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GUTTIFERAE(St John's Wort or Mangosteen family)
Also known as the Clusiaceae, this family comprises 1350 species in 47 genera found mainly in tropical regions but also in northern temperate regions. They are trees, shrubs, lianes and herbs with yellow or otherwise brightly coloured resinous juice. A number of useful timbers, drugs, dyes, gums, pigments, and resins are derived from members of the family (Mabberley 1987). The family now includes genera previously classified in the family Hypericaceae. Hypericum L. species and cultivars are widely cultivated as ornamentals. Hypericum perforatum L. (St John's wort) has recently become recognised as a herbal remedy for mild depression, but its potential to interact with other drugs, along with its dermatological side-effects, has led to calls to limit its availability to pharmacies only (Schultz 2001). The active antidepressant principle appears to be hyperforin, a prenylated phloroglucinol (Barnes et al. 2001). Several Hypericum L. species are well-known for their photosensitising activity in animals following ingestion, but although extracts of Hypericum perforatum L. are used orally by humans in the treatment of mild depression, photosensitisation is only rarely reported. Other genera, especially those found in tropical regions have well documented uses in folk medicine for a variety of skin affections. Topical activity against scabies, other ectoparasites, and ringworm is reported as well as against other causes of itch. Some insecticidal compounds have been characterised. The various oils and gum-resins obtained from members of this family also have reputations as healing agents for cuts and wounds as well as for ulcers. Occasional reports of contact dermatitis have appeared but the identity of the contact allergens / irritants is largely unknown. Mabberley (1987) notes that this genus comprises 187 species found mostly in IndoMalaysia. According to Willis (1973), C. tacamahaca Willd. and other species yield a resin known as tacamahac. Perry & Metzger (1980) record that the sap (? gum-resin) of the bark may be used to heal wounds and boils. The moist sawdust of jacareúba, especially that of older trees, caused persistent dermatitis and folliculitis in Brazilian woodworkers (Freise 1932, 1936). According to Lewis & Elvin-Lewis (1977), this species has been used in folk medicine to treat skin diseases.
The timber from this tree is known as Borneo mahogany. The green, strongly scented seed oil is known variously as domba oil, pinnay oil, tamanu oil, or dilo oil (Dweck & Meadows 2002). The sap of this species irritates the skin and eyes (Morton 1971). Githens (1949) lists the leaf and bark of this species as being rubefacient; and both Quisumbing (1951) and Morton (1962a) note that the oil derived from the seeds has rubefacient and irritant properties. The wood can produce dermatitis (Lewin 1962). According to Ridley (1906), the oil from the kernel has been used for ringworm. Nadkarni (1976) and Perry & Metzger (1980) record that the oil from the seeds may be used to treat scabies and ringworm and that the gum-resin exuding from the wounded bark is a remedy for infected wounds and ulcers. Perry & Metzger (1980) also noted that water from soaking slashed leaves may be used as a wash for inflamed eyes, whilst water squeezed from the leaves is an astringent that may be used to treat haemorrhoids. These and other uses of the plant have been reviewed in detail by Dweck & Meadows (2002). In a study involving 6 individuals bearing aged scars (1 year old or more), twice daily application for 9 weeks of a product of unspecified composition containing tamanu oil appeared to reduce the size of the scars and hence improved their appearance (Dweck & Meadows 2002). Le Coz (2004) described a case of allergic contact dermatitis caused by commercial products containing tocopheryl acetate-stabilised tamanu oil that had been used topically as a remedy for insect bites. Patch tests demonstrated sensitivity to the tamanu oil products (1% v/v in olive oil); no reactions were observed in 30 control subjects. UVA irradiation exacerbated the reaction to the oil in the patient. Patch tests with olive oil (see Olea europaea L., fam. Oleaceae) and with tocopheryl acetate (10% in petrolatum) elicited no reaction.
Perry & Metzger (1980) record that the gum-resin from these species, heated with coconut milk, may be applied to relieve itching and other skin affections. According to Nadkarni (1976), the oil from the seeds is used in Indian traditional medicine to treat leprosy and other cutaneous affections. According to Mabberley (1987), this genus comprises 21 species found in tropical South America. Willis (1973) notes that some species yield a useful hard timber known as tamacoari and a medicinal balsam. The sap of the bark and sapwood of this and other Caraipa species is said to be so caustic as to blister the skin (Record & Mell 1924, Record & Hess 1943). von Reis & Lipp (1982) found an herbarium note stating that the resin from this plant is used for treating leprosy and boils (in Venezuela).
In Cuba and Venezuela, resin obtained from the trunk and mature fruits is used in powdered form as an external application for sore muscles surrounding fractures and dislocations (Morton 1962a). von Reis & Lipp (1982) found an herbarium note stating that (in Mexico) the thick yellow latex from this plant is used to cure "granos" [= acne or pimples]. [Further information available but not yet included in database]
In a survey of the medicinal plants of East and South East Asia, Perry & Metzger (1980) recorded that on the Malay Peninsula and in Indonesia, the bark and leaves of these species pounded with coconut milk may be applied for skin troubles. About 400 species are found in tropical regions, especially of Asia, and in southern Africa (Mabberley 1987).
The gum-resin of this species is known as Cambodian gamboge. Mahendran & Shyamala Devi (2001) note that the rind of the fruits is an astringent and may be used in Indian traditional medicine for the treatment of ulcers and haemorrhoids. In a survey of the medicinal plants of East and South East Asia, Perry & Metzger (1980) recorded that on the Malay Peninsula, the juice from the roots is rubbed on cuts.
The gum-resin derived from this species is known as Siam gamboge or Cambodia gamboge. It has an acrid taste and when powdered is strongly sternutatory (Wren 1975). Care should be taken not to confuse gamboge with camboge lacquer, the latter being derived from Gluta laccifera Ding Hou (fam. Anacardiaceae), a source of allergenic and caustic alk(en)ylcatechols. [Further information available but not yet included in database] According to Watt & Breyer-Brandwijk (1962), a decoction of the bark is used by the Bemba as a lotion for septic and venereal sores. Kokum oil or kokum butter, also known as Goa butter derived from the seeds of this species may be used externally to heal ulcers, fissures of the lips, chapped skin, etc. (Nadkarni 1976). Ainslie (1937) noted that in Nigeria the powdered bark is applied to malignant tumours; the sap is used for parasitic skin diseases; and the latex or gum is applied externally to fresh wounds. In a survey of the medicinal plants of East and South East Asia, Perry & Metzger (1980) recorded that in Indonesia, the gum which flows from the wounded bark is used on leg wounds. The rind of the edible fruit is used for astringent purposes (Corner 1952). In a survey of the medicinal plants of East and South East Asia, Perry & Metzger (1980) recorded that on the Malay Peninsula, a decoction of the leaves with unripe banana and benzoin is applied externally for circumcision wounds. The gum-resin derived from this species is known as Ceylon, Indian, or Malabar gamboge. Nadkarni (1976) notes that the gum-resin is prepared as a paste for application to sprains, bruises, and swollen hands and feet. In a survey of the medicinal plants of East and South East Asia, Perry & Metzger (1980) recorded that in China, the gum resin is used either alone as a powder, or as an ingredient in preparations for the treatment of wounds, cancerous sores, and indolent ulcers. Gamboge is irritant to the eyes of rabbits (Duke-Elder & MacFaul 1972b). In a survey of the medicinal plants of East and South East Asia, Perry & Metzger (1980) recorded that the bark of this species with that of G. vilersiana Pierre crushed with a little alcohol makes a poultice to apply to sprains and morbid wounds. In West Africa, the yellow resinous sap makes a dressing for wounds (Dalziel 1937). [See Garcinia oliveri Pierre above] The genus is monotypic, the single species being found in tropical Africa and Mauritius (Mabberley 1987). Irvine (1961) notes that the sap is red and watery, but when the outer bark is removed a yellow (gummy) sap appears. Further, the reddish sap is styptic and applied to craw-craw and itch, or dried and pulverised and applied to wounds. Irvine (1961) also records that on the Ivory Coast in West Africa the gummy sap is applied locally for skin diseases, leprosy spots, and itch (mange). Githens (1949) notes that in Madagascar, the gummy exudate is used for scabies and that the resin from the flower is used as a rubefacient. von Reis & Lipp (1982) found an herbarium note stating that this plant is used for ringworm in Liberia. About 370 species are found in temperate regions and on tropical mountains (Mabberley 1987). Ingestion of the plants by animals can lead to primary photosensitisation from absorption of the plant pigment hypericin, producing a condition known as hypericism (Kingsbury 1964, Morton 1971). At least four species have been implicated, namely H. aethiopicum Thunb., H. crispum L., H. perforatum L., and H. revolutum Vahl (Pathak 1986). Watt & Breyer-Brandwijk (1962) provide an extensive bibliography dating back to 1787. The idea, formerly held, that contact with the plant was responsible for the condition has been disproved (Henry 1922). Photosensitivity from ingestion of the plants has not been observed in humans, but Novak et al. (1974) claimed success in treating vitiligo by oral administration and topical application of extracts of the plants. Farmer (1941) reported a case of contact dermatitis from St John's wort. A bullous patch test reaction was observed. Experimental feeding of the dried plant material to Merino sheep produced intense photosensitisation and oedematous swellings of the exposed parts of the skin. A deep red fluorescent pigment, soluble in acetone, alcohol and water, was extracted from the plant material and injected into sheep. This too caused marked photosensitisation. Symptoms were not accompanied by icterus (Quin 1933). Rabanal et al. (2002) investigating the traditional Canarian use of this species for skin infections, demonstrated antibacterial activity of variously prepared extracts against several test organisms. No antifungal activity could be demonstrated. Rabanal et al. (2002) investigating the traditional Canarian use of this species for skin infections, demonstrated antibacterial activity of variously prepared extracts against several test organisms. No antifungal activity could be demonstrated. Rabanal et al. (2002) investigating the traditional Canarian use of this species for skin infections, demonstrated antibacterial activity of variously prepared extracts against several test organisms. No antifungal activity could be demonstrated. Perry & Metzger (1980) noted that sap from the fresh leaves of this oriental plant is used on cuts and bruises; that a decoction of the mature dried plant acts as a styptic on wounds; and that a poultice of the crushed leaves and green stem may be applied to dog bites and bee stings. A case has been described (Torinuki 1990) of a 6 year old boy with acute eczema on the buttocks who was treated by his mother with a topical application of an aqueous solution extracted from Hypericum erectum. After using this for a week, pruritic erythematous eruptions suggestive of erythema multiforme developed on his thighs and buttocks and spread to the trunk. He was treated with topical corticosteroids. No patch testing was carried out. Mukherjee & Suresh (2000) investigating the traditional use of this species in India as a wound healing agent, prepared ointments from the dried extracts of the leaves and stems of this plant. The leaf extract in particular significantly enhanced various healing parameters in two experimental rat wound healing models. In traditional Chinese medicine, the dried whole plant is known as di er cao (Herba Hyperici Japonici); the extract of the plant is known as tian ji huang. Perry & Metzger (1980) noted that in China and Vietnam, this plant has been applied externally as a vulnerary in treating scrofula, contusions, abscesses, wounds, fungoid skin diseases, and leech bites. Mukherjee et al. (2000) reported that the leaves of this species are used by the people of Nilgiris, Tamilnadu, India for their wound healing activity. An ointment prepared from the methanol extract of the leaves was found to exhibit beneficial effects on various wound healing parameters in rat excisional and incisional wound models.
The fresh flowers of Hypericum perforatum in olive oil make a healing application to wounds, sores, ulcers, and swellings (Wren 1975). Both Ruddock (1937) and Stuart (1979) assert that H. perforatum is one of the most effective agents for assisting in the healing of wounds and burns when applied externally, especially when nervous tissue has been damaged. It is also applied to haemorrhoids and bruises. Ruddock (1937) also notes that an extract of the plant in warm linseed oil is an invaluable application in the case of bedsores [= decubitus ulcers]. Schempp et al. (2003a) prepared a Hypericum Cream for topical use standardised to contain 1.5% hyperforin, a substance in Hypericum Perforatum Extract and which has previously been shown to possess anti-inflammatory and antibacterial activity. This cream was tested in 21 patients with mild to moderate atopic dermatitis for a period of four weeks. Significant improvement relative to a control group treated with the vehicle alone was reported. There is some confusion regarding the nature of various extracts and preparations described in the literature. Infusions of the herb or flowers in a bland fixed oil such as olive oil are sometimes described as Hypericum Perforatum Extract and sometimes as Hypericum Perforatum Oil. A fixed oil can also be extracted or expressed from the seeds of the plant, whilst an aromatic volatile oil can be distilled from the whole plant - each of these too being described as Hypericum Perforatum Oil. The term Hypericum Perforatum Extract may also refer to a product prepared by solvent (e.g. methanol; ethanol) extraction of the capsules, leaves, and stem heads followed by evaporation of the solvent. Therefore, care has to be taken to determine exactly how extracts have been prepared when interpreting the literature on this subject. Both "Hypericum Perforatum Extract" and "Hypericum Perforatum Oil" have been included in cosmetic formulations. In a report (Zondlo Fiume 2001) on the safety of these preparations, it was noted that mixtures of the Extract and the Oil produced minimal or no ocular irritation in rabbit eyes; nor were they irritating or sensitising to the skin of animals or humans. However, animals fed the flowers for 2 weeks did show signs of dermal toxicity. It was further noted that adverse reactions to Hypericum Extract in the clinical treatment of depression include skin reddening and itching. Schempp et al. (2000) investigated the effect of topically applied Hypericum Oil and Hypericum Ointment on skin sensitivity to simulated solar radiation. No effect could be detected visually but erythema could be detected using sensitive photometric measurements in those treated with Hypericum oil. A number of studies have provided experimental evidence of the ability of the plant or extracts prepared from it to induce photosensitivity in animals including calves (Araya & Ford 1981), Australian Merino sheep (Bourke 2000), and German Blackface sheep (Kumper 1989). Administration of hypericin (the photosensitising pigment present in Hypericum perforatum) to a non-human primate at a dose level of 5 mg/kg produced a severe photosensitivity skin reaction (Fox et al. 2001). The phototoxic activity of Hypericum perforatum extract has been confirmed in cultured human keratinocytes by Bernd et al. (1999). Cotterill (2001) described a case of a patient who developed a severe phototoxic reaction to laser light at 532 nm and also an exaggerated and unexpectedly severe response to pulsed dye laser light at 585 nm. It subsequently transpired that the patient was taking St John's wort at the time of the treatment. In another case (Golsch et al. 1997), a 61-year old woman with depression developed recurring elevated itching erythematous lesions in light-exposed areas after taking St John's wort for three years. Other cases of erythroderma / photosensitivity associated with the use of St John's wort are described by Holme & Roberts (2000) and by Lane Brown (2000). However, the incidence of adverse skin reactions in humans taking St John's wort for depression is about 1 per 300000 treated cases whilst the incidence of all adverse reactions is 1–3% (Schulz 2001). These clinical observations are consistent with the outcome of a study reported by Schempp et al. (2003b) from which it was concluded that at typical clinical doses of Hypericum Perforatum Extract used to treat mild depression, administered for 7 days, no evidence of increased photosensitivity could be detected.
Experimental feeding of dried plant material (identified as Hypericum leucoptychodes) to Merino sheep produced photosensitisation but the effect was much weaker than that observed in similar feeding experiments with Hypericum aethiopicum Thunb. var. glaucescens Sond. (Quin 1933). Perry & Metzger (1980) noted that in China, this species has been used as a vulnerary in treating scrofula and contusions. This species is a source of 2,6-dimethoxy-1,4-benzoquinone (de Barros Corrêa et al. 1970), a known contact allergen (Hausen 1978a). The wood is said by Nigerian wood-workers to cause "skin itches" (von Werndorff 1964). Irvine (1961) notes that the resinous sap, or a lotion made from its roots, is used in West Africa for craw-craw and parasitic skin diseases. According to Castellani & Chalmers (1919), craw-craw is a term used by African natives to denote practically any pruriginous skin disease. These authors go on to note that most so-called craw-craw cases are cases of neglected scabies or of tinea corporis and are otherwise known as cooly itch or dermatitis pruriginosa tropica. Irvine (1961), on the other hand, identifies craw-craw as a form of filariasis. Irvine (1961) further notes that the bark shavings are used as rubbings for skin eruptions and for itch in dogs; that a bark decoction is used for rheumatic pains and to clear ulcers; and that a thick paste of pulped fruits, mixed with root and bark infusion, is painted on itch and other skin afflictions and allowed to dry. Crombie et al. (1972) noted that Mammea africana contains a similar insecticidal mixture to that found in Mammea americana L. Lans et al. (2000), investigating ethnoveterinary medicines in Trinidad and Tobago, recorded the use of the seeds of this species for controlling ectoparasites in dogs. The isolation and structure of the insecticidal 5,7-dihydroxycoumarins from the seeds was reported by Crombie et al. (1970, 1972). Mammea americana is cultivated for its edible fruit, the mammee apple, mammea or San Domingo apricot. The flowers are used in preparing a liqueur, eau de Créole (Willis 1973, Mabberley 1987).
Biswas & Mukherjee (2003) list this species as a plant whose stamens are used to treat erysipelas in Ayurvedic medicine. The fixed oil expressed from the seeds is also used in Indian traditional medicine as an application to cutaneous affections such as sores, scabies, and wounds; it is also used as an embrocation in rheumatism (Nadkarni 1976), suggesting that it may be rubefacient. Perry & Metzger (1980) noted that in Indonesia, the pounded kernels of the seeds may be applied externally for poulticing wounds and all forms of skin eruptions; and that the oil from the seeds may similarly be applied to affected spots. The report of the International Labor Office listed ironwood as a source of dermatitis (Senear 1933). He found that there were three woods named ironwoods viz. the above, Eusideroxylon zwageri Teijsm. & Binnend. (fam. Lauraceae; Borneo ironwood) and Hopea parviflora Bedd. (fam. Dipterocarpaceae; Malabar ironwood) and that it was not possible to decide which, if any, of these botanical species was relevant. Gardner & Bennetts (1956) note that the timber from the Australian tree Erythrophleum chlorostachys Baill. (fam. Leguminosae) also is known as ironwood. In West Africa, the seeds are a source of a greyish-yellow fat (known as Sierra Leone, Kanga, or lamy butter) which is used for cooking, soap making, and other purposes, hence the common names of the plant. This fat is used as an application to kill lice, jiggers, etc. The bark infusion is used in lotions for parasitic skin diseases (Irvine 1961). According to Githens (1949), a preparation of the root and leaf of this species has been used topically in Africa as a treatment for eczema. Watt & Breyer-Brandwijk (1962) record that the boiled root of this species has been reported to be an effective remedy against scabies and lice. According to Irvine (1961), the bark, with its red resin, and the pounded dried roots are a remedy for skin diseases such as scabies and craw-craw. Kerharo & Bouquet (1950) note that on the Ivory Coast in West Africa the pulped roots and bark are applied locally for skin diseases. Pobéguin (1912) notes that the boiled bark gives a soapy product which is mixed with oil to rub on the skin or applied to sores of animals to keep away flies.
Irvine (1961) records that the leaves and twigs, boiled and the oil skimmed off, are used for craw-craw and similar conditions. Aubréville 1936 notes that in West Africa the bark infusion is used in the treatment of subcutaneous wounds and eruptions. Preparations of this tree have also been used extensively in Central Africa for scabies (Irvine 1961).
In tropical West Africa, the bark is used for parasitic skin diseases (Dalziel 1937). Watt & Breyer-Brandwijk (1962), referring to P. febrifugum, note that the plant, especially the bark, has been regarded as having antileprous properties and to be of value against skin diseases and the bites of insects. They also note that the ground root mixed with oil is used as a remedy for pimples, skin eruptions and wounds. von Reis & Lipp (1982) found an herbarium note stating that the greenish yellow gum from this plant is used for wounds and cuts (in Panama). Perry & Metzger (1980) noted that the sap from the bark, if in contact with the skin, causes itch. In West Africa, the resin is used for craw-craw and other sores, for itch, and also is applied to wounds to protect from "flesh worms" (Irvine 1961); Brazilians use the seed oil of this species for dermatoses (Usher 1974, Schultes & Raffauf 1990); and Columbians prepare a decoction of the bark to rub on the skin for the treatment of cutaneous leishmaniasis (Lopez et al. 2001). von Reis & Lipp (1982) found an herbarium note stating that the branches of this species are covered with stinging ants in abundance. This suggests that the plant may be a "super-nettle" or myrmecophyte. Schmidt (1985) provides an extensive review of the dermatological hazard associated with such "ant plants".
The pounded yellowish-red resin makes an ointment for craw-craw; the sap is reportedly applied to circumcision wounds in Sierra Leone (Irvine 1961). Lopez et al. (2001) noted that in Columbian traditional medicine, the bark of this species is used externally in the treatment of cutaneous infections while the resin is used to treat carate [= pinta or mal del pinto; a contagious treponematosis affecting only the skin and caused by Treponaema carateum]. References
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