Commercial Cannabinoid Oil-Induced Stevens-Johnson Syndrome

Yin, Han; Hadjokas, Nicholas; Mirchia, Kanish; Swan, Robert T.; Alpert, Samuel

doi:10.1155/2020/6760272

Cited by 13 publications

(12 citation statements)

References 11 publications

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“…9 Most recently, SJS was reported in a woman two days after receiving sublingual CBD oil. 10 As with the dog in our report, the woman developed widespread ulceration including oral and palpebral involvement. The correlation between hemp oil exposure and the CADR was considered "probable" based on the Naranjo Adverse Drug Reaction Probability Scale, 11 given the following attributes: lesion appearance after administration, resolution after discontinuation of the oil, reports suggestive of drug-induced cutaneous lesions from cannabinoid products in people, and lack of support for alternative causes other than exposure to the CBD oil-containing product (Table S2).…”

Section: Discussionsupporting

confidence: 62%

“…Although cannabidiol is the active ingredient in the implicated product, other cannabinoids or terpenoids cannot be discounted as possible contributors. Coconut oil is listed as a carrier in this product, and has been implicated in a case of SJS in a woman, 10 but causation seems unlikely in this dog given the low concentration of coconut oil.…”

Section: Discussionmentioning

confidence: 99%

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Probable cutaneous adverse drug reaction due to a cannabidiol‐containing hemp oil product in a dog

Simpson

Bradley

Schissler

2020

Veterinary Dermatology

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Background Cannabidiol (CBD) in hemp oil has become a widely used product in veterinary medicine. To date, there have been no reports of cutaneous adverse events associated with CBD‐containing oil in the veterinary literature. Clinical summary A 4‐year‐old castrated male Labrador retriever presented with pad sloughing and rapidly progressive cutaneous and mucosal ulceration within five days of administering an oral CBD oil product. Histopathological findings in combination with cutaneous signs were consistent with Stevens–Johnson syndrome. All lesions completely resolved after discontinuation of the hemp oil in addition to a 12 day course of cephalexin and prednisone. Given the lack of alternative causes including other medications, an adverse drug event was deemed probable according to the Naranjo algorithm. Conclusions and clinical importance To the best of the authors’ knowledge, this is the first report of suspected cutaneous adverse drug reaction to a CBD‐containing hemp oil product.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Probable cutaneous adverse drug reaction due to a cannabidiol‐containing hemp oil product in a dog

Simpson

Bradley

Schissler

2020

Veterinary Dermatology

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“…9,10 Data on the prevalence and types of adverse effects of topical cannabis are lacking. A recent case of fatal Stevens-Johnsons Syndrome was reported upon the use of CBD spray sublingually, 26 reminding users and prescribers that serious adverse events are possible with products often thought of and marketed as natural.…”

Section: Discussionmentioning

confidence: 99%

A Survey of Topical Cannabis Use in Canada

2021

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Background Since its legalization in Canada, cannabis use has expanded to include commercially available topical formations. Several scientifically unsupported claims regarding the therapeutic efficacy of topical cannabis are also being made. Developing an understanding of the consumer uses of topical cannabis is important for clinicians to provide appropriate counseling and inform potential areas of therapeutic development. We are examining the prevalence, purpose of use, and sources of information regarding topical cannabis in the Canadian population, with a focus on dermatologic uses. Method A cross-sectional, anonymous electronic, voluntary survey was developed to assess the use of topical cannabis amongst adults in Canada. Results Cannabis was used topically at least once by 24.3% of respondents who started the survey. The commonest form of topical cannabis were creams (26.2%). The most common dermatologic conditions being treated with topical cannabis included atopic dermatitis (25%), acne (19%), and anti-aging (16%); for non-dermatologic conditions, common uses were for joint stiffness or tendonitis (30%) and headaches and migraines (27%). Topical cannabis was reported to be most effective for joint stiffness and tendonitis, general muscular soreness, headaches, eczema, pruritus, acne, and psoriasis. Most respondents obtained and received information about topical cannabis from dispensaries. Conclusion Canadians use topical cannabis for a broad range of systemic and dermatologic purposes, most of which have limited evidence. Future clinical studies are required to elucidate the therapeutic efficacy and safety of topical cannabis. Dermatologists should screen their patients for topical cannabis use and be aware of the limited evidence of therapeutic potential.

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“…The literature regarding side effects of CBD was considerably expanded since the writing of our article, so that besides the anecdotal reports and paediatric studies already mentioned, several case reports 8 – 10 , a survey 9 , a meta-analysis of clinical trials 11 and a post marketing safety assessment of a full spectrum hemp extract 12 became available. Specifically the survey 9 reports observations of side effects including “feeling high”, an effect likely to be explained by Δ 9 -THC contamination rather than by CBD.…”

Section: Side Effects Of Cbd Productsmentioning

confidence: 99%

Evidence for side effects of cannabidiol (CBD) products and their non-conformity on the European food market – response to the European Industrial Hemp Association

Lachenmeier

Walch

2020

F1000Res

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An interesting and valuable discussion has arisen from our recent article (Lachenmeier et al., 2020) and we are pleased to have the opportunity to expand on the various points we made. Equally important, we wish to correct several important misunderstandings that were made by Kruse and Beitzke (2020) on behalf of the European Industrial Hemp Association (EIHA) that possibly contributed to their concerns about the validity of our data, toxicological assessment and conclusions regarding regulatory status of cannabidiol (CBD) products. First and foremost, our study did only assess the risk of psychotropic Δ9-tetrahydrocannabinol (THC) without inclusion of non-psychotropic Δ9-tetrahydrocannabinolic acid (THCA). Secondly, as this article will discuss in more detail, there is ample evidence for side effects of CBD products, not only in paediatric patients, but also in adult users of over-the-counter CBD products (including inadvertent “high” effects). Thirdly, the exposure and risk assessment was conducted using up-to-date guidelines according to the European Food Safety Authority (EFSA) and the German Federal Institute for Risk Assessment (BfR). And finally, the current legal situation in the European Union, without approval of any hemp extract-containing product according to the Novel Food regulation, actually allows blanket statements that all such products are illegal on the market, and this indeed would imply a general ban on the use and marketing of such products as food or food ingredients until such an approval has been granted. We hope that this reassures the F1000Research readership regarding the validity of our results and conclusions. We are pleased, though, that the EIHA has acknowledged the fact that there are non-compliant CBD products available, but according to our data these are a substantial fraction of the market.

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Commercial Cannabinoid Oil-Induced Stevens-Johnson Syndrome

Cited by 13 publications

References 11 publications

Probable cutaneous adverse drug reaction due to a cannabidiol‐containing hemp oil product in a dog

Probable cutaneous adverse drug reaction due to a cannabidiol‐containing hemp oil product in a dog

A Survey of Topical Cannabis Use in Canada

Evidence for side effects of cannabidiol (CBD) products and their non-conformity on the European food market – response to the European Industrial Hemp Association

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