{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:27:16Z","timestamp":1780637236933,"version":"3.54.1"},"reference-count":55,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T00:00:00Z","timestamp":1599004800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Wound Journal"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Non\u2010Uremic Calciphylaxis (NUC) is a rare condition that often manifests as intractable and painful integumentary wounds, afflicting patients with a high burden of co\u2010morbidity. The Endocannabinoid System (ECS) is a ubiquitous signalling system that is theorised to be dysregulated within wound beds and associated peri\u2010wound tissues. Preclinical research has shown that the dominant chemical classes derived from the cannabis plant, cannabinoids, terpenes, and flavonoids, interact with the integumentary ECS to promote wound closure and analgesia. This is a prospective open label cohort study involving two elderly Caucasian females with recalcitrant NUC leg ulcers of greater than 6 months duration. Topical Cannabis\u2010Based Medicines (TCBM) composed of cannabinoids, terpenes, and flavonoids were applied daily to both the wound bed and peri\u2010wound tissues until complete wound closure was achieved. Wounds were photographed regularly, and the digital images were subjected to planimetric analysis to objectively quantify the degree of granulation and epithelization. Analgesic utilisation, as a surrogate\/proxy for pain scores, was also tracked. The cohort had a mean M3 multimorbidity index score of 3.31. Complete wound closure was achieved in a mean of 76.3\u2009days. Additionally, no analgesics were required after a mean of 63\u2009days. The treatments were well tolerated with no adverse reactions. The positive results demonstrated in very challenging wounds such as NUC, among highly complex patients, suggest that TCBM may have an even broader role within integumentary and wound management. This treatment paradigm warrants being trialled in other wound types and classes, and ultimately should be subjected to randomised controlled trials.<\/jats:p>","DOI":"10.1111\/iwj.13484","type":"journal-article","created":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T09:53:54Z","timestamp":1599040434000},"page":"1508-1516","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Topical cannabis\u2010based medicines \u2013 A novel paradigm and treatment for non\u2010uremic calciphylaxis leg ulcers: An open label trial"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8693-0617","authenticated-orcid":false,"given":"Vincent","family":"Maida","sequence":"first","affiliation":[{"name":"Division of Palliative Care University of Toronto  Toronto Ontario Canada"},{"name":"Division of Supportive &amp; Palliative Care William Osler Health System  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5690-2394","authenticated-orcid":false,"given":"Runjie B.","family":"Shi","sequence":"additional","affiliation":[{"name":"Division of Palliative Care University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco G. T.","family":"Fazzari","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Ottawa  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia","family":"Zomparelli","sequence":"additional","affiliation":[{"name":"Faculty of Science McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,9,2]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1505292"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2015091065"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2016.06.025"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1755.2002.00375.x"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijd.13622"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/DAD.0000000000000824"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2006.08.065"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.00530108"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tips.2015.02.008"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2018.10.002"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/molecules24050918"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tips.2009.05.004"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-43157-4_15"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bcp.2018.08.022"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpls.2018.01969"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1080\/09546634.2019.1690620"},{"key":"e_1_2_9_18_1","unstructured":"PwC Canada.PwC Canada's cannabis series: Chapter 9 \u2010 Cannabis in the pharmaceutical industry[Internet];2019. Available from:https:\/\/www.pwc.com\/ca\/en\/industries\/cannabis\/pwc-cannabis-series-chapter-9-cannabis-in-the-pharmaceutical-industry.html."},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12662"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.25270\/owm.2018.2.1029"},{"issue":"1","key":"e_1_2_9_21_1","first-page":"19","article-title":"Others. Taking wound assessment beyond the edge","volume":"6","author":"Dowsett C","year":"2015","journal-title":"Wounds Int"},{"issue":"1","key":"e_1_2_9_22_1","first-page":"83","article-title":"The importance of periwound skin in the treatment of \u201cdifficult wound\u201d","volume":"32","author":"Onesti MG","year":"2011","journal-title":"G Chir"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2017.08.005"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2018.04.002"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.13011"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0885-3924(03)00162-3"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.13019"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/6831703"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/ced.12505"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/1346-8138.12139"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2230.2012.04350.x"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2010.08.005"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.2310\/7750.2011.10046"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1001\/archdermatol.2008.602"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2230.2008.02877.x"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12738"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/pde.13545"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2016.09.003"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2017.06.005"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1108"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms17122085"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1096\/fj.201600646R"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1002\/ptr.6400"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvp240"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1002\/jps.22354"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1124\/dmd.109.026930"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2018.00622"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.4172\/21532435.1000378"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1111\/bph.12309"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1111\/febs.12125"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.1089\/wound.2014.0522"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.1517\/13543776.2014.870154"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0216104"},{"key":"e_1_2_9_54_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12240"},{"key":"e_1_2_9_55_1","first-page":"187","article-title":"Quercetin accelerated cutaneous wound healing in rats by increasing levels of VEGF and TGF\u2010\u03b21","volume":"54","author":"Gopalakrishnan A","year":"2016","journal-title":"Indian J Exp Biol"},{"key":"e_1_2_9_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2005.04.017"}],"container-title":["International Wound Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iwj.13484","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/iwj.13484","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iwj.13484","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T03:30:13Z","timestamp":1744860613000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/iwj.13484"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,2]]},"references-count":55,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2020,10]]}},"alternative-id":["10.1111\/iwj.13484"],"URL":"https:\/\/doi.org\/10.1111\/iwj.13484","archive":["Portico"],"relation":{},"ISSN":["1742-4801","1742-481X"],"issn-type":[{"value":"1742-4801","type":"print"},{"value":"1742-481X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,2]]},"assertion":[{"value":"2020-05-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-07-31","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-09-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}