Assessing the risk of epidemic dropsy from black salve use

J Appl Toxicol. 2018 Oct;38(10):1274-1281. doi: 10.1002/jat.3619. Epub 2018 Mar 30.

Abstract

Epidemic dropsy is a potentially life-threatening condition resulting from the ingestion of argemone oil derived from the seeds of Argemone mexicana Linn. Exposure to argemone oil is usually inadvertent, arising from mustard cooking oil adulteration. Sanguinarine, an alkaloid present in argemone oil, has been postulated as a causative agent with the severity of epidemic dropsy correlating with plasma sanguinarine levels. Cases of epidemic dropsy have also been reported following the topical application of argemone containing massage oil. Black salve, a topical skin cancer therapy also contains sanguinarine, but at significantly higher concentrations than that reported for contaminated massage oil. Although not reported to date, a theoretical risk therefore exists of black salve inducing epidemic dropsy. This literature review explores the presentation and pathophysiology of epidemic dropsy and assesses the risk of it being induced by black salve.

Keywords: Sanguinaria canadensis; black salve; bloodroot; epidemic dropsy; herbal; sanguinarine; skin cancer; toxicity.

Publication types

  • Review

MeSH terms

  • Animals
  • Argemone / chemistry*
  • Benzophenanthridines / blood
  • Benzophenanthridines / isolation & purification
  • Benzophenanthridines / toxicity*
  • Edema / blood
  • Edema / chemically induced*
  • Humans
  • Isoquinolines / blood
  • Isoquinolines / isolation & purification
  • Isoquinolines / toxicity*
  • Plant Oils / chemistry
  • Plant Oils / toxicity*
  • Plant Preparations / toxicity*
  • Seeds / chemistry

Substances

  • Benzophenanthridines
  • Isoquinolines
  • Plant Oils
  • Plant Preparations
  • argemone oil
  • sanguinarine