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CANNABACEAE

(Hemp family)

• Medicinal / Folk-medicinal aspects: Preparations for treating sore eyes have been used in traditional medicine in both Central Africa and Central America. Some other uses, mostly for skin infections and wound healing have been recorded from in and around northern India; and for pediculosis in northern Africa. •
• Adverse effects: Cannabis sativa L. and Humulus lupulus L. are both documented as causes of occupational allergic contact dermatitis. The responsible allergens have not been unequivocally identified. Mechanical irritation of the skin and eyes caused by rough hairs present on many species and mechanical injury caused by the spines on other species may also occur. Timber derived from certain Celtis L. species has been reported to produce skin reactions in woodworkers. •
• Veterinary aspects: Dermatitis and photodermatitis in cattle has been ascribed to a member of the genus Trema Lour. in Australia. •

Once included in the Moraceae and formerly known as the Cannabidaceae or Cannabinaceae, this family was until recently considered to comprise just 4 species in 2 genera, namely Cannabis L. and Humulus L. The transfer into this family by the Angiosperm Phylogeny Group (2003) of a number of genera formerly included in the Ulmaceae or Celtidaceae has now expanded the Cannabaceae to 9 genera and about 90 species (Mabberley 2017).

Two of the species are of unusual economic importance. Cannabis sativa L. provides the fibre hemp from its stems, cannabis resin from its flowering tops, and bird seed and fishing bait from its seeds. The plant is cultivated mainly (and illicitly) for its resin, which has mood and perception altering properties. Humulus lupulus L., a climbing herb, is also extensively cultivated. It provides hops. These are used both in the brewing industry and at home in the production of beer and similar alcoholic beverages. Thus, a large number of people throughout tropical and temperate regions are likely to come into contact with the plants or their products.

Some Celtis L. species are known to horticulture, being grown as ornamental trees (Hunt 1968/70). Several provide useful timber (Irvine 1961).

Humulus lupulus L. is included in a number of proprietary herbal sedative preparations (Stuart 1979, Wren 1988, Reynolds 1996). It may also be used in a smoke or tea (Siegel 1976).

Cannabis sativa L.: [syns Cannabis indica Lam., Cannabis ruderalis Janisch.]
Indian Hemp, Marihuana, Marijuana, True Hemp

Although it is commonly believed that the morphological differences seen in different populations of the cannabis plant are indicative of the existence of two or even three distinct species (Cannabis indica Lam., Cannabis ruderalis Janisch., Cannabis sativa L.) or subspecies, only one rather variable species is now accepted (Lapierre et al. 2023). The previously recognised more northerly cultivated subspecies Cannabis sativa subsp. sativa (loosely, the "Sativa" phenotype) is grown as a source of fibre known as hemp, whilst the more southerly cultivated Cannabis sativa subsp. indica (Lam.) E.Small & Cronquist (loosely, the "Indica" phenotype) yields a psychotropic drug which in its various forms is known as churrus, gunjah, bhang, hashish, marihuana, pot, grass, dagga, kif, etc. (Pereira 1842, Trease & Evans 1966, Mabberley 2017). However, it is now recognised that whilst these phenotypes were originally shaped by natural selection in their respective environments, subsequent domestication has enhanced phytochemical divergence. In a quest to increase the content of the psychoactive component Δ⁹-tetrahydrocannabinol [THC], massive crossbreeding has now obliterated differences between "Sativa" and "Indica" phenotypes, this having been adduced from "DNA barcode" studies (McPartland 2020), creating a multitude of what are now best described as chemotypes, chemovars, or cultivars. Accordingly, due caution needs to be exercised when interpreting the dermatological / medical literature.

A woman who worked in a hemp field developed dermatitis, blepharitis, conjunctivitis, and keratitis; trichiasis resulted (Mieses-Reif 1936). Szegő (1965) also referred to occupational sensitisation to hemp. Contact dermatitis caused by the leaves or flowers in susceptible individuals was noted by Allen (1943) and by Behl et al. (1966).

Workers who process the plant for its fibre, known as hemp, can develop maceration of the skin from standing in water in the retting basins. The dust from the dried fibre may also cause irritation and pruritus. Secondary infection from scratching, and reactions to the oil used in the process can also occur (Slaviero 1915, Schwartz et al. 1957, Hegyi et al. 1965). Meneghini & Gianotti (1953), Touton (1932), Porias (1922) and Oppenheim (1914) also refer to this topic.

Harrison (1906) included Cannabis indica in a list of drugs, applied externally or taken internally, which may cause dermatitis. He could have been referring to the report of a skin eruption in a patient who had taken an extract of cannabis to which Morrow (1893) also referred. Beliaev (1964) provided a case report of a 26-year old man in whom a universal papular and vesicular eruption appeared a few hours after he smoked Indian hemp. Generalised pruritus occurred in another 26-year old male after he smoked cannabis (Schwarzenbach Stöckli & Bircher 2007).

Urticarial eruptions on the hands and lower arms, rhinitis, and conjunctivitis elicited by the dried flowering tops and resin from Cannabis sativa in a criminological technician, who reacted also to hop pollen (Humulus lupulus L. [see below]), was described by Lindemayr & Jäger (1980). A similar case was described by Majmudar et al. (2006).

Silverstein & Lessin (1974) found that the chronic use of marihuana did not decrease the capacity of a subject to become sensitised to, and to develop delayed cutaneous hypersensitivity when challenged with 2,4-dinitrochlorobenzene (DNCB). An arteriopathy known as cannabis arteritis, which leads to digital necrosis necessitating amputation, has been described in cannabis users (Peyrot et al. 2007).

Marihuana can be contaminated with herbicides including Agent Orange, phencyclidine, and paraquat, and also storage fungi belonging to the form-genus Aspergillus Mich., fam. Eurotiaceae (Kagen 1981, Kurup et al. 1983). In addition to the potential toxicity/pathogenicity associated with inhalation of these materials, they may render the results from patch tests with crude plant material or with simple extracts unreliable.

Several surveys of traditional medical practice in and around northern India document the use of the leaves and roots for the treatment of skin affections. Thus, in Islamabad the leaves are crushed with onion [Allium cepa L., fam. Amaryllidaceae] and used in the form of a poultice for boils (Shinwari & Khan 2000); in Nepal, the crushed fresh leaves are rubbed onto skin infections (Joshi & Joshi 2000); in north-eastern India, the crushed root is applied in the treatment of leukoderma and the crushed leaves are applied to pimples, boils, cuts, and wounds (Begum & Nath 2000); and in Meghalaya, India, the crushed leaves are used by the Khasi and Garo tribes for [unspecified] skin diseases (Rao 1981). In a treatise on the Indian materia medica, Nadkarni (1976) asserted that the powder of the leaves applied to fresh wounds promotes granulation.

In traditional Chinese medicine, a preparation of the seeds (Semen Cannabis Sativa; huo ma ren; 火麻仁; Cannabis Fructus; ma zi ren; 麻子仁; da ma; 大麻) is used externally for eruptions, ulcers, favus, wounds, and falling of the hair. The freshly expressed juice from the leaves is also used to stop the hair from falling out and to prevent it from turning grey (Stuart 1911).

In NW Moroccan traditional medicine, the seeds and leaves are kept in olive oil (Olea europea L., fam. Oleaceae) for use as an antipediculous and hair tonic (Merzouki et al. 2000).

Celtis L.
Hackberry, Nettle Tree, Sugar Berry

Classified until recently in the Ulmaceae (Brummitt 1992), and regarded by some authorities (Sattarian 2006) as a member of the Celtidaceae, genetic analysis (Angiosperm Phylogeny Group 2003) now places the genus in the Cannabaceae. It comprises 60–70 species of trees that occur mostly in tropical regions. Some are known in horticulture (Hunt 1968/70), being grown as ornamental trees and as bonsai specimens. They also provide timber, which is noted for its objectionable odour in for example Celtis africana Burm.f. and in Celtis timorensis Span. (syn. Celtis cinnamomea Lindl. ex Planch.), both timbers being known by the common name stinkwood (Irvine 1961, Menninger 1967).

South American Celtis L. species are characterised by the presence of thorns (Berg & Dahlberg 2001). In addition to those species considered separately below, the following may be listed:

Celtis orthacanthos Planch.
Celtis spinosa Spreng.
Celtis tala Gillies ex Planch.

Ainslie (1937) noted that in Nigerian traditional medicine, the leaves of all Celtis L. species are boiled and used as a fomentation for sore eyes.

Celtis boninensis Nakai: [syn. Celtis liukiuensis Nakai]

According to Perry & Metzger (1980), the juice of the leaves of Celtis liukiuensis is reported from Japan to be useful as an antidote to treat lacquer poisoning [see Toxicodendron vernicifluum F.A.Barkley, fam. Anacardiaceae].

Celtis iguanaea (Jacq.) Sarg.: [syns Celtis aculeata Sw., Celtis ehrenbergiana (Klotzsch) Liebm., Celtis spinosa Ruiz ex Miq., Mertensia iguanaea (Jacq.) Schult., Momisia iguanaea (Jacq.) Rose & Standl., Rhamnus iguanaea Jacq.]
Iguana Hackberry, Desert Hackberry

Indians of Yucatan apply the sap from this spiny plant to sore eyes, but in excess it is irritating and may cause blindness (Steggerda 1943).

Celtis madagascariensis Sattarian

The bark is used by the Mikea hunter-gatherers of Madagascar in the treatment of gum disease (Stiles 1998).

Celtis pallida Torr.: [syn. Celtis spinosa var. pallida (Torr.) M.C.Johnst.]
Desert Hackberry, Granjeno, Spiny Hackberry

This medium-sized shrub has smooth grey branches that are zig-zagged and armed^a,b with single and paired thorns (Schindler et al. 2003).

Celtis tessmannii Rendle: [syn. Celtis brieyi De Wild.]

This species provides a timber known as diania, ohia, or Celtis d'Afrique.^a Mucosal and/or cutaneous reactions in persons working with the wood from Celtis brieyi in the Belgian wood-working industry have been reported (see Hublet et al. 1972, Oleffe et al. 1973, Oleffe et al. 1975a).

Celtis timorensis Span.: [syn. Celtis cinnamomea Lindl. ex Planch.]

In north-eastern Indian traditional medicine, the roots and bark are crushed then applied as a paste to cuts and wounds (Begum & Nath 2000).

Chaetachme aristata Planch.: [syns Chaetachme madagascariensis Baker, Chaetachme microcarpa Rendle, Chaetachme serrata Engl.]
Thorny Elm

Classified until recently in the Ulmaceae, this African species forms a scrambling shrub or tree whose branches are distinctly zig-zagged and armed with axillary spines (Irvine 1961, Hyde et al. 2022).

Humulus lupulus L.
Bine, Common Hop, Hops, Echter Hopfen

Dermatitis from hops has long been recognised. Badham (1834) described a case of a 14-year old girl who had been engaged in hop-picking for a week. Because her hands were cold and chapped, she placed them in the hop-bin to warm them. Shortly afterwards, she felt a tingling and smarting of the hands. The affliction was spread to her face because of her habit of passing her hand over her forehead to arrange her hair. She became somnolescent and had visual disturbances. Her face became deeply erythematous and swollen. By the next evening her hands and face were covered with vesicles. Further cases were described or referred to by Danlos (1900), Schaffner (1903a), White (1903), Cleland (1925), Broers (1926), Flury (1927), and Lewith (1928). The dermatitis has been attributed to mechanical abrasion by the rough hairs on the climbing stem (Maiden 1918, Wimmer 1926). Maiden (1918) suggested also that lupulin, a yellow powdery secretion of the glandular hairs on the scales of the hop cones, may be responsible for the irritation.

Systematic studies of occupational hop-related skin diseases have been carried out in the UK by Cookson & Lawton (1953) and in eastern Europe by Tsyrkunov (1978) and by Śpiewak et al. (2001). Krasniuk et al. (1978) also addressed this topic.

The hands of hop-pickers are subject to irritation as the hop cones (strobiles) are removed from their stalks. During wet or dewy weather, the rough hairs are made firmer and the skin is made soft by the moisture. Hop-pickers can develop vesicular dermatitis of the exposed skin of the hands, wrists, and face, and also of the genitals (Galbraith 1924, O'Donovan 1924, Jirásek & Trapl 1960). The eruption may be mistaken for sunburn, impetigo, erysipelas, or urticaria (O'Donovan 1924). In addition to dermatitis of the hands and face, a purpuric eruption on the legs was attributed to hop-picking (Streich 1924). The true hop rash is not difficult to distinguish from bites of "hop-fleas", red spiders, and harvest mites (Cookson & Lawton 1953, Van Thiel 1953).

A 43-year old female who worked in a laboratory carrying out chemical analyses of hops developed conjunctivitis, rhinitis, bronchitis and dermatitis of the face from exposure to airborne hop dust. A patch test with hop dust produced a positive reaction after 2 days, and an intradermal test with an aqueous hop extract produced erythema and a wheal after 5 minutes, suggesting that she had developed both an immediate and a delayed-type hypersensitivity to hops. No tests in controls were reported (Raith & Jäger 1984). Śpiewak & Dutkiewicz (2002) described a case of airborne dermatitis to hops in a 57-year old female farmer who also experienced acute dermatitis of the hands. Prick tests to saline and glycerol extracts of hop leaves and cones were positive; and a glycerol extract of the hop cones produced a positive patch test reaction at 48 h and 72 h. Relapses of her dermatitis occurred upon connubial exposure to hop allergens on her husband, and to hop extract present in an externally-applied beauty cream and in an orally-administered herbal sedative.

The disorder known as hop (or hoppers') eye is probably the result of mechanical injury of the conjunctiva by the spiny hairs found on the top bracts, leaves, and vines of the plant; keratitis and hypopyon can result (Adams 1893, Lewin & Guillery 1913). Merté & Roggenkämper (1974) also referred to this topic. Whitwell (1943) speculated that the urticating hairs from tussock moth (Calliteara pudibunda L., fam. Erebidae, sub-family Lymantriinae) caterpillars — commonly known as "hop dogs" because they were frequently encountered in hop fields before the widespread use of insecticides — might be responsible. Hop (or hoppers') gout is a form of tenosynovitis in pickers (Galbraith 1924, Smithies 1929, Trotter 1929).

The true incidence of hop rash in pickers may be underestimated since persons who are mildly affected leave the seasonal work. Although only 1 in 3000 hop-pickers received medical attention, about 1 in 30 were probably affected by dermatitis (Cookson & Lawton 1953). These authors obtained positive patch test reactions to fresh hop oil (in 6/18 tests), aged hop oil (in 1/18), hop cones (in 6/18), humulone (in 2/18) and lupulone (in 2/18). Fresh hop oil contains about 40% myrcene, but this compound becomes oxidised and disappears from aged hop oil. Irritant reactions were not excluded by their tests (Bettley 1953) but the possibility that insecticides or fungicides were responsible was excluded. Fisher (1975) recommends that β-myrcene is patch tested at 1% in petrolatum.

[Humulone; Lupulone; Myrcene]

Opdyke (1976) documented that β-myrcene applied full strength to intact or abraded rabbit skin for 24 hours under occlusion was moderately irritating, but when tested at 4% in petrolatum it produced no irritation after a 48-hour closed patch test on human subjects. In a maximisation test, myrcene tested at 4% in petrolatum produced no sensitisation reactions in 25 volunteers.

Hops in beer were alleged to have caused dermatitis in a bar-tender (Hurst 1942). Estrada et al. (2002) described a patient who complained of urticaria on both hands while working with ripe dried hops, though not with fresh ones. Type 1 allergy was confirmed by prick test and specific IgE. He also had a history of urticaria-angioedema immediately after oral peanut (Arachis hypogaea L., fam. Leguminosae), banana (probably a triploid, so-called AAA group cultivar of Musa acuminata Colla, fam. Musaceae), and chestnut (Castanea sativa L., fam. Fagaceae) intake. Respiratory allergy to hops can also occur (O'Donovan 1924, Newmark 1978, Godnic-Cvar 1999).

Remington et al. (1918) noted that:

Fomentations with hops, and cataplasms made by mixing them with some emollient substance, are often beneficial in local pains and tumefactions.

This use of hops may have been described originally by Dale (1739) who wrote:

De Lupulo Salictario — Extrinsecus sedat dolores, auxiliatur contusionibus, luxationibus, tumoribus.

Pereira (1842) also referred to this use:

Hops have been applied, topically, in the form of fomentation or poultice, as a resolvent or discutient, in painful swellings and tumours.

Humulus scandens (Lour.) Merr.: [syn. Humulus japonicus Siebold & Zucc.]
Japanese Hop, Wild Hop, Houblon Japonais, Japanischer Hopfen

This is a fast-growing annual twining vine native to the Far East, which has been introduced^a into North America, Europe, and elsewhere as an ornamental. However, in certain countries (for example, USA, Hungary, Italy) it has become invasive, threatening natural vegetation on river banks in particular (Balogh & Dancza 2008). It can climb to heights of 3m (10ft) or more with the help of many small hooked prickles that cover the stem, which can cause irritation to bare skin. The leaves are divided into 5–9 lobes with downward pointed prickles and down-curved bracts at their base. The down-curved bracts and sharp prickles are distinguishing characteristics of this plant (Heise 2015). Stuart (1911) noted that the wild hop of China and Japan is covered with fine prickles which chafe the skin when they come into contact with it.

Humulus Japonicus Extract & Humulus Japonicus Flower/Leaf/Stem Extract [INCI] are recognised cosmetic product ingredients purported, respectively, to have skin protecting and skin conditioning properties (Standing Committee on Cosmetic Products 2019, CosIng 2023/4).

Trema Lour.

Classified until recently in the Ulmaceae (Brummitt 1992), the genus comprises 10–15 fast-growing trees that occur naturally in tropical and warm regions.

Trema cannabina Lour.: [syns Celtis microphylla Zipp. ex Blume, Trema carinatum Blume, Trema morifolium (Planch.) Blume, Trema virgatum (Planch.) Blume]
Lesser Trema, Poison Peach

von Reis Altschul (1973) found an herbarium note stating that in the Solomon Islands, the leaves of Trema cannabina are heated with lime [= calcium hydroxide ?] and applied to boils.

Trema orientale (L.) Blume: [syns Celtis guineensis Schumach. & Thonn., Celtis orientalis L., Trema bracteolatum (Hochst.) Blume, Trema guineense (Schumach. & Thonn.) Ficalho]
Charcoal Tree, Gunpowder Tree, Pigeonwood, Rhodesian Elm, Indian Nettle Tree, Poison Peach, Peach Cedar, Woolly Cedar

The leaves of Trema guineensis [sic], the upper surfaces of which are rough, have been used as a substitute for sandpaper (Williamson 1955). Watt & Breyer-Brandwijk (1962) noted that handling the tree has sometimes resulted in the development of eczema.

Trema tomentosa var. asperum (Brongn.) Hewson: [syns Celtis aspera Brongn., Trema asperum (Brongn.) Blume]
Native Peach, Poison Peach, Peach-Leaved Poison Bush

Referring to Trema aspera, Hurst (1942), citing Ewart & Tovey (1909), noted that the leaves [upon ingestion ?] act as a mechanical irritant to animals or cause impaction of the stomach owing to the tough nature of the fibre. The plant has also been suspected of producing photosensitisation in cattle (Hurst 1942), this ostensibly being a secondary manifestation of the liver damage caused by an ingested hepatotoxin, trematoxin, reported from this species by Oelrichs (1968). However, according to Cullen & Stalker (2016), whilst this species has caused severe losses of cattle in Australia, the syndrome is acute, there is no photosensitization, and mildly intoxicated animals may recover completely.

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