abuse and has no officially accepted medical use. Yet last fall, the Food and Drug Administration approved Epidiolex, an anti-seizure drug that contains cannabis-sourced CBD, as a Schedule V drug. That places it alongside Robitussin AC in the category of drugs that are least regulated and deemed to have the lowest abuse potential. 

In December, Congress updated its longstanding farm bill, opening the door for companies to sell products containing hemp-derived CBD. Any product claiming therapeutic benefits still needs FDA approval, but the December 2018 farm bill greenlit the sale of CBD products with that familiar fine-print warning: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.”

What the science says

Although scientists began studying CBD for dermatology in the early 2000s, the field is still in its infancy. A 2018 review published in Dermatology Online Journal identified only 38 human trials published in the last decade on the use of cannabinoids for a dermatological condition. “There’s a lot more research to come,” says study author Dr. Robert Dellavalle, a dermatologist and professor at the University of Colorado.

Dermatologists believe cannabinoids support skin health in two main ways. First, the layers of our skin, like other parts of the body, contain cannabinoid receptors. In the skin, these receptors may control the production and survival of skin cells, as well as immune system cells. Research suggests that imbalances in the endocannabinoid system might lead to skin diseases, and that topically applied CBD could restore endocannabinoid balance.

Second, CBD appears to calm down inflammation. “More than half of the approximately 2,000 [diagnosable] skin diseases are inflammatory,” says Dellavalle, “so the potential [for treatment with CBD] is quite large.” This category of skin issues includes conditions like acne, psoriasis, eczema and dermatitis.

What’s more, research provides some evidence that cannabinoids can reduce the production of skin sebum, an oily substance that can lead to acne. According to recent findings, CBD can kill what’s called gram-positive bacteria. “This bacteria gets in the sebaceous glands and stops the normal flow of sebum out, so it gets backed up and forms acne,” says Dr. Jeanette Jacknin, a dermatologist who focuses on CBD skincare and was not involved in the research. “In each case where I’ve prescribed CBD for acne, it’s cleared up their acne.”

Or take psoriasis, which is characterized by the rapid production of keratinocytes, a type of cell in the outermost layer of skin. Scientists think cannabinoids might inhibit keratinocyte proliferation, and thus have potential for treating psoriasis.

A big asterisk comes with this body of research: It primarily consists of rodent and cell studies. Dellavalle and colleagues concluded that high-quality, large-scale, randomized controlled trials are necessary to know if cannabinoids are safe and effective for treating skin conditions. The most recent farm bill should encourage this, but in practice, it’s still TBD.

More than 100 cannabinoids exist, which means we need a lot more research in general. “Different combinations may have different effects on the cannabinoid receptors,” Dellavalle says, “and some concentrations of cannabinoids may work better than others. It will probably take a while to figure that all out.”

It remains unknown if this early research will lead to CBD-based prescription skin meds, but Dellavalle is doubtful. “It takes a lot of money to get FDA approval,” he says. “I don’t see anyone doing the FDA clearance tests for a CBD product that can be put on the open market following the Farm Bill Act passage.”

What to look for

Over-the-counter CBD skincare products are not regulated; there’s no way to know for sure if a product contains any CBD whatsoever, let alone the dosage listed on the label. No one knows the ideal CBD dosages for specific conditions yet either. But Dellavalle recommends higher-concentration products over lower-concentration products. “The skin is a good barrier at preventing the absorption of low-concentration things,” he says. “You need a lot [of CBD] in there to cause an effect locally.”

While it’s not entirely clear what constitutes a high-concentration product, Dellavalle says he’d “recommend a 2-percent CBD containing cream over a 0.00002 percent CBD containing cream.”

If you try a product, Dellavalle suggests visiting a local dispensary (if you live near one): “They are often the ones most aware of the local brands used most often, and they will have anecdotal feedback from people telling what’s working for them or not.” 

Jacknin recommends scanning a product’s ingredient list for “CBD isolate” or “CBD whole plant.” The higher up the ingredient appears, the higher the concentration. “If it’s the last thing on the list, even though it says it has all these milligrams of CBD,” she says, “it most likely contains little CBD.” 

Also look for a certificate of analysis on the company’s website. This breaks down the amount of various cannabinoids in the product, certifying that it does actually contain the amount of CBD listed on the label. The analysis is also typically, but not always, performed by a third party.

And before you slather any CBD-infused oil, cream or lotion all over your body, Dellavalle urges testing it out first. While allergies to cannabinoids aren’t common, they’re not unheard of. Put a small dollop on your forearm daily for a few days and keep an eye out for any reactions. If you develop redness, hives or itching, stop using it. Otherwise, go ahead and apply as directed, with the understanding that the product might work to varying degrees — or it might have no effect whatsoever.

This story has been updated.

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