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Ordille AJ, Porter A, Scholl AM. Black Salve: A Dangerous Corrosive Disguised as an Alternative Medicine. Cureus 2023; 15:e41248. [PMID: 37529807 PMCID: PMC10388685 DOI: 10.7759/cureus.41248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
Black salve is a dangerous compound that has long been used as an alternative and complementary medicine despite clear warnings of its hazards from the medical community and governmental agencies. A paucity of information exists for clinicians seeking guidance regarding the management of black salve-related adverse outcomes. Secondary infection is a common sequela of black salve application to skin lesions. This case report presents a summary of the management of a secondary infection in a patient who applied black salve to an open skin wound. The resolution of this patient's symptoms was a function of the interdisciplinary care provided by infectious disease specialists, an acute surgical care team, and dermatologists. The patience, clinical expertise, and judgment provided by these healthcare teams resulted in an appropriate diagnosis while also avoiding unnecessary medical procedures. This case sheds light on one of the varied consequences of black salve use and advocates for the incorporation of multiple medical teams in the management of black salve-related events.
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Affiliation(s)
- Andrew J Ordille
- Biomedical Sciences, Cooper Medical School of Rowan University, Camden, USA
| | - Ashley Porter
- Internal Medicine, Cooper University Hospital, Camden, USA
| | - Amy M Scholl
- Internal Medicine, Cooper University Hospital, Camden, USA
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Croaker A, Liu L, Myers SP. Persisting Cancer in Black Salve Treated Skin Lesions: Results of a Large 5 Year Retrospective Analysis of Australian Histopathology Specimens. Integr Cancer Ther 2023; 22:15347354221151145. [PMID: 36718525 PMCID: PMC9893055 DOI: 10.1177/15347354221151145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND To date there has been minimal research on the use of black salve escharotics. Whether cancer persistence is a frequent finding in treatment areas, the types of lesion being treated by patients, whether rural patients are more likely to use black salve and whether current government prevention initiatives are succeeding are all issues needing investigation. METHODS This study was a large national retrospective black salve pathology case series from 2015 to 2019. Five private pathology companies with 1471 collection centers located in 5 of the 8 Australian states and Territories provided de-identified skin pathology report information where black salve treatment had been documented in the pathology request. RESULTS Over the 5-year period 409 patients had treated 475 lesions with black salve. Benign lesions were present at the treatment site in 18% of cases; persisting cancer was found in 34.2% of the remaining black salve treated areas. The majority of treatment areas were located on the head and neck. Black salve caused necrosis of normal tissue when treating benign lesions, refuting claims of cancer specificity. Likelihood of black salve use increased with rurality based on Modified Monash (MM) scores. Black salve use, despite regulatory efforts, appears to be increasing with specimen numbers more than doubling from 2015 to 2019. CONCLUSIONS Patients undergoing histopathological assessment of black salve treatment areas have high rates of cancer persistence. Patients are applying black salve to benign lesions and lesions in cosmetically sensitive areas. Rural patients have higher proportional rates of black salve use. The increasing incidence of black salve pathology specimens suggests current Australian black salve public health initiatives are failing.
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Affiliation(s)
- Andrew Croaker
- Southern Cross University, Lismore, NSW, Australia,Toormina Medical Centre Skin Cancer Clinic, Toormina, NSW, Australia,Andrew Croaker, Faculty of Health, Southern Cross University, Military Road East, Lismore, NSW 2480, Australia.
| | - Lei Liu
- Southern Cross University, Lismore, NSW, Australia
| | - Stephen P. Myers
- Southern Cross University, Lismore, NSW, Australia,NatMed Research, Evans Head, NSW, Australia
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Rosario N, Castro JF. Black salve: risky escharotic. Scars Burn Heal 2022; 8:20595131221122376. [PMID: 36157312 PMCID: PMC9500246 DOI: 10.1177/20595131221122376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction Black salve ointments are variable in their composition with no standard formula. Patient's may turn to unregulated products to self-treat their conditions. Products that are accessible without a prescription are not necessarily safe and may pose risk to those who use them, as in this case with the use of black salve ointment. Methods This case report discusses the use of black salve ointment on a nodular neck cyst in a 55-year-old Hispanic male patient. The patient applied the black salve ointment (Two Feathers Healing Ointment®) to the cyst, where the ointment remained in contact with his skin for seven days. He required oral antibiotics and was referred to wound care for follow up. Discussion After close follow up and treatment with antibiotics, the eschar healed and left a concave scar on his neck with no other observed complications. Conclusion Healthcare providers are encouraged to discuss complementary and alternative medicine options with patients as some may lead to dangerous effects. Lay Summary This is a case report about a 55 year old male patient who used an over the counter product called Black Salve to treat a cyst on his neck. He came to his primary care doctor's office for a usual checkup. Just before leaving his appointment, he mentioned a dark discolored area on his neck appeared after applying the black salve ointment. The black salve caused his skin to break down, get infected, and turn black. He was treated with antibiotics and close follow up care. After the wound healed, he was left with a scar on his neck from where the ointment broke down the skin. Since this product is available without a prescription, it is important that consumers know that it is not safe for use and may cause complications. If in doubt, ask a healthcare provider about a products risks before use.
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Affiliation(s)
- Natalie Rosario
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Kingsville, USA
| | - Juan F Castro
- Department of Pharmacy Practice, Texas A&M Rangel College of Pharmacy, USA
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Bozung AK, Ko AC, Gallo RA, Rong AJ. Persistent Basal Cell Carcinoma Following Self-Treatment With a "Natural Cure," Sanguinaria canadensis. Ophthalmic Plast Reconstr Surg 2021; 37:e71-e73. [PMID: 32732547 DOI: 10.1097/iop.0000000000001784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A 65-year-old woman presented with a 6-week history of redness, eyelid swelling, and discharge in the right eye. Slit lamp examination revealed right medial canthal erythema with cicatricial lower lid ectropion, retraction, and inferior punctal obliteration. The patient was previously diagnosed with a medial canthal basal cell carcinoma 1.5 years ago, but opted for self-treatment with black salve, a commonly used naturopathic "cure" for skin cancer. Each application resulted in increasingly severe periorbital inflammation with eventual eschar formation. Over time, this led to cicatricial band formation over the medial canthus. After biopsy confirmation of residual basal cell carcinoma within the cicatricial tissues, the patient underwent Mohs surgery followed by multistaged reconstruction. Herein, we report a case of patient whose use of an unproven naturopathic "cure" led to persistent periorbital inflammation, persistence of malignancy, and significant tissue destruction.
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Affiliation(s)
- Alison K Bozung
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Audrey C Ko
- Wolfe Eye Clinic, Des Moines
- Department of Ophthalmology and Visual Sciences, Carver College Of Medicine, Iowa City, Iowa, U.S.A
| | - Ryan A Gallo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Andrew J Rong
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Fravor L, Khachemoune A. Dermatologic uses of bloodroot: a review and reappraisal. Int J Dermatol 2020; 60:1070-1075. [PMID: 33128472 DOI: 10.1111/ijd.15273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 06/26/2020] [Accepted: 09/29/2020] [Indexed: 12/14/2022]
Abstract
Bloodroot (Sanguinaria canadensis) is a plant, native to North America, containing bioactive compounds that interrupt biological processes. It has been around for centuries and is known for its medicinal properties. Today, naturopathic remedies are becoming more and more popular, especially for skin ailments. There are an alarming number of online vendors marketing their bloodroot-containing products as cures for skin cancer without any scientific evidence supporting such claims. Clinical data concerning the efficacy of bloodroot primarily come from case studies with unfavorable outcomes involving patients who self-treated with bloodroot-containing black salves. However, recent preclinical studies have concluded that sanguinarine, the active component of bloodroot, shows positive evidence of being an efficacious treatment for skin cancers at micromolar doses. This article reviews the mechanism of action of bloodroot as a skin cancer treatment, its misuse in clinical dermatology, and the FDA's stance on products containing bloodroot that are marketed and sold to laypersons. Members of the public should be made aware of the dangers of self-treating with bloodroot-containing products through effective communication and education by clinicians.
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Affiliation(s)
- Lauren Fravor
- West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA
| | - Amor Khachemoune
- Veterans Affairs Medical Center, State University of New York Downstate, Brooklyn, NY, USA
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Croaker A, King GJ, Pyne JH, Anoopkumar-Dukie S, Liu L. Black salve composition: An evaluation of the potential for normal tissue toxicity and treatment failure from black salve products. J Herb Med 2019. [DOI: 10.1016/j.hermed.2018.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Duncanson A, Kopstein M, Skopit S. Advanced Presentation of Homeopathically treated Giant Melanoma: A Case Report. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2019; 12:28-31. [PMID: 30881574 PMCID: PMC6405247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We report the case of a 47-year-old woman who presented to the emergency department with a 9.7cm × 8.3cm melanoma on her foot, which impeded her ability to walk. The patient had been treating the fungating mass with black salve after seeking treatment from a homeopathic physician when first noticing a mole increasing in size several years previously. Additionally, we examine published reports of giant melanoma in the literature and investigate the possible maleficence of black salve treatment.
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Affiliation(s)
- Andrew Duncanson
- Drs. Dunconson and Skopit are with the Larkin Community Hospital/LECOM Dermatology Residency Training Program in Miami, Florida
- Dr. Kopstein is with the Sky Ridge Medical Center/RVUCOM Internal Medicine Residency Training Program in Lone Tree, Colorado
| | - Michael Kopstein
- Drs. Dunconson and Skopit are with the Larkin Community Hospital/LECOM Dermatology Residency Training Program in Miami, Florida
- Dr. Kopstein is with the Sky Ridge Medical Center/RVUCOM Internal Medicine Residency Training Program in Lone Tree, Colorado
| | - Stanley Skopit
- Drs. Dunconson and Skopit are with the Larkin Community Hospital/LECOM Dermatology Residency Training Program in Miami, Florida
- Dr. Kopstein is with the Sky Ridge Medical Center/RVUCOM Internal Medicine Residency Training Program in Lone Tree, Colorado
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Abstract
BACKGROUND Alternative herbal remedies for skin cancer are commonly found on the Internet. Many websites contain inaccurate or false information regarding side effects and efficacy. OBJECTIVE To review the evidence behind several commonly advertised herbal remedies that claim to cure skin cancer: black salve, eggplant, frankincense, cannabis, black raspberry, milk thistle, St. John's wort, and turmeric. METHODS A PubMed search was performed using the common and scientific names of frequently advertised herbal remedies along with the terms "nonmelanoma skin cancer," or "basal cell carcinoma" or "squamous cell carcinoma," or "melanoma." RESULTS Some preclinical studies have shown positive evidence that these substances can induce apoptosis in skin cancer, but clinical studies proving efficacy are either insufficient, nonexistent, or show negative evidence. Botanicals that were excluded are those that do not have published studies of their efficacy as skin cancer treatments. CONCLUSION Online advertising may tempt patients to use botanical agents while citing efficacy found in preclinical studies. However, many agents lack strong clinical evidence of efficacy. Dermatologists must be aware of common herbal alternatives for skin cancer treatment to maintain effective patient communication and education.
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Affiliation(s)
- Janet Y Li
- *Both authors are associated with the Department of Medicine, Division of Dermatology, University of Washington School of Medicine, Seattle, Washington
| | - Jeremy T Kampp
- Both authors are associated with the Department of Medicine, Division of Dermatology, University of Washington School of Medicine, Seattle, Washington
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Abstract
The use of complementary and alternative medicines in Australia has grown significantly. Much of this growth is due to their ease of accessibility from online vendors, often marketed with claims that are not scientifically tested. Black salve is a topical escharotic compound containing the active component sanguinarine, derived from the bloodroot plant. It has been advertised as a natural treatment for skin cancer. This article reviews the current state of black salve as an alternative skin cancer treatment, discussing its distribution and regulation, and provides a summary of clinical and laboratory studies. Clinical trials in this area are lacking, with most clinical data in the form of case reports demonstrating suboptimal therapeutic and cosmetic outcomes associated with its use. However, in vitro studies of sanguinarine suggest it causes indiscriminate destruction of healthy and cancerous tissue at doses higher than 5 µM, limiting its practical utility. It is vital that members of the public are aware of the potential effects and toxicity of commercial salve products.
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Affiliation(s)
- Alvin Lim
- a Faculty of Medicine, Dentistry and Health Sciences , University of Melbourne , Parkville , Australia
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Croaker A, King GJ, Pyne JH, Anoopkumar-Dukie S, Simanek V, Liu L. Carcinogenic potential of sanguinarine, a phytochemical used in 'therapeutic' black salve and mouthwash. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2017; 774:46-56. [PMID: 29173498 DOI: 10.1016/j.mrrev.2017.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/17/2017] [Accepted: 09/02/2017] [Indexed: 02/07/2023]
Abstract
Black salves are escharotic skin cancer therapies in clinical use since the mid 19th century. Sanguinaria canadensis, a major ingredient of black salve formulations, contains a number of bioactive phytochemicals including the alkaloid sanguinarine. Despite its prolonged history of clinical use, conflicting experimental results have prevented the carcinogenic potential of sanguinarine from being definitively determined. Sanguinarine has a molecular structure similar to known polyaromatic hydrocarbon carcinogens and is a DNA intercalator. Sanguinarine also generates oxidative and endoplasmic reticulum stress resulting in the unfolded protein response and the formation of 8-hydroxyguanine genetic lesions. Sanguinarine has been the subject of contradictory in vitro and in vivo genotoxicity and murine carcinogenesis test results that have delayed its carcinogenic classification. Despite this, epidemiological studies have linked mouthwash that contains sanguinarine with the development of oral leukoplakia. Sanguinarine is also proposed as an aetiological agent in gallbladder carcinoma. This literature review investigates the carcinogenic potential of sanguinarine. Reasons for contradictory genotoxicity and carcinogenesis results are explored, knowledge gaps identified and a strategy for determining the carcinogenic potential of sanguinarine especialy relating to black salve are discussed. As patients continue to apply black salve, especially to skin regions suffering from field cancerization and skin malignancies, an understanding of the genotoxic and carcinogenic potential of sanguinarine is of urgent clinical relevance.
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Affiliation(s)
- Andrew Croaker
- Southern Cross Plant Science, Southern Cross University, Lismore, NSW, Australia; Wesley Medical Research Institute, Wesley Hospital, Auchenflower, QLD, Australia; Quality Use of Medicines Network, Queensland, Australia
| | - Graham J King
- Southern Cross Plant Science, Southern Cross University, Lismore, NSW, Australia
| | - John H Pyne
- School of Medicine, University of Queensland, St Lucia, QLD, Australia
| | - Shailendra Anoopkumar-Dukie
- Quality Use of Medicines Network, Queensland, Australia; School of Pharmacy and Pharmacology, Griffith University, Gold Coast Campus, Gold Coast, QLD, Australia
| | - Vilim Simanek
- Department of Medical Chemistry and Biochemistry, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic
| | - Lei Liu
- Southern Cross Plant Science, Southern Cross University, Lismore, NSW, Australia.
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A Review of Black Salve: Cancer Specificity, Cure, and Cosmesis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:9184034. [PMID: 28246541 PMCID: PMC5299188 DOI: 10.1155/2017/9184034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/28/2016] [Indexed: 11/28/2022]
Abstract
Black salve is a topical escharotic used for the treatment of skin cancer. Although promoted as a safe and effective alternative to conventional management by its proponents, limited clinical research has been undertaken to assess its efficacy and potential toxicities. Patients are increasingly utilizing the Internet as a source of health information. As a minimally regulated space, the quality and accuracy of this information vary considerably. This review explores four health claims made by black salve vendors, investigating its natural therapy credentials, tumour specificity, and equivalence to orthodox medicine in relation to skin cancer cure rates and cosmesis. Based upon an analysis of in vitro constituent cytotoxicity, in vivo post black salve histology, and experience with Mohs paste, black salve is likely to possess normal tissue toxicity with some cancer cell lines being relatively resistant to its effects. This may explain the incongruous case study reports of excessive scarring, deformity, and treatment failure.
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Sanguinaria canadensis: Traditional Medicine, Phytochemical Composition, Biological Activities and Current Uses. Int J Mol Sci 2016; 17:ijms17091414. [PMID: 27618894 PMCID: PMC5037693 DOI: 10.3390/ijms17091414] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 12/26/2022] Open
Abstract
Sanguinaria canadensis, also known as bloodroot, is a traditional medicine used by Native Americans to treat a diverse range of clinical conditions. The plants rhizome contains several alkaloids that individually target multiple molecular processes. These bioactive compounds, mechanistically correlate with the plant’s history of ethnobotanical use. Despite their identification over 50 years ago, the alkaloids of S. canadensis have not been developed into successful therapeutic agents. Instead, they have been associated with clinical toxicities ranging from mouthwash induced leukoplakia to cancer salve necrosis and treatment failure. This review explores the historical use of S. canadensis, the molecular actions of the benzophenanthridine and protopin alkaloids it contains, and explores natural alkaloid variation as a possible rationale for the inconsistent efficacy and toxicities encountered by S.canadensis therapies. Current veterinary and medicinal uses of the plant are studied with an assessment of obstacles to the pharmaceutical development of S. canadensis alkaloid based therapeutics.
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Basch CH, Basch CE, Hillyer GC, Reeves R. YouTube Videos Related to Skin Cancer: A Missed Opportunity for Cancer Prevention and Control. JMIR Cancer 2015; 1:e1. [PMID: 28410167 PMCID: PMC5367668 DOI: 10.2196/cancer.4204] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/21/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early detection and treatment influence the mortality risk of skin cancer. OBJECTIVE The objective of this study was to analyze the content of the most viewed professional and consumer videos uploaded to YouTube related to skin cancer. METHODS A total of 140 professional and consumer videos uploaded between 2007 and 2014 were identified and coded. Coding involved identifying and sorting followed by gathering descriptive information, including length of the video, number of views, and year uploaded. A dichotomous coding scheme (ie, yes or no) was used in coding specific aspects of video content, including provision of information, type of skin cancer, age group, family history, risk reduction, risk factors, fear, and home remedies for skin cancer treatment. RESULTS The majority of videos provided information related to screening. Many consumer videos conveyed information related to the use of a black salve as a home remedy for skin cancer, despite the fact that there is no evidence that it is an effective treatment. CONCLUSIONS Research is needed to identify characteristics of videos that are most likely to be viewed to inform the development of credible communications.
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Affiliation(s)
- Corey H Basch
- William Paterson University, Wayne, NJ, United States
| | - Charles E Basch
- Teachers College, Columbia University, New York, NY, United States
| | - Grace Clarke Hillyer
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Rachel Reeves
- William Paterson University, Wayne, NJ, United States
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