Scientific Name(s): Myroxylon balsamum (L.) Harms var. pereirae (Royle) Harms.
Common Name(s): Balsam of Peru, Balsamo blanco, Baumier du Perou, Black balsam, Indian balsam, Peru balsam, Perubalsambaum, Peruvian balsam
Drug class: Miscellaneous topical agents
Medically reviewed by Drugs.com. Last updated on Jan 20, 2021.
Peru balsam has been used in the treatment of dry socket in dentistry, topically as a treatment for wounds and ulcers, and in suppositories for hemorrhoids. However, there are only older, small case studies to support this use. The material is not used internally.
Peru balsam has been used topically in 5% to 20% formulations for wounds and burns. Case reports and small clinical studies report the efficacy of balsam combined with other ingredients in the management of certain wounds; however, there are no recent, well-controlled clinical studies to support appropriate dosing.
Contraindications have not been identified.
Information regarding safety and efficacy in pregnancy and lactation is lacking. Systemic toxicity following application of Peru balsam to the nipples of breast-feeding mothers has been reported.
None well documented.
Peru balsam is an allergen. The use of its constituents is widespread and found in cosmetics as well as foods, including ketchup. Cross-reactivity with naturally occurring sources of similar chemicals has been reported with orange peel, clove, and tomatoes.
Information is lacking.
- Fabaceae (pea)
- Leguminosae (bean)
The species Myroxylon balsamum is a tall tree (15 to 23 m high) native to the high plains and mountains of Central and South America. The plant bears evergreen pinnate leaves and racemes of white flowers. The hardwood tree contains oil that is naturally resistant to insects and has a characteristic scent. The plant is the only species within the genus Myroxylon; however, there are 2 varieties, var. pereirae and var. balsamum, known as balsam of Peru and balsam of Tolu, respectively. (See Tolu Balsam).Duke 2002, USDA 2012 Synonyms are Myroxylon pereirae (Royle) Klotzsch, Myrospermum pereirae Royle (basionym), and Toluifera pereirae (Royle) Baill.
Crude Peru balsam is a dark brown, thick liquid with an aromatic smell similar to that of cinnamon and vanilla and a bitter taste. It is obtained from the tree after the bark has been removed. The trunk is wrapped with rags that are later boiled to extract the resin.Leung 2003
The balsam was imported almost exclusively from El Salvador to Europe through Peruvian ports, which is how the material derived 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 expel worms. Formerly, it was used widely as a treatment for scabies; it has also been used in suppositories for hemorrhoids and in dentistry in the treatment of dry socket (postextraction alveolitis) and as a component of dental impression material. 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.Leung 2003, Osol 1955
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. Considerable chemical variations exist in the balsam, depending on the source of the material.Duke 2012, Evans 1989, Leung 2003
Uses and Pharmacology
Combined with zinc oxide and bismuth oxide, Peru balsam was used in the management of a wound following the removal of squamous cell carcinoma in a white rhinoceros.Goodman 2007
Studies have evaluated the use of Peru balsam as a treatment of partial-thickness wounds. Some benefit has been shown for the use of a castor oil–balsam of Peru–trypsin ointment as treatment for skin graft donor sites, moist desquamation after radiation, wound care after tissue debridement, and skin tissue damage from heparin-induced thrombocytopenia, but only in small studies or case reports.Beitz 2005, Carson 2003, Glenn 2006, Gray 2004, McDougall 2005, Thomas 2008
Peru balsam has been used topically in 5% to 20% formulations for wounds and burns; however, there are no recent, well-controlled clinical studies to support appropriate dosing. Use of the balsam is documented in the Complete German Commission E Monographs for poorly healing wounds, burns, frostbite, bruises, and hemorrhoids.Blumenthal 2000
Pregnancy / Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking. Systemic toxicity following application of Peru balsam to the nipples of breast-feeding mothers has been reported.Duke 2002
None well documented.
Peru balsam is a contact allergen, and contact dermatitis occurs frequently with the product.Balato 2011, Krob 2004, Nijhawan 2009, Thyssen 2009 In a systematic review of 34 studies covering a 15-year period, it was found to be among the top 10 most common allergens in adolescents and a less common antigen in children. Equivocal data prevented an association being made with atopic vs non-atopic individuals.Rodrigues 2016 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. Additional patch testing is recommended in Peru balsam–sensitive individuals to trace the origins of sensitization.Hausen 2001, Srivastava 2009 As a basic screening tool to improve detection and management of allergic contact eyelid dermatitis cases, balsam of Peru 25% in petrolatum has been recommended as a standard patch-test component based on data supporting its high frequency as a relevant antigen.Herro 2012
The importance of recognizing food items that contain balsam of Peru-associated constituents was highlighted in a case series of 7 children with systemic manifestations of recalcitrant dermatitis. Thorough questioning revealed that all 7 patients had significant ketchup intake (from daily to 3 times/week). Instituting a low balsam of Peru diet that included avoidance of ketchup achieved 80% improvement in 5 of the 7 children, 70% in the 6th child, and 60% improvement in the 7th. Cross-reactivity with food sources that naturally contain chemicals similar to the volatile oils and resins in balsam of Peru include orange peel, clove, and tomatoes. The 5 foods listed on the avoidance list for the low balsam of Peru diet were tomatoes and tomato-containing products, peels of citrus fruits, chocolate, cola and spiced sodas, and cinnamon, cloves, and vanilla.Herro 2013 Similarly, initiation of a low balsam of Peru diet improved pruritic allergic dermatitis symptoms in a 48-year-old man within 1 month of dietary changes, which was sustained for several months.Nanda 2016 Cases of cheilitis and perioral dermatitis have been reported in 2 individuals who used Lucas Papaw ointment, which included small amounts of Myroxylon pereirae that was not listed as an ingredient on the labeling but was later confirmed by the manufacturer.Tan 2011
Information is lacking.
- Myrospermum pereirae Royle (basionym)
- Myroxylon pereirae (Royle) Klotzsch
- Toluifera pereirae (Royle) Baill.
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