Acne Treatment Based on Cannabinoids: Efficacy and Legislation Perspectives

Context: Acne is a prevalent inflammatory condition affecting individuals globally, particularly during adolescence, and has a significant psychosocial impact. Its pathogenesis involves sebaceous hypersecretion, follicular hyperkeratinization, and microbial dysbiosis, primarily associated with Cutibacterium acnes. Conventional acne treatments, including topical and systemic therapies, often cause adverse effects, highlighting the need for new, safer options. Cannabidiol (CBD), a non-psychoactive compound from Cannabis sativa, has emerged as a promising candidate due to its anti-inflammatory and antioxidant properties. This review discusses acne pathophysiology and examines CBD's therapeutic potential alongside global regulatory perspectives on its use in cosmetics. Evidence Acquisition: A literature search was conducted for articles on acne pathogenesis, endocannabinoid systems, and CBD's pharmacological effects. Results: Acne’s inflammatory nature is driven by androgen-induced sebum production, follicular hyperkeratinization, and microbial imbalance, mainly involving C. acnes. Androgens activate receptors in sebaceous glands, increasing sebum production and contributing to pore blockages and inflammatory responses. Although effective, conventional treatments such as retinoids and antibiotics often have undesirable side effects, driving interest in plant-based alternatives. The CBD shows potential as an acne treatment by modulating inflammation through CB2 receptor and TRPV1 channel activation, which directly helps reduce the inflammatory response that contributes to acne severity. It also reduces sebocyte proliferation, addressing the hyperkeratinization that leads to clogged pores, and inhibits cytokines like TNF-α, reducing the inflammatory processes that exacerbate acne lesions. The CBD also acts as an antioxidant, mitigating oxidative stress associated with acne-related inflammation. Furthermore, CBD’s lipophilic nature facilitates its accumulation in the stratum corneum, enabling prolonged skin interaction with minimal systemic absorption. A review of regulations reveals varying levels of acceptance for CBD in cosmetics, with North America and Europe allowing its use under specific guidelines, while restrictions remain stricter in other regions. Conclusions: The CBD represents a multi-targeted, safer alternative for acne management, addressing key mechanisms of acne pathogenesis, such as inflammation, sebocyte activity, and oxidative stress, without the adverse effects of conventional treatments. Further studies are necessary to validate these findings in clinical settings and establish standardized guidelines for the safe inclusion of CBD in skincare products.