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Each month we ask Nurse Practitioner Eloise Theisen a few of your burning questions. Have questions you’d like answered? Email them to [email protected] 

Q: How do I know when to use a THC topical or a CBD topical? Which works better for what issues?

Topical cannabis preparations can be great for localized relief. Because they are not likely to cause systemic side effects, topical cannabis can be a great way for a new user to explore cannabis.

Typically, the onset of a topical will occur within 10-20 minutes and last 2-3 hours. Cannabis can enter the body through the skin by topical application of plant extracts. There is very little data to detail the pharmacokinetics of topically administered cannabinoids. In fact, there remains some disagreement about whether topicals enter the bloodstream. Cannabis is a fat-soluble medicine and this limits the absorption of cannabinoids in topical, oral, sublingual and rectal administration. Topical cannabis generally only penetrates a few layers of the of skin, which is why it is unlikely to produce any systemic effects. However, if there is an opening in the skin, like a cut, the topical cannabis can enter the bloodstream and therefore produce systemic effects. Another way cannabis can enter the bloodstream is with the assistance of a transdermal agent. Transdermal products have chemical agents that help cannabis penetrate the skin and enter the bloodstream.

Research shows that humans have cannabinoids receptors on the skin. When the cannabinoid receptors are activated through topical cannabinoids, skin issues such as pain, inflammation, itchiness and temperature can be reduced. Cannabidiol (CBD) and Cannabinol (CBN) have been shown to penetrate the skin 10 times better than delta-8 THC. In more severe cases of pain, itchiness and inflammation, a CBD dominant topical may be more effective than a THC prepared topical product. Potency of the topical may also play a role in the effectiveness of the topical for symptom relief. Currently there are no human studies that have evaluated dosage and concentration of topical cannabinoids. As with most cannabis products, some exploration will occur.

Not surprising, many patients are using topical cannabis to relieve pain, itching, inflammation, and burning of the skin. Skin related conditions such as acne, eczema, dermatitis and psoriasis can be effectively treated with topical cannabis. In these conditions, a CBD dominant topical may provide better reduction in inflammation than a THC topical.

Pain is more difficult to treat with a topical application. Depending on the type of pain and location, a topical application of cannabis may only provide limited relief, if any relief at all. Topical cannabis has been shown to help with arthritic pain in the hands, ankles, neck and shoulders. Pain from spinal stenosis, sciatica or neuropathy is less likely to respond to a topical. Chronic pain that is deep and constant will benefit from treating it systemically rather than topically.

Determining whether to use a CBD versus a THC topical may simply be based on personal preference. If you find that a THC topical is ineffective, then I recommend trying a CBD topical and vice versa. Not all products are created equal in potency, absorbency and quality.


For over 17 years, Eloise Theisen has been a dedicated and patient-focused nurse specializing in aging, cancer, chronic pain, dementia, Alzheimers, Parkinsons, anxiety, depression, fibromyalgia, and various auto-immune and neurological diseases. The founder of Radicle Health (formerly Green Health Consultants), she started her career at John Muir Medical Center caring for patients suffering from cancer, terminal illnesses, respiratory failure/complaints, drug overdoses, acute alcohol ingestion, gastrointestinal bleeds, traumatic brain injury, and multiple traumas and from there worked her way up to management. Following that, her work with Aunt Zelda’s and the American Cannabis Nurses Association gained her an extensive knowledge of the Endocannabinoid system and how cannabis and cannabinoids can be used successfully to treat patients. 

An East Bay, California native, Eloise is a passionate advocate for medical cannabis and cannabis oil alternatives after seeing the positive benefits it has had for patients. In partnership with Dr. R. David Ferrara MD, she started Radicle Health, a clinic dedicated to ensuring patients receive the qualified counseling they need to safely and effectively use cannabinoids to manage a health condition, cure an illness or reduce their intake of pharmaceuticals. She also provides education and training to other medical practitioners on the therapeutic potential of cannabis as a treatment option.

Eloise was a board director for the American Cannabis Nurses Association (ACNA) (2014-2016) where she helped develop the first on-line core curriculum program for nurses on cannabinoid therapeutics. She currently serves on the scope and standards committee for the ACNA. She is working to help further legalize and destigmatize therapeutic cannabis therapy. She’s a regular speaker at industry events and teaches classes at universities in the San Francisco Bay Area.

She has a Post Masters certification as an Adult-Geriatric nurse practitioner from University of Mass, Boston; an MSN in Nursing Administration from California State University; and a Bachelor of Science in Nursing from San Francisco State University.


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