108: New Research On CBD For Your Rashes w/ Lily Mazzarella

CBD is all the rage at the moment. My guest is back to discuss new research on CBD and its potential for those of us with skin rashes.  

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My guest today, Lily Mazzarella, MS, CNS, is an herbalist, nutritionist, educator and writer.

She is the owner of Farmacopia, a modern apothecary and integrative practice in Santa Rosa, CA. Lily is the formulator and creator of Farmacopia’s line of Signature Tinctures, Adaptogen Powders and Superfoods, and co-founder and formulator of Reishi Roast Original and Reishi Roast Elixir.

Join us as we discuss new research on CBD for skin rashes.

Have you used CBD or echinacea for your skin rashes? Let me know in the comments!

In this episode:

  • When did Lily's interest in CBD start?
  • Oral vs. topical use of CBD
  • All about echinacea
  • Red-flag ingredients for those with skin rashes
  • How to find good quality CBD products
  • Can the skin become addicted to CBD?


“Staph is present on 90% of people with eczema and is a complicating factor on eczema lesions with itch and is one of the things that causes the oozing and the crusting and all that stuff.” [12:11]

“CBD shows a lot of promise for regulating the osteocytes and turning down, again, not turning it off, not making your skin dry, but turning down inflammatory sebum production that's driven by testosterone and inflammatory fats, so poor quality fats in the diet.” [25:57]


Find Lily online here

Healthy Skin Show episode 026: Skin Irritants You've Probably Not Heard Of w/ Lily Mazzarella


Dogwood Botanicals

Follow Lily on Instagram

108: New Research on CBD For Your Rashes w/ Lily Mazzarella FULL TRANSCRIPT

Jennifer: Hi, everyone. Welcome back. Today's guest has already been on the Healthy Skin Show. She's one of my actually favorite guests to talk to, especially because she's also a clinical nutritionist, but she's got this added bonus of being a brilliant mind around how we can tap into the use of herbs and all sorts of botanicals to help on our healing journey. You may remember Lily Mazzarella, she's an herbalist, nutritionist, educator, and writer. She's also the owner of Farmacopia, a modern apothecary and integrative practice in Santa Rosa, California. She is the formulator and creator of Farmacopia's line of signature tinctures, adaptogen powders, and super foods, and co founder and formulator of Reishi Roast Original and Reishi Roast Elixir.

Jennifer: Here's the thing about Lily that's also very awesome. She's done a ton of traveling and she teaches all over the place. She also can be found, obviously teaching on the road, or at California School of Herbal Studies serving as the Ceres Community Project expert advisor on herbal medicine, botanacizing in the desert, and engaging in herbal urban wildfire recovery, and that's a big deal for those of you who can remember that Northern California has had some really serious wildfires.

Jennifer: And my sister is actually a colleague of Lily, and so they live in the same area and they've both been… You guys have both lived in the same community where these wildfires have really taken place. And so today, Lily, I just a, so appreciative that you were willing to come back on the show, but I wanted to talk to you about CBD and cannabinoids and for those of you who've listened to the two other episodes on this, this conversation is quite different because now we're going to talk a little bit about how it shows up in clinical practice, so to speak. So why don't you share with us, Lily, where did your interest in CBD begin this whole journey for you?

Lily: Yeah, well I think it was interesting moving out to the West coast from the East coast about 12, 13 years ago and kind of moving into a culture that was more sort of, in general, cannabis and hemp ready and active. It was a big sort of culture shock and culture shift. And just seeing cannabis and hemp products sort of woven into the fabric of everyday life. And then recently as a state, we have experienced legalization of recreational use of cannabis, but you and I are talking about something a little bit different, which is hemp-derived cannabis, so it can be a little confusing. It is the same plant, botanically speaking, Cannabis Sativa. But the CBD-derived products that you and I are talking about, Jen, they contain less than 0.3% THC and they are derived from hemp, as opposed to cannabis.

Lily: And that's sort of a… It's a tricky designation since they are botanically the same plant, but legally that's what allows CBD to kind of be on the market as an ingredient in various oral supplements and also topical supplements. So I was sharing with you before the interview started that CBD has obviously been one of these boom products and it's everywhere. And I was just reading how executives from L'Oreal and Goop are leaving their positions to move into CBD-based skin care lines. And so we're really going to be seeing an explosion of this. I mean, there's already a ton of products out on the marketplace, but we're going to be seeing even more.

Lily: And so as someone who owns an apothecary with a really high standard of what we carry in terms of third-party testing, and products meeting label claim, and certificate of analysis, I had been sort of watching the CBD craze and being like, okay, what am I comfortable with, both legally and as a practitioner, in terms of bringing the best products on for the people looking for relief?

Lily: So yeah, I've been a sort of curious observer and then personally, I have used topical CBD-only creams from a full spectrum. So not a CBD isolate, not a CBD synthetic molecule, but full spectrum CBD, I have used topically for nerve pain for about six years and just gotten incredible results. Nerve pain is something that actually, as a previous eczema sufferer… I, like you, healed from eczema and no longer have it, but did have really painful and uncomfortable and itchy eczema for years. Nerve pain is kind of in the same category where it's really hard to treat. The drugs around it, you kind of want to stay away from them, and they actually have some overlap in how they work.

Lily: Itch is a nerve phenomenon. So itch, which is one of the main components, well one of the main dreadful components of eczema, in terms of quality of life, itch is a neurological phenomenon. So interestingly, CBD seems to quell itch and I don't deal with itch anymore, but I was dealing with this nerve pain and topically, I was just a huge fan.

Lily: But I still didn't carry it in the formulary in my apothecary until the passage of the 2018 Farm Bill, which legalized hemp-derived CBD. So now I'm really comfortable carrying it from reputable companies, and I know what to look for. And so clinically, what I'm seeing is that people with kind of difficult to treat inflammatory skin conditions, so eczema, psoriasis, rosacea, and just any of kind of the chronic flaring, itchy red skin conditions, including, actually, contact dermatitis, which a lot of people deal with on a regular basis from components at their work or things like that, are really, really helped by CBD-based ointments and creams and oils.

Lily: And so for a long time that's been kind of anecdotal. And actually when I was doing research, there are some really interesting case reports on PubMed and in clinical journals of very difficult to treat skin conditions resolving or dramatically improving with CBD use. So there were three case reports from Stanford kind of tracking this chronic blistering skin condition and just these massive improvements, people getting off oral opioids, people reducing their topical steroid use. So yeah, it's really a field that's kind of opening up, and I think we're going to see a lot more coming around the bend. So it's kind of good for people listening who are dealing with chronic skin conditions to understand sort of what the potentials are and what some of the, I wouldn't say risks because I think it's really safe, but what some of the limitations may be.

Jennifer: And with this, I think a lot of times people get concerned should they use it orally or should they use it topically, does it matter? Is one better than the other? Any thoughts on that?

Lily: Yeah, so I think orally, CBD does have potential as a systemic anti inflammatory. A lot of the research, or a lot of the promise, on oral CBD is around pain, anxiety, sleep, specifically nerve pain, and inflammatory pain. So if we just take the example of eczema, which you and I love to talk about, then we can think about a chronic immune dysregulation, a chronic inflammatory condition. It's a bit of an extrapolation, but it makes sense to me.

Lily: I also know that CBD orally will help quell itch. That's something I've had reported to me from a host of people, and have experienced myself even just from situations where I've gotten completely consumed by mosquito bites and haven't been able to sleep.

Jennifer: Oh, wow.

Lily: Yeah. And I've gotten relief from CBD, topically and internally.

Lily: So in my research, the topical world, so far what we're looking at, is mainly creams. So in the human studies, I'll just say, aside. So not a murine model, which is a rat or a mouse, and not an in vitro study, and not a tissue culture study, but actually in humans.

Lily: There are some large trials on a cannabinoid. So it's not actually CBD, which is cannabidiol, but a different endo cannabinoid, so one that we make inside our own bodies called PEA. And so, listeners can actually look this up online, PEA is available as a supplement that you can take orally for inflammatory conditions and also as a topical cream, there's something called Sooth amide. So these trials, they were called the [PEAs 00:10:09] trials. So PEA-containing emollients, and these large trials found really substantial improvements in eczema lesions, basically.

Lily: So improving quality of the skin, improving skin hydration barrier function, which as we know, is really important. Restoring normal barrier function is really important in eczema. So, incredibly safe, relatively inexpensive. Unfortunately, it's out of pocket. You're not going to get this covered by insurance at this point. And given that there's not a ton of money to be made from a molecule that our own bodies make because you can't patent it, I don't know how far this is going to go, but I'm really happy that it's available to the consumer online. You can Google this and buy these things online. So PEA shows a lot of promise, and that's a topical application. I don't think it would hurt to take it orally. There's a lot of safety studies on PEA, but they're actually not on inflammatory skin conditions, those are all topical.

Lily: I came across a really interesting other study which is that we think about cannabinoids, so these molecules from plants which interact with our own endo cannabinoid receptors, they're actually contained in the plant echinacea. And echinacea was traditionally used in eczema in the old time herbal writings of the Eclectic physicians, who were these doctors in the 1800s in the Western herbal tradition in the United States. They were writing about using eczema, using echinacea, both topically and internally, for eczema and other chronic inflammatory skin conditions.

Jennifer: Wow.

Lily: Yeah, I know. Which actually makes a lot of sense, given that we know that staph co-occurs on eczema skin, so staph is present on 90% of people with eczema and is a complicating factor on eczema lesions with itch and is one of the things that causes the oozing and the crusting and all that stuff.

Lily: So echinacea is kind of a broad antimicrobial. We know it's an immune modulator, so the alkalamide, which are these components in echinacea that make it tingle on your tongue, so if you've ever taken an echinacea tincture and felt that crazy, buzzing tingle, those are alkalamide, and those compounds actually interact with endo cannabinoid receptors. And there was a really cool trial on an echinacea-based cream and eczema, again showing these really, really dramatic and substantial improvements in people with eczema and again, perfectly safe. So none of the side effects of, oh cortisone and anti-inflammatory, great, it'll clear it up quickly. But then you get rebounds, you get withdrawal, and you get thinning of the skin, and sort of damage to your local immunity on the skin. So obviously, tons of problems with cortisone creams. And so these natural creams, here's an endo cannabinoid-based cream, the PEA, and here's a tetrahydrocannabinol-based cream, echinacea, not even from a hemp or cannabis plant, all showing this dramatic improvement, it's really, really fascinating.

Jennifer: That is so cool.

Lily: Yeah, isn't it? And then thinking about the fact that, and remembering that hemp, or Cannabis Sativa, is a plant. That it contains a broad array of these cannabinoids and there's more than just CBD. Actually, if you obtain a product that's not a CBD isolate or a synthetic CBD, you're actually going to have a broader array of cannabinoids in there. And there's some research to show that the different cannabinoids have different benefits, actually. Around dry skin or inflammation, anti neoplastic, so anticancer capacities. There's promise in the realm of skin cancers and melanomas and things like that with certain of these cannabinoids. But the thing that I think you and I and your listeners are going to find most readily in the marketplace is a CBD-based skin topical.

Jennifer: Yeah. I wanted to ask you about that actually.

Lily: Yeah.

Jennifer: Because I feel like you're tuned into this area, and when I look on websites for CBD products, they all have these salves now, but I think a lot of the salves are really geared toward pain relief and muscle soreness and whatnot because they contain menthol. So I think the important thing that I would love for you to share are, if you've got rashes, especially rashes that may cause cracking of the skin or wounds that you can't heal up, what are some ingredients, some big red flags, if somebody was like, oh, I'll get a salve that has CBD. What are some red flag ingredients that they should not… That means that product is probably not the best choice for their eczema or whatever they have.

Lily: Yeah, absolutely. That is such a good point, and actually, some of those topicals, they could actually be really uncomfortable to place on the skin and worsen things. So yeah, you do want to exhibit caution. You're absolutely right that those preparations can be really effective for pain, but they typically really pile on the essential oils. And you and I talked about this before, where essential oils for sensitive skin and eczema skin often aren't a good fit. They cause sensitization, especially things like menthol and camphor. So those are things that are kind of got that tiger balm smell.

Lily: So a lot of the pain relief stuff, a lot of the topical CBD stuff, will have that in there. So look for things like menthol and camphor and cajeput and anything that's got kind of a, well, that tiger balmy smell.

Jennifer: Minty, too.

Lily: Yeah, minty, camphor, all of that. That basically, that can exacerbate things. And so really what you're looking for is a basic salve that contains minimal ingredients and ideally, no essential oils. And you can also find, now, topical serums are pretty big, so oil-based serums. Straight CBD oils can also be appropriate. So something that's say, in a coconut MCT oil that maybe is actually marketed for internal use, can be used topically and that's going to be absent of any other ingredient, which is great.

Lily: So there's no emulsifiers, there's nothing, yeah, there's nothing to get reactive to, basically, in there. So something like that could be helpful. There's a product line called Sunsoil. They make what they call an edible salve. And it is a CBD only, less than 0.3% THC, but really plant-based. They actually do organic farming in Vermont. They have a great chain of custody and provide certificate of analysis. That's a great product for… You can actually use it internally if you want, but you could put it on topically.

Jennifer: You were also mentioning Dogwood Botanicals?

Lily: Yeah, Dogwood Botanicals, I love. These two amazing women who are actually originally from Tennessee and now live out in California, they make a beautiful product for sensitive people that is just MCT and hemp-derived CBD.

Lily: And they have this really cool thing where you can actually look up your batch number on their website and you can see the certificate of analysis yourself, as the consumer. It's really, really neat. And I did just help formulate a cream with them and I loved their specifications because they really wanted it to be a face and body cream and they really wanted it to be essential oil free for sensitive skin. And so that cream did just come out, and that's available. So they have a rose and calendula essential oil free cream.

Jennifer: That's awesome.

Lily: Which is, yeah. Which we're seeing great results from, in terms of skin healing and skin hydration, and just getting amazing feedback from that cream. They were at the Renegade Craft Fair in San Francisco with that cream and they had a great time kind of introducing it to the public, and so that's going really nicely.

Lily: But yeah, there's a lot of good companies out there. There's a lot of crap out there, but there's a lot of, yeah, there's a lot of good stuff happening. And so just looking for substantiation too, how much CBD is in this product? For a topical product, you want to know. Okay, there's 350 milligrams in a two ounce jar or a one ounce jar. Because when it just says CBD, you just have no idea how much is in there. Is it a clinically relevant amount? Is that something that's going to even make a difference for your skin or is it just a more expensive cream because it says CBD?

Jennifer: That is true. I've also been forewarned, as a reminder to everyone, that just because it says CBD on the label doesn't necessarily mean that there's actual CBD in it. It could just be hemp oil and they're saying it's CBD. So that's why it is important to get products from reputable companies that have that chain of documentation and they are showing these certificates… It's so crazy that this one ingredient has so much hoopla around it. And on top of it, it's so difficult in this very moment because there's not a real regulatory body at the moment that's making sure that what people are producing is good quality.

Lily: No. They're just making it very confusing, legally, at the moment. I think the really good producers, the good companies are really taking it upon themselves to kind of elevate their industry and make the standards themselves. And they basically, like the Dogwood women for example, they really… Their stuff arrives tested and then they test it again and then we know that exactly what is in the bottle is what is on the certificate of analysis. We know that exactly the amount that's in the bottle is in the bottle, so you're not just spending your money, basically, on something that's not going to work, necessarily.

Jennifer: Out of curiosity, if you have a client that you're working with who's struggling with this and you recommend a topical, I mean, with CBD, are there any particular guidelines? Do you say, “Oh use it in the evening” or anything specific? Because I'm sure people are thinking, when would I use this or what's the best way to use a cream [inaudible 00:22:16]?

Lily: Yeah, absolutely. So I would suggest a minimum of two times a day, and more if you're experiencing sort of noxious symptoms like itch. You can reapply, there's not an issue with that. I think some of the hemp-based ointments can actually be green and kind of smell like plant material, and so those are often best used at night, particularly depending on where you're placing them. But if you're using a really neutral product or one with no or low scent, I would say, as you would with any other ointment or cream for eczema, after a shower to kind of trap in moisture and hydration, and two times a day, minimum.

Jennifer: Okay, and also one last question. Would someone have the same concern… I know the answer to this, but would someone have the same concern with… We do naturally have this fear of steroid creams. I think people who listen to this show, if they listen to a lot of the episodes, they understand, to some degree, that there can be really negative side effects of overuse with topical steroids. Is it possible, at least from the research and also your clinical experience, can somebody's skin become addicted to having the CBD present? Or maybe we're just not there yet. What's your thoughts?

Lily: Yeah, I mean, it's a great question and I think this is where the plant medicines just really shine, in that they are complex, they're sort of multi-modal, they work on lots of different kind of regulatory aspects of a system. So we have this complex array of cannabinoids in a plant-based product that are interacting with the endo cannabinoid system, not shutting it off or… If we think about the difference between modifying or modulating inflammation and working with the immune system, which is obviously very closely tied in with the endo cannabinoid system that no, we don't actually see these same issues at all. In fact, the skin seems to be nourished, and one of the things that we think CBD helps with is proper, we call apoptosis, so that's programmed cell death of cells that are sort of aging or diseased, even potentially cancer affected. But apoptosis is just a general process that we need our cells to kind of turn over and die and then we make healthy new cells.

Lily: And the endo cannabinoid system seems to regulate that process. And so CBD and other cannabinoids potentially just really support that process. And instead of turning something off or turning it on, the way prescription medications do, which is just causes things like rebound, causes things like withdrawal, and then downsides like skin thinning. So yeah, I mean, obviously your listeners are aware of all those issues. So, no. Yeah, I don't see an issue there.

Lily: And also, we're talking about eczema or atopic dermatitis, but in my research and then also in practice, I've seen benefit for rosacea. So other chronic inflammatory skin conditions that are really tricky to treat, rosacea, acne rosacea, acne. So CBD shows a lot of promise for regulating the osteocytes and turning down, again, not turning it off, not making your skin dry, but turning down inflammatory sebum production that's driven by testosterone and inflammatory fats, so poor quality fats in the diet.

Jennifer: Yeah, super cool.

Lily: And then did I mention psoriasis? And psoriasis. So these difficult to treat kind of and very, for the people who have them, very depressing skin conditions that do require, often conventional meds, and aren't treated well by those. So I feel really excited about it. I was saying this and probiotic creams to me, seem like the next frontier of safe skin care for chronic skin conditions.

Jennifer: Yeah, absolutely. And I think that this is the area where there's so much gray zone right now because it is so new and that's why I'm really appreciative that you were willing to share this information so that people can, as they learn about it multiple times, they grow comfortable giving these things a try. And that's an important thing because while I'm not necessarily anti-medication because there's a time and a place, sometimes we need that. I also think there's a value in saying, “Well, could I do some other things in the meantime to help reduce the inflammation, to help reduce whatever's going on that's causing the issues under the surface.” And if this is something that can help even just one person out there, I'm so grateful that we can share it with them and hopefully connect them with some products. I'm certainly going to put all of the products we've talked about in the show notes. That way people are able to find it, as well as your website, farmacopia.net and your Instagram handles. You've got a lot of great information and you also have a clinic, correct? Out in Santa Rosa, California.

Lily: Yes, we do. Yeah.

Jennifer: So if people are looking for some help, they can find those there.

Lily: Yeah.

Jennifer: Awesome. Well, thank you so much, Lily. I really appreciate the time and I hope we can have you back sometime.

Lily: Yeah, I really appreciate the opportunity. This was great. Thank you, Jen.

Staph is present on 90% of people with eczema and is a complicating factor on eczema lesions with itch and is one of the things that causes the oozing and the crusting and all that stuff.

Jennifer Fugo, MS, CNS

Jennifer Fugo, MS, CNS is an integrative Clinical Nutritionist and the founder of Skinterrupt. She works with women who are fed up with chronic gut and skin rash issues discover the root causes and create a plan to get them back to a fuller, richer life.

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