Peru Balsam

Peru Balsam

Peru Balsam

Clinical overview

Use

dosage

Balsam of Peru is used topically in 5 to 20 percent formulations to treat wounds and burns. Case reports and small clinical studies report the effectiveness of balm in combination with other ingredients in treating certain wounds; However, there are no current, well-controlled clinical studies demonstrating appropriate dosage.

Contraindications

Contraindications have not been identified.

Pregnancy/breastfeeding

There is a lack of information on safety and effectiveness during pregnancy and breastfeeding. Systemic toxicity has been reported following application of Balsam of Peru to the nipples of nursing mothers.

Interactions

None are well documented.

Side effects

Balsam of Peru is an allergen. The use of its components is widespread and can be found in both cosmetics and food, including ketchup. Cross-reactivity with naturally occurring sources of similar chemicals has been reported in orange peel, cloves, and tomatoes.

toxicology

Information is missing.

Scientific family

• Fabaceae (Erbse)
• Leguminosen (Bohne)

botany

The species Myroxylon balsamum is a tall tree (15 to 23 m high) native to the plateaus and mountains of Central and South America. The plant bears evergreen pinnate leaves and clusters of white flowers. The hardwood tree contains oil that is naturally resistant to insects and has a distinctive scent. The plant is the only species within the genus Myroxylon; However, there are two varieties, Var. pereirae and var. balsamum, known as Peru balsam and Tolu balsam, respectively. (See Tolu Balm). Duke 2002, USDA 2012 Synonyms are Myroxylon pereirae (Royle) Klotzsch, Myrospermum pereirae Royle (basionym) and Toluifera pereirae (Royle) Baill.

Story

Raw Peru Balsam is a dark brown, thick liquid with an aromatic smell reminiscent of cinnamon and vanilla and a bitter taste. It is extracted from the tree after the bark has been removed. The trunk is wrapped with rags, which are later boiled to extract the resin.Leung 2003

The balm was almost exclusively imported to Europe from El Salvador via Peruvian ports, which is why the material got its name. Amado 2006, Evans 1989 Central and South American natives used the material to stop bleeding and promote wound healing. They also used the material as a diuretic and to repel worms. It was once commonly used to treat scabies; It has also been used in suppositories for hemorrhoids and in dentistry to treat dry alveolitis (post-extraction alveolitis), as well as as a component of dental impression material. Today the substance is contained in numerous pharmaceutical preparations and plays an important role in perfumery. It is not used as an internal medication.Leung 2003, Osol 1955

Chemistry

The balm contains 50 to 65% of an essential oil called cinnamon and about 25% resin. The essential oil contains mainly benzyl cinnamate and other benzoic and cinnamic acid esters, as well as small amounts of benzyl alcohol and related compounds. In addition, traces of styrene, vanillin and coumarin were found in the material. Oil distilled from the wood consists of around 70% nerolidol. Depending on the source of the material, there are significant chemical differences in the balm. Duke 2012, Evans 1989, Leung 2003

Use and Pharmacology

wound healing

Animal data

In combination with zinc oxide and bismuth oxide, Peru balsam was used to treat a wound following the removal of a squamous cell carcinoma in a white rhinoceros.Goodman 2007

Clinical data

Studies have examined the use of Balsam of Peru to treat moderate thickness wounds. Some benefit has been demonstrated for the use of castor oil-Peru Balm-trypsin ointment for the treatment of skin graft donor sites, moist desquamation after radiation, wound care after tissue debridement, and skin tissue damage caused by heparin-induced thrombocytopenia, although only in small studies or case reports. Beitz 2005, Carson 2003, Glenn 2006, Gray 2004, McDougall 2005, Thomas 2008

Other

Antimicrobial properties of the balm have been described and applications such as use against mosquito larvae and pathogenic bacteria have been investigated.de Barros Machado 2005, Seo 2012

dosage

Balsam of Peru is used topically in 5 to 20 percent formulations on wounds and burns; However, there are no current, well-controlled clinical studies demonstrating appropriate dosage. The use of the balm is documented in the complete monographs of the German Commission E for poorly healing wounds, burns, frostbite, bruises and hemorrhoids. Blumenthal 2000

Pregnancy/breastfeeding

There is a lack of information on safety and effectiveness during pregnancy and breastfeeding. Systemic toxicity has been reported following application of Balsam of Peru to the nipples of nursing mothers.Duke 2002

Interactions

None are well documented.

Side effects

Balsam of Peru is a contact allergen and contact dermatitis is common with the product.Balato 2011, Krob 2004, Nijhawan 2009, Thyssen 2009 A systematic review of 34 studies over a 15-year period found it to be among the top 10 most common allergens in adolescents and a rarer antigen in children. Ambiguous data prevented a link between atopic and non-atopic individuals. Rodrigues 2016 It can cause dermatitis in people sensitive to benzoin. The main contact allergens in Peru balsam have been identified and include cinnamic acid esters, benzoates and terpenoids. Additional patch testing is recommended in Peruvian balsam-sensitive individuals to determine the origin of sensitization.Hausen 2001, Srivastava 2009 As a basic screening tool to improve the detection and treatment of cases of allergic contact eyelid dermatitis, Perubalsam 25% in Vaseline has been recommended as a standard patch test component, based on data that prove its high frequency as a relevant antigen.Herro 2012

The importance of recognizing foods containing Peru-associated balsam was highlighted in a case series of 7 children with systemic manifestations of recalcitrant dermatitis. A thorough interview revealed that all 7 patients had significant ketchup consumption (ranging from daily to three times per week). The introduction of a Peruvian balm diet that included eliminating ketchup resulted in an 80% improvement in five of the seven children, a 70% improvement in the sixth child, and a 60% improvement in the seventh child. Cross-reactions with food sources that naturally contain chemicals similar to the essential oils and resins in Balsam of Peru include orange peel, cloves and tomatoes. The 5 foods included on the avoidance list for the low-balm Peruvian diet were tomatoes and tomato-containing products, citrus fruit peels, chocolate, cola and spiced sodas, and cinnamon, cloves, and vanilla. Herro 2013 Likewise, initiation of a low-balm diet from Peru improved symptoms of pruritic allergic dermatitis in a 48-year-old Man within a month of changing his diet, which lasted for several months. Nanda 2016 Cases of cheilitis and perioral dermatitis were reported in 2 people who took Lucas Papaw ointment containing small amounts of Myroxylon pereirae, which was not listed as an ingredient on the label but was later confirmed by the manufacturer.Tan 2011

toxicology

Information is missing.

Index terms

• Myrospermum pereirae Royle (Basionym)
• Myroxylon pereirae (Royle) Klotzsch
• Toluifera pereirae (Royle) Baill.

References

Disclaimer

This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been evaluated for safety or effectiveness by the FDA and is not subject to the quality and safety information collection standards that apply to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not confirm that this product is safe, effective, or approved to treat any patient or medical condition. This is just a brief summary of general information about this product. It does NOT contain all information about the possible uses, instructions, warnings, precautions, interactions, side effects or risks that may apply to this product. This information does not constitute specific medical advice and does not replace the information you receive from your healthcare provider. You should speak to your doctor to get complete information about the risks and benefits of using this product.

This product may interact negatively with certain health and medical conditions, other prescription and over-the-counter medications, foods or other dietary supplements. This product may be unsafe if used before surgery or other medical procedures. It is important to fully inform your doctor about the herbs, vitamins, minerals, or other supplements you are taking before any surgery or medical procedure. With the exception of certain products generally considered safe in normal amounts, including the use of folic acid and prenatal vitamins during pregnancy, this product has not been adequately studied to determine whether it is safe for use during pregnancy, breastfeeding, or in those younger than 2 years of age.

Amado A, Taylor JS. Balm from Peru or balm from El Salvador? Contact dermatitis. 2006;55(2):119.16930242Balato A, Balato N, Di Costanzo L, Ayala F. Contact sensitization in the elderly. Clinic Dermatol. 2011;29(1):24-30.21146728Beitz JM. Bullous lesions with heparin-induced thrombocytopenia syndrome treated with trypsin balm from Peru castor oil ointment: a case study. Ostomy wound management. 2005;51(6):52-54, 56-58.16014993Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Extended Monographs of the Commission E. Newton, MA: Integrative Medical Communication; 2000.Carson SN, Wiggins C, Overall K, Herbert J. Use of a castor oil balm-Peru trypsin ointment to promote healing of skin graft donor sites. Ostomy wound management. 2003;49(6):60-64.12874484de Barros Machado T, Leal IC, Kuster RM, et al. Brazilian phytopharmaceuticals – evaluation against hospital bacteria. Phytother Res. 2005;19(6):519-525.16114081Dr. Duke's Phytochemical and Ethnobotanical Databases [Online Database]. Accessed July 22, 2012. Duke JA. Handbook of medicinal herbs. 2nd ed. Boca Raton, FL: CRC Press; 2002:133-239.Evans WC. The pharmacognosy of Trease and Evans. 13th edition London: Bailliere Tindall; 1989.Glenn J. Treatment of a traumatic wound in a geriatric patient. Ostomy wound management. 2006;52(4):94-98.16636366Goodman G, Rhind S, Meredith A. Successful treatment of squamous cell carcinoma in a white rhino, Ceratotherium simum. Veterinarian Dermatol. 2007;18(6):460-463.17991166Gray M, Jones DP. The effect of different formulations of equivalent active ingredients on the performance of two topical wound treatment products. Ostomy wound management. 2004;50(3):34-38, 40, 42-44.15206088Hausen BM. Contact allergy to Balsam of Peru. II. Patch test results in 102 patients with selected balm from Peruvian ingredients. Am J Contact Dermat. 2001;12(2):93-102.11381345Herro EM, Elsaie ML, Nijhawan RI, Jacob SE. Recommendations for a screening series for allergic contact eyelid dermatitis. Dermatitis. 2012;23(1):17-21.22653064Herro EM, Jacob SE. Systemic contact dermatitis – children and ketchup. Pediatrics Dermatol. 2013;30(3):e32-e33.22299798Krob HA, Fleischer AB Jr, D’Agostino R Jr, Haverstock CL, Feldman S. Prevalence and relevance of contact dermatitis allergens: a meta-analysis of 15 years of published TRUE test data. J Am Acad Dermatol. 2004;51(3):349-353.15337975Leung AY, Foster S. Encyclopedia of common natural ingredients used in foods, drugs and cosmetics. 2nd ed. Hoboken, NJ: Wiley-Interscience; 2003.McDougall CJ, Franklin LE, Gresle SO. Treatment of radiation dermatitis in a postmastectomy patient. J Wound Stoma Continence Nurses. 2005;32(5):337-339.16234729Nanda A, Wasan A. Allergic contact dermatitis to balm from Peru. Ann Allergy Asthma Immunol. 2016;117(2):208-209.27499544Nijhawan RI, Molenda M, Zirwas MJ, Jacob SE. Systemic contact dermatitis. Dermatol Clinic. 2009;27(3):355-364, vii.19580929Osol A, Farrar GE Jr, eds. The Dispensation of the United States of America. 25th ed. Philadelphia, PA: JB Lippincott; 1955:1023.Rodrigues DF, Goulart EM. Patch test results in children and adolescents: systematic review of a 15-year period. A BH dermatol. 2016;91(1):64-72.26982781Seo SM, Park HM, Park IK. Larvicidal action of Ajwain (Trachyspermum ammi) and Peru Balsam (Myroxylon pereira) oils and mixtures of their components against mosquitoes, Aedes aegypti, acute toxicity to water fleas, Daphnia magna and aqueous residues. J Agrifood Chemistry. 2012;60(23):5909-5914.22620984 Srivastava D, Cohen DE. Identification of the components of Balsam of Peru in tomatoes. Dermatitis. 2009;20(2):99-105.19426616Tan S, Tam MM, Nixon RL. Allergic contact dermatitis to Myroxylon pereirae (Balm from Peru) in papaya ointment causing cheilitis. Australas J Dermatol. 2011;52(3):222-223.21834822Thomas R. Acoustic pressure wound therapy in the treatment of stage II pressure ulcers. Stoma wound management. 2008;54(11):56-58.19037138Thyssen JP, Menné T, Linneberg A, Johansen JD. Contact sensitization to fragrances in the general population: A cooking approach may reveal disease burden. Br J Dermatol. 2009;160(4):729-735.19210499USDA, ARS, National Genetic Resources Program. Germplasm Resources Information Network – (GRIN) [Online Database]. National Germplasm Resources Laboratory, Beltsville, Maryland. Accessed July 19, 2012.

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