Division of Palliative Care, University of Toronto, Toronto, ON, Canada.
Division of Supportive & Palliative Care, William Osler Health System, Toronto, ON, Canada.
Exp Dermatol. 2021 Sep;30(9):1258-1267. doi: 10.1111/exd.14395. Epub 2021 Jun 3.
Venous leg ulcers are highly prevalent lower limb integumentary wounds that remain challenging to heal despite the use of evidence-based compression therapies. A multitude of adjuvant treatments has been studied but none have demonstrated enough efficacy to gain adoption into treatment guidelines. Global attention on Cannabis-Based Therapies is increasing and has been driven by quantum scientific advancements in the understanding of the endocannabinoid signalling system. Topical Cannabis-Based Medicines represent a novel treatment paradigm for venous leg ulcers in terms of promoting wound closure. Fourteen complex patients with sixteen recalcitrant leg ulcers were treated with Topical Cannabis-Based Medicines in conjunction with compression bandaging, every second day, to both wound bed and peri-wound tissues. The cohort had a mean age of 75.8 years and was medically complex as reflected by a mean M3 multimorbidity index score of 2.94 and a mean Palliative Performance Scale score of 67.1%. Complete wound closure, defined as being fully epithelialized, was achieved among 11 patients (79%) and 13 wounds (81%) within a median of 34 days. All three remaining patients demonstrated progressive healing trends but were lost to follow-up. The treatments were well tolerated, and no significant adverse reactions were experienced. The rapid wound closure of previously non-healing venous leg ulcers among elderly and highly complex patients suggests that Topical Cannabis-Based Medicines may become effective adjuvants in conjunction with compression therapy. This may also indicate that they may have an even broader role within integumentary and wound management. Therefore, this treatment paradigm warrants being subjected to controlled trials.
静脉性腿部溃疡是下肢常见的皮肤伤口，尽管采用了循证压缩治疗，但仍难以愈合。已经研究了许多辅助治疗方法，但没有一种方法显示出足够的疗效，无法被纳入治疗指南。全球对基于大麻的治疗方法的关注度正在增加，这是由于对内源性大麻素信号系统的理解取得了量子科学的进步。局部使用大麻类药物是促进伤口闭合的静脉性腿部溃疡的一种新的治疗方法。14 名患有 16 处难治性腿部溃疡的复杂患者接受了局部使用大麻类药物治疗，同时进行压缩绷带包扎，每两天一次，包扎伤口床和伤口周围组织。该队列的平均年龄为 75.8 岁，由于平均 M3 合并症指数评分为 2.94 和平均姑息治疗表现量表评分为 67.1%，反映出他们的医疗情况非常复杂。11 名患者（79%）和 13 处伤口（81%）在中位数为 34 天的时间内完全闭合，定义为完全上皮化。所有其余 3 名患者均表现出持续愈合的趋势，但已失访。治疗耐受良好，无明显不良反应。局部使用大麻类药物治疗以前不愈合的静脉性腿部溃疡在老年和高度复杂患者中的快速愈合表明，局部使用大麻类药物可能成为与压缩治疗联合使用的有效辅助手段。这也可能表明它们在皮肤和伤口管理方面可能具有更广泛的作用。因此，这种治疗方法值得进行对照试验。
