Acne and Medical Cannabis
Acne, sometimes called Acne vulgaris, is a skin condition that is characterised by the formation of comedones (blackheads and whiteheads) and pus-filled spots (pustules). Acne is caused by a sensitivity to hormones, which causes the glands in the skin to produce an excess of oil. Dead skin cells are not shed properly, which in turn creates an ideal environment for the bacterium, Propionibacterium acnes, to multiply and trigger the inflammation that leads to spots and blackheads.
Potential Efficacy / Quality of Evidence (Low, Average, High) of Medical Marijuana for Acne
Cannabinoids, Terpenes/Terpenoids, Strains and Ratios that May Help
The evidence of the efficacy of cannabis for acne is mixed. Some state that THC causes a spike in testosterone, which may cause an outbreak of acne. Others point out that, after this spike, we see a drop in testosterone , so THC may beat acne over the long-term. THC may therefore increase sebum production and the chances of an acne outbreak in the short-term, but possibly treat it in the long-term. CBD, on the other hand, seems to stop sebum production and dry out the skin. Both cannabinoids have anti-inflammatory properties. Terpenoids such as pinene may also help, as could linalool.
Medical Cannabis Pros
CBD may stop or slow down sebum production and “has potential as a promising therapeutic agent for the treatment of acne vulgaris” .
THC may increase sebum production and reduce testosterone levels to some extent over the long-term, preventing further outbreaks.
Can replace the need for antibiotics.
Contains other terpenoids that may help against bacterial infections, such as pinene and linalool.
Medical Cannabis Cons
THC can increase sebum production, whilst CBD can dry the skin out – these are both positives and negatives, depending upon skin type.
Using the right type of product for your skin is essential for effective treatment – sadly, not enough evidence to say for sure at the moment.
More About the Condition
Acne is something that affects many people in their lives, especially in their teenage years. Worldwide, acne affects around 633 million people. For some, though, acne can persist into adulthood. Being treated with steroid-based medications can also increase the likelihood of developing acne, as such medications increase the production of testosterone. In some instances, the acne is severe enough to affect self-esteem. Acne has little to do with personal hygiene or exposure to sunlight.
Cutting out refined sugars and following a healthy diet may help reduce acne, but does not necessarily stop it entirely. Exercise can also help, but sweat can aggravate the condition. Showering as soon as possible after exercise can therefore prevent outbreaks to some extent. Smoking tobacco may also increase the likelihood of developing acne. Other treatment methods include azelaic acid, benzoyl peroxide, salicylic acid, antibiotics and retinoids. However, although antibiotics can be useful for acne at times, it is not an ideal solution, as this can increase diseases’ antibiotic tolerance. Antidepressants may be prescribed for those whose self-esteem has been severely affected and the acne sufferer has severe anxiety.
There are cannabinoid receptors on the skin, and there is some evidence to suggest that THC may cause a drop in testosterone and reduce the chances of an acne outbreak. Others argue that THC can cause an initial increase in testosterone, thereby increasing sebum production and increasing the likelihood of an acne outbreak. CBD, meanwhile, seems to stop sebum production and dry out the skin. This can help treat acne to some extent as it makes exfoliating easier.
However, if you do not exfoliate properly, the dry, dead skin can accumulate and cause further breakouts. This can happen if a person has overused an acne-treating product, especially ones containing azelaic acid, salycylic acid and/or benzoyl peroxide. Pinene, which is found in all cannabis types in at least small amounts, can also act as an antibacterial  and help beat bacteria, negating the need for antibiotics.
Quotes / Expert Opinion
“Collectively, our findings suggest that, due to the combined lipostatic, antiproliferative and anti-inflammatory effects, CBD has potential as a promising therapeutic agent for the treatment of acne vulgaris.” Matthew Callahan, Executive Director, Botanix Pharmaceuticals . Source: https://www.newshub.co.nz/home/health/2017/07/cannabis-oil-touted-as-new-acne-cure.html 
Case Studies / Patient Stories