An Internet misadventure: bloodroot salve toxicity

Bloodroot (Sanguinaria canadensis) is a perennial flowering plant native to North America. Sanguinarine, a benzylisoquinoline alkaloid, is a powerful escharotic contained in the root. Herbalists prescribe bloodroot for multiple conditions including skin lesions and sore throats. We report 2 patients who treated skin lesions with bloodroot to untoward effect. CASE REPORT 1: A 53-year-old man with unremarkable medical history developed a 5-mm papule on his chest that gradually blackened. The patient searched the Internet for "herbal cures" and found bloodroot salve as a therapy for skin lesions. The patient applied bloodroot black salve for 10 days. After 6 months the remaining lesion resumed increasing in size. The patient restarted bloodroot treatments despite intense pain. After 6 weeks the lesion doubled, became ulcerated and purulent, prompting presentation to the Emergency Department. Pathological examination of the lesion revealed malignant melanoma. CASE REPORT 2: A 42-year-old man with a history of metastatic colon cancer developed palpable subcutaneous nodules on the anterior abdominal wall. The patient's mother searched the Internet for cancer salves and purchased black and yellow bloodroot salve. After 8 days, feces were noted discharging from an ulcer where the salve was applied. The patient was admitted for total parenteral nutrition until the enterocutaneous fistula healed.

Bloodroot is widely available on the Internet and easily purchased. Web sites discuss the efficacy of bloodroot in treating skin cancer. The cases describe attempts to self-treat skin lesions with unregulated Internet therapy. Lack of regulation of information on the Internet allows alternative therapies to be promoted without full consideration of potential toxicity. Greater awareness of agents with such potential for danger needs to be available to health care providers, and the taking of such remedies should always be discussed with the supervising physician.