Peru Balsam

Scientific Name(s): Myroxylon pereirae (Royle) Klotzsch. Family: Fabaceae (beans). A synonym is Myroxylon balsamum var. pereirae (Royle) Harms.

Common Name(s): Peru balsam , Peruvian balsam , Indian balsam , black balsam , balsam Peru

Uses

Peru balsam has been used in the treatment of dry socket in dentistry, topically as a treatment of wounds and ulcers, and in suppositories for hemorrhoids. The material has no use as an internal medication.

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Dosing

Peru balsam has been used topically as 5% to 20% formulations for wounds and burns; however, there are no recent well-controlled clinical studies to support appropriate dosing.

Contraindications

Contraindications have not been identified.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

Peru balsam may cause contact dermatitis.

Toxicology

Systemic toxicity following application of Peru balsam to nipples of nursing mothers has been described.

Botany

Peru balsam is a large tree that grows 15 to 23 m in height in Central America. It often is cultivated as a shade tree. 1 Crude Peru balsam is a dark brown, thick liquid with an aromatic smell of cinnamon and vanilla, and a bitter taste. 2 , 3 To remove it from the tree, the bark alternately is scorched and beaten. The balsam in the bark is obtained by boiling. Following removal of strips of bark from the tree, the exposed wood also secretes balsam. The material soaks into rags wrapped around the tree, which then are boiled in water. The balsam sinks to the bottom and is collected. Approximately 1 kg of balsam per tree is yielded annually.

History

The drug first was imported from Spain through Peruvian ports, from which the material derives its name. 3 Peru balsam has been used for the treatment of topical wounds and infections, and as a flavoring in the food industry. The Indians of Central and South America used the material to stop bleeding and to promote wound healing. They also used the material as a diuretic and to expel worms. 1 Today, the material is in a number of pharmaceutical preparations and plays an important role in perfumery. It is not used as an internal medication.

Chemistry

The balsam contains 50% to 65% of a volatile oil called cinnamein along with about 25% resin. The volatile oil primarily contains benzyl cinnamate and other benzoic and cinnamic acid esters, with small amounts of benzyl alcohol and related compounds. In addition, traces of styrene, vanillin, and coumarin have been identified in the material. Oil distilled from the wood is about 70% nerolidol. 4 Considerable variations exist in the balsam, depending on the source of the material. 3

Uses and Pharmacology

Peru balsam has mild antiseptic properties and is said to promote the growth of skin cells. 2 The balsam has been used in dentistry in the treatment of dry socket (postextraction alveolitis) and as a component of dental impression material. It formerly was used widely as a treatment for scabies, and it has been used in suppositories for hemorrhoids. 5

Wounds

Peru balsam is included in topical preparations for the treatment of wounds and ulcers. 2

Animal data

Research reveals no animal data regarding the use of Peru balsam.

Clinical data

Studies have evaluated the use of Peru balsam as a treatment of partial thickness wounds. 6 Studies tend to be small and limited, but some benefit has been shown for the use of a castor oil-balsam of Peru-trypsin ointment as a treatment of skin graft donor sites. 6 , 7 Additional study is warranted.

Dosage

Peru balsam has been used topically as 5% to 20% formulations for wounds and burns; however, there are no recent well-controlled clinical studies to support appropriate dosing.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

Peru balsam is a contact allergen and contact dermatitis occurs frequently with the product. 8 It may cause dermatitis in individuals who have a sensitivity to benzoin resinoids.

The main contact sensitizers in Peru balsam have been identified and include cinnamates, benzoates, and terpenoids. 9 Additional patch testing is recommended in Peru-balsam sensitive individuals to trace how sensitization is acquired. 9

Toxicology

Systemic toxicity following application of Peru balsam to nipples of nursing mothers has been described. 10

Bibliography

1. Dobelis IN, ed. Magic and Medicine of Plants . Pleasantville, NY: Reader's Digest Association; 1986.
2. Leung AY. Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics . New York, NY: J. Wiley and Sons; 1980.
3. Evans WC. Trease and Evans' Pharmacognosy . 13th ed. London: Bailliere Tindall; 1989.
4. Morton JF. Major Medicinal Plants . Springfield, IL: C.C. Thomas; 1977.
5. Osol A, Farrar GE Jr., eds. The Dispensatory of the United States of America . 25th ed. Philadelphia, PA: J.B. Lippincott; 1955:1023.
6. Carson SN, Wiggins C, Overall K, Herbert J. Using a castor oil-balsam of Peru-trypsin ointment to assist in healing skin graft donor sites. Ostomy Wound Manage . 2003;49:60-64.
7. Gray M, Jones DP. The effect of different formulations of equivalent active ingredients on the performance of two topical wound treatment products. Ostomy Wound Manage . 2004;50:34-44.
8. Krob 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 T.R.U.E. test data. J Am Acad Dermatol . 2004;51:349-353.
9. Hausen BM. Contact allergy to balsam of Peru. II. Patch test results in 102 patients with selected balsam of Peru constituents. Am J Contact Dermat . 2001;12:93-102.
10. Duke JA. CRC Handbook of Medicinal Herbs . Boca Raton, FL: CRC Press; 1985.

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