CBD-Containing Hemp Extracts and Isolated CBD for Acne: A Systematic Review of Anti-Inflammatory Mechanisms, Clinical Signals and Sustainability

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“Industrial hemp (Cannabis sativa L.) has emerged as a sustainable source of bioactive compounds, with increasing interest in cosmeceutical applications for acne management.

This systematic review synthesises evidence on cannabinoid-containing hemp extracts, particularly cannabidiol (CBD), with emphasis on anti-inflammatory and sebostatic mechanisms, alongside formulation considerations and supply-chain sustainability.

Reporting followed PRISMA 2020 guidelines and encompassed preclinical and clinical evidence relevant to acne-associated outcomes. The review protocol was registered prospectively with PROSPERO (CRD420251272093).

Across cell-based, ex vivo and early clinical studies, CBD modulated key inflammatory mediators, including TNF-α, IL-1β, IL-6 and IL-8; normalised sebocyte activity and attenuated Cutibacterium acnes (Propionibacterium acnes)-induced inflammatory signalling.

Preliminary clinical observations indicate reductions in lesion counts and erythema, with generally favourable short-term tolerability; however, interpretation is limited by small sample sizes, predominantly non-randomised designs, heterogeneous formulations and frequent co-formulation with additional active ingredients. Evidence supporting direct antimicrobial efficacy and durable clinical benefit remains limited.

Lipid-rich hemp seed-derived products were considered only in a contextual capacity for barrier-supportive and nutritional properties and were excluded from efficacy synthesis unless cannabinoid content was verified. Sustainability analyses highlight hemp’s low water requirements, carbon sequestration potential and relevance to Sustainable Development Goal 3 (SDG 3: Good Health and Well-Being) and Sustainable Development Goal 12 (SDG 12: Responsible Consumption and Production), supporting its role in environmentally responsible cosmeceutical development.

Overall, CBD-containing hemp extracts show biologically plausible and clinically promising adjunctive potential for mild-to-moderate inflammatory acne, but current evidence remains preliminary. This review highlights the need for methodologically rigorous and transparent clinical studies, standardised formulations, validated outcome measures and the integration of sustainability metrics to strengthen evidence synthesis, clarify clinical relevance and guide responsible cosmeceutical development.”

https://pubmed.ncbi.nlm.nih.gov/42357416

“This systematic review focuses on CBD-containing hemp extracts and isolated CBD as cosmeceutical interventions for acne, explicitly distinguishing these from hemp seed oil, which is a cold-pressed nutritional oil with negligible cannabinoids.”

“Mechanistic evidence demonstrates that CBD exerts sebostatic and anti-inflammatory effects in human sebocytes and modulates keratinocyte responses to Cutibacterium acnes vesicles, providing biologically plausible pathways for clinical benefit.”

“Collectively, the available evidence supports the biological plausibility and emerging clinical relevance of CBD-containing hemp extracts in acne management”

https://www.mdpi.com/1420-3049/31/12/2017

Sedative and anesthetic-sparing effects of perioperative full-spectrum cannabis oil in female dogs undergoing unilateral mastectomy and ovariohysterectomy

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“The anesthetic management of female dogs with mammary neoplasia, usually classified as ASA II and undergoing invasive procedures such as mastectomy and ovariohysterectomy, requires effective sedation and anesthetic stability due to the increased anesthetic risk associated with advanced age and underlying disease.

In this context, this study aimed to evaluate the sedative effects and reduction in anesthetic requirements of a full-spectrum cannabis oil (FSCO) containing cannabidiol (CBD) and tetrahydrocannabinol (THC) in female dogs undergoing mastectomy and ovariohysterectomy.

Twenty dogs were randomly assigned to two groups: group A (n = 10), treated with FSCO (0.02 mL/kg PO; 0.2 mg/kg CBD and 0.12 mg/kg THC) twice daily for seven days, plus 0.2 mL/kg (2 mg/kg CBD; 1.2 mg/kg THC) one hour before premedication; and group B (n = 10), treated with placebo. Groups A and B had similar ages (9.6; 10.2 years) and weights (7.4; 6.8 kg). Anesthesia was induced with propofol and maintained with sevoflurane. Outcomes included sedation scores, anesthetic requirements, rescue analgesia, responses to instrumentation, and adverse effects. The treated group required less propofol (2.33 vs. 5.98 mg/kg; p = 0.001) and lower sevoflurane concentrations from T0 to T4 (p < 0.05). Sedation scores were higher at 40 and 60 min (median of 4 vs. 0, and 6.5 vs. 0.5; p = 0.015 and p = 0.002, respectively). Fewer treated dogs required rescue analgesia (3/10 vs. 6/10; p = 0.178). No differences were observed in catheterization, intubation, or adverse effects.

Preoperative CBD/THC oil produced sedative effects and reduced anesthetic requirements without clinical complications.

These findings support the potential of cannabinoids as safe adjuvants in multimodal anesthesia in veterinary medicine.”

https://pubmed.ncbi.nlm.nih.gov/42348039

“The findings of this study indicate that preoperative administration of full-spectrum Cannabis sativa oil containing CBD and THC exerts significant sedative and anesthetic-sparing effects in female dogs with mammary neoplasia undergoing mastectomy and ovariohysterectomy.

The use of this phytocannabinoid extract significantly reduced the required doses of both propofol for induction and sevoflurane for maintenance, supporting its potential as an adjuvant in multimodal anesthetic protocols. Furthermore, the therapy was not associated with clinical adverse effects or compromised anesthetic safety, suggesting a favorable safety profile for perioperative use in oncological patients.”

https://link.springer.com/article/10.1007/s11259-026-11367-1

Preparation of new natural hemp fiber-based antibacterial hydrogel dressing and its performance in promoting wound healing of bacterial infection

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“Bacterial infections can lead to wound inflammation and delay wound healing due to the cytotoxicity of the chemicals used in conventional wound dressings. Therefore, developing a new natural and non-toxic form of antibacterial hydrogel dressing is very important.

In this study, natural hemp fibers were used as the internal skeleton of hydrogels, combined with N-halamine antimicrobial nanosystems, and chitosan reaction was used to prepare Schiff base-type N-halamine hemp fiber-based hydrogels (N-hemp-gel).

This is mainly due to the unique polygonal cavity structure and phenolics of the hemp fibre itself, as well as the release of oxidized halide ions by N-halamine through electrostatic action, and the oxidation of bacterial enzymes and other intracellular compounds, which synergistically and significantly enhance the antimicrobial properties of the wound dressing.

Antimicrobial experiments showed that N-hemp-gel had significant bactericidal effects against both Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus). In a mouse model of infected wounds, N-hemp-gel showed a 100 % wound healing rate on day 7 with no visible scarring. Storage stability confirmed that the chlorine content of N-hemp-gel decreased by only 25.5 % after 30 days at room temperature. Renewability demonstrated that the chlorine content of N-hemp-gel decreased by only 0.54 % after ten cycles.

This natural hemp fibre hydrogel with excellent antimicrobial properties, good storage stability and renewability, and green environmental protection has a broad prospect in the field of wound dressing and biomedicine.”

“Hemp fibre belongs to the bast natural fibre, is extracted from the stem of the hemp plant, is the highest toughness of natural fibres, can be naturally decomposed green fibre, through photosynthesis can be renewable, and more than 60 kinds of unique phenolic substances in the hemp hemp fibre makes hemp fibre has excellent anti-bacterial and anti-inflammatory function.”

“In this study, N-halamine Schiff base type cannabinoid cellulose based hydrogels were successfully prepared.

Antibacterial assays demonstrated that the material exhibits significant antibacterial activity against E. coli and S. aureus, effectively addressing the innate lack of antibacterial properties in cellulose materials, while also offering good storage stability and renewability.”

https://www.sciencedirect.com/science/article/abs/pii/S0927775725009112

A cannabidiol-containing alginate based hydrogel as novel multifunctional wound dressing for promoting wound healing

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“In addition to preventing infection and promoting angiogenesis, novel hydrogel dressings are highly expected to possess the potential to scavenge reactive oxygen species (ROS) and reduce inflammatory responses during the wound healing process.

In this study, we designed and fabricated a hydrogel dressing (CBD/Alg@Zn) containing cannabidiol (CBD) based on the ion crosslinked interaction between Zn2+ ions and the alginate polymer (Alg).

The as-fabricated hydrogel exhibited a suitable swelling ratio, sufficient thermal stability, and stable rheological property. In vitro biological activity experiments indicated that the hydrogel has good biocompatibility, antibacterial activity, and angiogenesis properties. Moreover, it could significantly scavenge DPPH (2,2-diphenyl-1-picrylhydrazyl) free radicals and reduce the inflammatory response.

In vivo studies revealed that the CBD/Alg@Zn hydrogel significantly facilitated the wound healing process by controlling the inflammatory infiltration, promoting collagen deposition and the granulation tissue, and benefiting the formation of blood vessels.

We, therefore, suggested that CBD/Alg@Zn hydrogel should be a potential candidate material for wound dressing and skin tissue engineering.”

https://pubmed.ncbi.nlm.nih.gov/35523648/

“A cannabidiol-containing alginate based hydrogel (CBD/Alg@Zn) was developed as novel multifunctional wound dressing.•

The Alg@Zn hydrogel not only acts as a drug carrier but also shows significantly anti-bacterial and angiogenic activities.•

The introduction of cannabidiol (CBD) endowed the hydrogels with antioxidant and anti-inflammatory effects.•

The CBD/Alg@Zn hydrogel showed accelerated wound healing effect in vivo.”

https://www.sciencedirect.com/science/article/abs/pii/S0928493121007001?via%3Dihub

Chitosan-based films with cannabis oil as a base material for wound dressing application

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“This study focuses on obtaining and characterizing novel chitosan-based biomaterials containing cannabis oil to potentially promote wound healing.

The primary active substance in cannabis oil is the non-psychoactive cannabidiol, which has many beneficial properties.

In this study, three chitosan-based films containing different concentrations of cannabis oil were prepared. As the amount of oil increased, the obtained biomaterials became rougher as tested by atomic force microscopy. Such rough surfaces promote protein adsorption, confirmed by experiments assessing the interaction between human albumin with the obtained materials. Increased oil concentration also improved the films’ mechanical parameters, swelling capacity, and hydrophilic properties, which were checked by the wetting angle measurement. On the other hand, higher oil content resulted in decreased water vapour permeability, which is essential in wound dressing. Furthermore, the prepared films were subjected to an acute toxicity test using a Microtox.

Significantly, the film’s increased cannabis oil content enhanced the antimicrobial effect against A. fischeri for films in direct contact with bacteria. More importantly, cell culture studies revealed that the obtained materials are biocompatible and, therefore, they might be potential candidates for application in wound dressing materials.”

https://pubmed.ncbi.nlm.nih.gov/36333591/

“In this study, novel chitosan-based biomaterials containing cannabidiol were obtained, with cannabis oil being used as a source of cannabidiol.”

“The results suggest that the cannabidiol-containing chitosan-based films (CBD-CS) possess the most prerequisites for a good dressing for wound healing applications.”

“Therefore, chitosan-based films incorporating cannabis oil might be an excellent candidate for wound treatment and dressing.”

https://www.nature.com/articles/s41598-022-23506-0

Self-reported cannabis use to manage opioid withdrawal symptoms and reductions in opioid use among people who use unregulated opioids: a cross-sectional analysis

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Background: Opioid withdrawal is a significant challenge for people seeking to reduce or eliminate opioid use, and unmanaged withdrawal increases the risk of relapse and overdose. Using cannabis to manage opioid withdrawal has been reported by people who use opioids, yet it is not clear whether this leads to reductions in opioid use. Moreover, because pain is prevalent among people who use unregulated opioids (PWUO) and may contribute to ongoing opioid use, the effects of cannabis use to manage withdrawal symptoms may differ among individuals experiencing moderate to severe pain. We investigated the relationship between cannabis use to manage unregulated opioid withdrawal and self-reported reductions in opioid use among PWUO.

Methods: Data were derived from a cross-sectional questionnaire administered to cannabis-using PWUO in Vancouver, Canada, between December 2019 and November 2021. Multivariable logistic regression estimated the associations between cannabis use for opioid withdrawal and self-reported reductions in opioid use. A sub-analysis explored if these associations varied among participants living with and without moderate to severe pain.

Results: Among 197 participants, 89 (45.2%) reported cannabis use to manage symptoms of opioid withdrawal in the past six months. In multivariable analysis, cannabis use for opioid withdrawal was significantly associated with self-reported reductions in opioid use (adjusted Odds Ratio [AOR] = 2.16, 95% Confidence Interval [CI]: 1.13-4.19) in the same time period. In a sub-analysis, this association was only significant among participants with moderate to severe pain (AOR = 6.55; 95% CI: 2.44-19.63).

Conclusions: We observed a significant association between self-reported use of cannabis to manage unregulated opioid withdrawal and reductions in opioid use among cannabis-using PWUO living with pain. Aligned with other studies, these findings support conducting experimental trials of cannabinoids to support individuals experiencing opioid withdrawal and living with pain.”

https://pubmed.ncbi.nlm.nih.gov/42343486

https://link.springer.com/article/10.1186/s42238-026-00458-0

Signaling pathways of inflammation in CIA model of rheumatoid arthritis regulated by cannabichromene

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“Background: Rheumatoid arthritis is a chronic autoimmune disease characterized by synovial inflammation, cytokine imbalance, and progressive joint destruction. The endocannabinoid system has emerged as a potential therapeutic target; however, the anti-inflammatory mechanisms of non-psychoactive cannabinoids such as cannabichromene (CBC) remain insufficiently defined. This study aimed to evaluate the anti-inflammatory effects of CBC in vitro and in a collagen-induced arthritis (CIA) rat model, with a focus on key inflammatory signaling pathways.

Methods: CBC effects were assessed in LPS-stimulated HUVEC cells by qPCR analysis of inflammatory markers. In vivo, female Wistar rats were assigned to four groups: CIA + saline (placebo), CIA + CBC, CIA + methylprednisolone, and non-immunized controls receiving saline. Disease progression was evaluated using clinical scoring, paw thickness, and body weight. Synovial tissues and serum were analyzed by qPCR, Western blotting, and ELISA to assess cytokines, inflammasome components, and signaling pathways, including NF-κB and JAK/STAT.

Results: CBC reduced TNF-α expression in vitro at low micromolar concentrations. In vivo, CBC significantly decreased arthritis scores compared to placebo and attenuated weight loss, although it did not significantly reduce paw swelling. Molecular analyses revealed downregulation of IL-6, STAT3, and IL-17 A, indicating suppression of the TNF-NF-κB-IL-6-STAT3-Th17 axis. CBC also significantly inhibited inflammasome components (NLRP3, NLRP1A, caspase-11). However, MMP-3 and MMP-9 levels were not significantly affected.

Conclusions: CBC exhibits significant anti-inflammatory activity in vitro and in vivo by modulating key cytokine and inflammasome pathways. While its effects on structural joint damage markers were limited, CBC represents a promising candidate for inflammatory arthritis therapy, warranting further investigation.”

https://pubmed.ncbi.nlm.nih.gov/42343451

https://link.springer.com/article/10.1186/s42238-026-00464-2

Efficacy and Safety of Cannabinoid-Based Products in Children and Adolescents with Autism Spectrum Disorder, Fragile X Syndrome and Rett Syndrome: A Systematic Review

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“Introduction: Neurodevelopmental disorders (NDDs), including Autism Spectrum Disorder (ASD), Fragile X syndrome (FXS), and Rett Syndrome (RTT), share impairments in cognitive and behavioral functioning and may involve an altered excitatory/inhibitory balance modulated by the endocannabinoid system. This systematic review evaluated the safety and efficacy of cannabinoid-based products (CBPs) in these pediatric NDDs.

Methods: We conducted a systematic review according to Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) 2020, including randomized and nonrandomized studies of patients under 18 years treated with cannabidiol (CBD), cannabidivarin (CBDV), tetrahydrocannabinol (THC), or their combinations. Outcomes were adverse events (AEs) and treatment discontinuation, seizure reduction, and behavioral and cognitive changes. Study quality and certainty of evidence were assessed using design-specific risk-of-bias tools and the GRADE approach.

Results: Seventeen studies (two randomized controlled trials, observational studies, and case series) met the inclusion criteria. Across diagnoses, CBPs were generally associated with mild-to-moderate AEs and low discontinuation rates. Descriptive pooled proportions suggested behavioral improvements in ASD and FXS and seizure reduction in RTT, with exploratory analyses indicating differential effects of CBD versus CBD + THC on behavioral and cognitive outcomes in ASD.

Conclusion: CBPs may offer potential benefits for selected behavioral symptoms and comorbid epilepsy in pediatric NDDs, but current evidence is insufficient to support routine clinical use. High-quality randomized controlled trials with standardized outcome measures and long-term follow-up are needed to clarify efficacy, safety, and syndrome-specific effects.”

https://pubmed.ncbi.nlm.nih.gov/42339654

https://journals.sagepub.com/doi/10.1177/10445463261462382

CBD-rich oil nanoemulsion mitigates long-term testicular and endocrine toxicity induced by prenatal valproic acid exposure in rats

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“Valproic acid is a widely used antiepileptic drug and a recognized model of developmental reproductive toxicity, as exposure during critical periods of testicular development can lead to persistent endocrine and reproductive dysfunction in adulthood.

Cannabidiol (CBD) has therapeutic potential in several pathological conditions but exhibits low oral bioavailability due to its lipophilic nature.

This study evaluated whether chronic treatment with a CBD-rich corn oil nanoemulsion could attenuate long-term testicular and endocrine alterations induced by prenatal valproic acid exposure in rats.

CBD-rich nanoemulsions were prepared and physicochemically characterized. On gestational day 12.5, pregnant rats received a single intraperitoneal dose of valproic acid (500mg/kg). In adulthood, male offspring from valproic acid-exposed dams were treated orally with CBD nanoemulsions at doses of 1 or 2mg/animal, administered twice daily. After euthanasia, testes were collected for morphometric, biochemical, and hormonal analyses.

Prenatal exposure to valproic acid induced persistent testicular alterations, including reduced Leydig cell number, decreased serum testosterone levels, reduced seminiferous epithelium height, and increased seminiferous tubule diameter. Increased activities of superoxide dismutase and glutathione S-transferase suggested an adaptive antioxidant response. These findings are consistent with long-term testicular and endocrine dysfunction following developmental exposure to an endocrine-disrupting drug.

Importantly, treatment with the CBD-rich nanoemulsion reversed the morphometric, hormonal, and oxidative alterations induced by valproic acid.

Overall, these results indicate that nanoformulated CBD may mitigate long-term reproductive toxicity induced by prenatal valproic acid exposure, highlighting the importance of drug formulation in determining the biological effects of cannabinoids on the male reproductive system.”

https://pubmed.ncbi.nlm.nih.gov/42342051

“In conclusion, our findings provide preclinical evidence that chronic treatment with a CBD-rich corn oil nanoemulsion attenuates several reproductive effects induced by prenatal exposure to valproic acid in male rats.”

https://www.sciencedirect.com/science/article/abs/pii/S0890623826001401?via%3Dihub

Development and clinical evaluation of a nanoemulsion for buccal delivery of cannabis extract in refractory chronic pain

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“Cannabinoid-based therapies have gained increasing attention for the management of chronic and treatment-resistant pain, although their clinical application is limited by the poor aqueous solubility and variable bioavailability of Δ9-tetrahydrocannabinol (THC).

In this study, we developed and characterized a nanoemulsion (THC-NE) for buccal administration of a Cannabis sativa L. extract (Bedrocan®), with the aim of improving solubility, stability and bioavailability.

The optimized formulation, composed of pharmaceutically acceptable excipients, showed a narrow droplet size distribution (DH ≈ 73 nm, PDI ≈ 0.2), a THC content consistent with the theoretical value (3.53 ± 0.56 mg/mL), and good physicochemical stability at 4°C for at least 90 days. The formulation maintained its properties upon extensive dilution in simulated buccal fluids and after spray nebulization, supporting its suitability for oromucosal delivery. In vitro release studies confirmed sustained THC release from THC-NE, whereas negligible release was observed from the oil extract, highlighting the role of nanoformulation in enhancing solubilization and controlled release.

An observational study was conducted in 18 patients with chronic pain unresponsive to standard treatments. After a median follow-up of 189 days, mean pain scores (NRS) decreased significantly from 8.6 ± 0.9 to 5.4 ± 2.8 (p < 0.001), with 83% of patients achieving a ≥ 20% reduction. Among responders, the mean NRS decreased by 45% and treatment persistence was found to be high, with 64% of patients still remaining under therapy after six months. A total of 17 adverse events were reported in 11 patients, most of which were mild to moderate and transient. Additionally, treatment interruption occurred in three patients due to adverse events, in other three owing to limited efficacy and in two for logistical reasons.

Overall, these findings indicate that buccal administration of THC-NE represents a promising patient-friendly approach for cannabis-based therapy, offering improved solubility, controlled release and meaningful clinical benefit in patients with refractory chronic pain.”

https://pubmed.ncbi.nlm.nih.gov/42336000

“Among the bioactive compounds found in Cannabis sativa, Δ9-tetrahydrocannabinol (THC) has been identified as the primary psychoactive component, exhibiting significant analgesic, antispastic, and neuroprotective properties. “

“This study demonstrates that NE technology can be successfully applied to develop a stable and efficient buccal formulation of Cannabis sativa extract. The optimized THC-NE proved to be physicochemically stable, robust under dilution, and suitable for administration via standard spray devices, while ensuring enhanced release of THC compared to the oily extract.”

https://www.sciencedirect.com/science/article/pii/S0939641126001839?via%3Dihub