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Witch Hazel

Scientific Name(s): Hamamelis virginiana L.
Common Name(s): Cortex Hamamelis, Folium Hamamelis, Hamamelis, Hamamelis water, Magician's rod, Snapping hazel, Spotted alder, Tobacco wood, White hazel, Winter bloom, Witch hazel

Clinical Overview

Use

Hamamelis preparations are commonly used for dermatological conditions, including diaper-related dermatitis; however, clinical studies supporting these uses are generally lacking. Witch hazel has been evaluated for uses including analgesic, antiseptic, antioxidant, and antitumor activity.

Dosing

Topical — Steam distillates of Hamamelis are used diluted (1:3 with water) or undiluted, and in semisolid preparations at 5% to 10% of crude drug. Rectal — Suppositories containing witch hazel contain from 0.1 to 1 g/dose. Oral — Not recommended.

Contraindications

Internal use of extracts is not recommended because of the tannin content.

Pregnancy/Lactation

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

Interactions

None well documented.

Adverse Reactions

Allergic contact dermatitis has been reported from topical applications.

Toxicology

Although extracts of witch hazel are available commercially, it is not recommended that they be taken internally because the toxicity of the tannins has not been well defined.

Botany

Witch hazel grows as a highly branched deciduous bush or small tree, often reaching approximately 6 m in height. The plant is indigenous to the Atlantic coast and found in damp woods throughout most of North America. Its broad, toothed leaves are ovate, and the threadlike golden-yellow flowers bloom in the fall. Brown fruit capsules appear after the flowers and, when ripe, eject 2 seeds away from the tree. The dried leaves, bark, and twigs are used traditionally.1, 2 A synonym is Hamamelis macrophylla.

History

Witch hazel is a widely known plant with a long history of use in the Americas. The plant, including the crude leaf and bark, is used in a variety of forms; fluid extracts, poultice, and commonly as witch hazel water. The latter, also known as Hamamelis water or distilled witch hazel extract, is obtained from recently cut, partially dormant twigs. This plant material is soaked in warm water, followed by distillation and the addition of alcohol to the distillate. Witch hazel water is the most commonly found commercial preparation, usually kept in most homes as a topical cooling agent or astringent.

Traditionally, witch hazel was known to native North American people as a treatment for tumors and eye inflammations. It was used internally for hemorrhage. Other uses include treatment of hemorrhoids, burns, cancers, tuberculosis, colds, and fever. Preparations have been used topically for symptomatic treatment of itching and other skin inflammation, and in ophthalmic preparations for irritation.2, 3, 4, 5

Chemistry

H. virginiana bark primarily contains polyphenols, including tannins, phenolic acids, and flavonoids. At least 27 phenolic constituents have been identified using high-pressure liquid chromatography, liquid chromatography, and mass spectrometric methods. Methods for quantifying gallic acid, hamamelitannin (approximately 1.5% in leaves and up to 65% in bark), and the proanthocyanidins have been described. The gallotannins are heat labile.2, 6, 7, 8, 9, 10 Because witch hazel water is a steam distillate of the extract, it does not contain tannins.4, 11

Other components include kaempferol, quercetin, chlorogenic acid isomers, and hydroxycinnamic acids. The volatile oil contains small amounts of safrole and eugenol as well as numerous other minor components, such as resin, wax, and choline.2, 9

Uses and Pharmacology

Antimicrobial

Animal data

In vitro studies have shown antibacterial properties of the plant extract (both leaf and bark) versus Escherichia coli, Staphylococcus aureus (including resistant strains), Bacillus subtilis, and Enterococcus faecalis.2, 12 Activity against periodontopathic bacteria has also been reported.13

Clinical data

Clinical trials are lacking. In healthy volunteers, a distillate of Hamamelis demonstrated weak topical antibacterial activity.14 Antiviral effects in herpes labialis were reported in a clinical trial of Hamamelis ointment compared with placebo; however, a reduction in inflammation was only noted on day 8.2

Dermatological uses

Hamamelis preparations are commonly used for dermatological conditions in several countries; however, quality clinical studies supporting these uses are lacking.2, 4

Animal data

Animal models have been used to demonstrate astringent and hemostatic properties of the plant extracts. At lower concentrations, Hamamelis extracts decreased cell permeability, while at higher concentrations, a healing effect was produced by influence on proteins and colloidal tissue.2, 15 Fluid extracts administered parenterally to rabbits were also vasoconstrictive, 2, 16 reducing suppuration in purulent skin.2

Clinical data

Older, uncontrolled clinical studies evaluated the efficacy of Hamamelis preparations in anorectal conditions (eg, hemorrhoids). Equivalence with bismuth subgallate has been shown.2, 17

In healthy volunteers, topical extracts of Hamamelis reduced the erythema consequent to ultraviolet (UV) and chemical irritation to a lesser extent than hydrocortisone 1%, but greater than the antihistamine (dimethindene).2, 18, 19, 20 In an open-label study, Hamamelis 6.25% ointment was effective in reducing symptoms related to minor skin injuries, diaper dermatitis, and localized inflammation of the skin in children.21

Limited clinical studies exist on the use of Hamamelis ointment in managing eczema. Results of these studies are equivocal, with some reporting no difference in Hamamelis ointment over placebo.2, 22 Polyphenols from Hamamelis have been used in collagen sponges in studies on long-term wound healing.23

Other uses

Hamamelis cream has been used as an analgesic following episiotomy or perineal trauma following childbirth; no difference in pain relief or additional analgesic use was observed between use of witch hazel and an ice pack.2, 24, 25

Antioxidant properties have been described for Hamamelis extracts.2, 26 This line of study is in the context of antiaging dermatological preparations; however, the activity of witch hazel appears lower compared with other preparations.27, 28

H. virginiana mouthwash was much less effective at reducing tooth biofilm and plaque compared to other agents tested in a 4-week randomized blind study (n=50). Chlorhexidine gluconate, cetylpyridinium chloride, and triclosan reduced mean plaque index values significantly (range, 66% to 69% at baseline to 13% to 32%), whereas H. virginiana produced a much smaller reduction (71% to 59%).29

Fractions of Hamamelis extracts have been evaluated in vitro for antitumor and UV protective activity.30, 31, 32

Prevention of purpuric lesions associated with tattooed skin by incorporating witch hazel into tattoo ink has also been suggested in a case study.33

Dosing

Topical

Steam distillates of Hamamelis are used diluted (1:3 with water) or undiluted, and in semisolid preparations at 5% to 10% of crude drug.2, 34

Rectal

Suppositories containing witch hazel contain 0.1 to 1 g/dose.2, 34

Oral

Not recommended.2, 34

Pregnancy / Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.2

Interactions

None well documented.

Adverse Reactions

Although tannins are not usually absorbed following oral administration, doses of Hamamelis extracts 1 g have caused nausea, vomiting, or constipation. Hepatic damage may occur if the tannins are absorbed to an appreciable extent.3, 35 Witch hazel water is not intended for internal use. Teas can be brewed from leaves and twigs commercially available in some health food stores, but their safety is unknown.

Allergic contact dermatitis has been reported, and cross-sensitivity to Compositae plants (including arnica and chamomile) is possible.2, 36, 37

Toxicology

Information is generally lacking. Aqueous extract of Hamamelis leaves were not carcinogenic to rodents when administered subcutaneously.2 Although the volatile oil contains the carcinogen safrole, it is found in much smaller quantities than in sassafras.5 Extracts of witch hazel are available commercially; however, it is not recommended that they be taken internally because the toxicity of the tannins has not been well defined.11 Witch hazel accounted for 6% of reported adverse events to the California Poison Control System from January 1997 to June 1998.38

References

1. Hamamelis virginiana L. USDA, NRCS. 2011. The PLANTS database (http://plants.usda.gov, October 2011). National Plant Team, Greensboro, NC 27401–4901 USA.
2. Folium et Cortex Hamamelidis. In: WHO Monographs on Selected Medicinal Plants. Vol. 2. Geneva, Switzerland: World Health Organization; 2004. apps.who.int/medicinedocs/en/d/Js4927e/14.html#Js4927e.14
3. Bisset N. Herbal Drugs and Phytopharmaceuticals. Stuttgart, Germany: CRC Press; 1994.
4. Chevallier A. The Encyclopedia of Medicinal Plants. New York, NY: DK Publishing; 1996.
5. Duke JA. Handbook of Medicinal Herbs. Boca Raton, FL: CRC Press; 1985.
6. Bernard P, Bovis A. Chromatographic assay of galenic preparations from Hamamelis leaves [in French]. J Pharm Belg. 1971;26(6):661-668.5142152
7. Vennat B, Pourrat H, Pouget MP, Gross D, Pourrat A. Tannins from Hamamelis virginiana identification of proanthocyanidins and hamamelitannin quantification in leaf, bark, and stem extracts. Planta Medica. 1988;54(5):454-457.17265314
8. González MJ, Torres JL, Medina I. Impact of thermal processing on the activity of gallotannins and condensed tannins from Hamamelis virginiana used as functional ingredients in seafood. J Agric Food Chem. 2010;58(7):4274-4283.20222659
9. Duckstein SM, Stintzing FC. Investigation on the phenolic constituents in Hamamelis virginiana leaves by HPLC-DAD and LC-MS/MS. Anal Bioanal Chem. 2011;401(2):677-688.21626454
10. Wang H, Provan GJ, Helliwell K. Determination of hamamelitannin, catechins and gallic acid in witch hazel bark, twig and leaf by HPLC. J Pharm Biomed Anal. 2003;33(4):539-544.14623578
11. Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-Care Professionals. London, England: Pharmaceutical Press; 1996.
12. Kiran MD, Adikesavan NV, Cirioni O, et al. Discovery of a quorum-sensing inhibitor of drug-resistant staphylococcal infections by structure-based virtual screening. Mol Pharmacol. 2008;73(5):1578-1586.18314496
13. Iauk L, Lo Bue AM, Milazzo I, Rapisarda A, Blandino G. Antibacterial activity of medicinal plant extracts against periodontopathic bacteria. Phytother Res. 2003;17(6):599-604.12820224
14. Gloor M, Reichling J, Wasik B, Holzgang HE. Antiseptic effect of a topical dermatological formulation that contains Hamamelis distillate and urea. Forsch Komplementarmed Klass Naturheilkd. 2002;9(3):153-159.
15. Bate-Smith EC. Haemanalysis of tannins: the concept of relative astringency. Phytochemistry. 1973;12(4):907-912.
16. Bernard P, Balansard P, Balansard G, Bovis A. Venitonic pharmacodynamic value of galenic preparations with a base of hamamelis leaves [in French]. J Pharm Belg. 1972;27(4):505-512.
17. Weiner B, et al. Medical management of hemorrhoids: pharmacist's role in counseling the hemorrhoid patient. Nat Assoc Retail Drug J. 1983;105:459.
18. Hughes-Formella BJ, Filbry A, Gassmueller J, Rippke F. Anti-inflammatory efficacy of topical preparations with 10% hamamelis distillate in a UV erythema test. Skin Pharmacol Appl Skin Physiol. 2002;15(2):125-132.11867970
19. Reuter J, Wölfle U, Korting HC, Schempp C. Which plant for which skin disease? Part 2: Dermatophytes, chronic venous insufficiency, photoprotection, actinic keratoses, vitiligo, hair loss, cosmetic indications. J Dtsch Dermatol Ges. 2010;8(11):866-873.20707877
20. Deters A, Dauer A, Schnetz E, Fartasch M, Hensel A. High molecular compounds (polysaccharides and proanthocyanidins) from Hamamelis virginiana bark: influence on human skin keratinocyte proliferation and differentiation and influence on irritated skin. Phytochemistry. 2001;58(6):949-958.11684194
21. Wolff HH, Kieser M. Hamamelis in children with skin disorders and skin injuries: results of an observational study. Eur J Pediatr. 2007;166(9):943-948.17177071
22. Yates JE, Phifer JB, Flake D. Clinical inquiries. Do nonmedicated topical relieve childhood eczema? J Fam Pract. 2009;58(5):280-281.19442393
23. Francesko A, Rocasalbas G, Touriño S, et al. Cross-linked collagen sponges loaded with plant polyphenols with inhibitory activity towards chronic wound enzymes. Biotechnol J. 2011;6(10):1208-1218.
24. East CE, Begg L, Henshall NE, Marchant P, Wallace K. Local cooling for relieving pain from perineal trauma sustained during childbirth. Cochrane Database Syst Rev. 2007;(4):CD006304.17943903
25. East CE, Begg L, Henshall NE, Marchant P, Wallace K. Local cooling for relieving pain from perineal trauma sustained during childbirth. Cochrane Database Syst Rev. 2012;(5):CD006304.
26. Choi HR, Choi JS, Han YN, Bae SJ, Chung HY. Peroxynitrite scavenging activity of herb extracts. Phytother Res. 2002;16(4):364-367.12112294
27. Thring TS, Hili P, Naughton DP. Anti-collagenase, anti-elastase and anti-oxidant activities of extracts from 21 plants. BMC Complement Altern Med. 2009;9:27.19653897
28. Touriño S, Lizárraga D, Carreras A, et al. Highly galloylated tannin fractions from witch hazel (Hamamelis virginiana) bark: electron transfer capacity, in vitro antioxidant activity, and effects on skin-related cells. Chem Res Toxicol. 2008;21(3):696-704.18311930
29. Mouchrek Junior JC, Nunes LH, Arruda CS, et al. Effectiveness of oral antiseptics on tooth biofilm: A study in vivo. J Contemp Dent Pract. 2015;16(8):674-8.
30. Lizárraga D, Touriño S, Reyes-Zurita FJ, et al. Witch hazel ( Hamamelis virginiana) fractions and the importance of gallate moieties—electron transfer capacities in their antitumoral properties. J Agric Food Chem. 2008;56(24):11675-11682.19035659
31. Habtemariam S. Hamamelitannin from Hamamelis virginiana inhibits the tumour necrosis factor-alpha (TNF)-induced endothelial cell death in vitro. Toxicon. 2002;40(1):83-88.11602283
32. Dauer A, Hensel A, Lhoste E, Knasmüller S, Mersch-Sundermann V. Genotoxic and antigenotoxic effects of catechin and tannins from the bark of Hamamelis virginiana L. in metabolically competent, human hepatoma cells (Hep G2) using single cell gel electrophoresis. Phytochemistry. 2003;63(2):199-207.12711142
33. Pinal-Fernandez I, Solans-Laqué R. The 'sparing phenomenon' of purpuric rash over tattooed skin. Dermatology. 2014;228(1):27-30.
34. Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000.
35. Spoerke DG. Herbal Medications. Santa Barbara, CA: Woodbridge Press; 1980.
36. Granlund H. Contact allergy to witch hazel. Contact Derm. 1994;31(3):195.7821023
37. Paulsen E, Chistensen LP, Andersen KE. Cosmetics and herbal remedies with Compositae plant extracts–are they tolerated by Compositae-allergic patients? Contact Dermatitis. 2008;58(1):15-23.18154553
38. Yang S, Dennehy CE, Tsourounis C. Characterizing adverse events reported to the California Poison Control System on herbal remedies and dietary supplements: a pilot study. J Herb Pharmacother. 2002;2(3):1-11.15277085

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This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

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