Peruvian Balsam – Properties, Uses, Risk of Allergic Reactions

Peruvian Balsam (*Balsamum Peruvianum*) is a natural resinous exudate obtained from the wood of the balsam tree (*Myroxylon balsamum*), a species indigenous to the so-called "Balsamic Coast" of El Salvador—not, as the name might imply, Peru. Its introduction to Europe originated from the port of Callao, which lent the substance its commercial designation. The raw material presents as a viscous, dark brown liquid emitting a rich, sweet-spicy aroma reminiscent of vanilla and cinnamon. The primary bioactive constituent is **cinnamein**, an oily fraction composed predominantly of benzyl benzoate and benzyl cinnamate. Historically, owing to its antiseptic and fragrant properties, Peruvian Balsam was extensively utilized in pharmaceutical formulations (e.g., ulcer ointments, cough syrups, dental preparations) and cosmetic products (perfumes, creams). However, its application in contemporary formulations has been significantly curtailed due to its high allergenic potential: Approximately 50% of individuals with confirmed fragrance allergies exhibit positive patch-test reactions to Peruvian Balsam [1, 2].

A comprehensive review of current scientific literature confirms that Peruvian balsam exhibits multifaceted biological activity, including potent antiseptic properties, the capacity to modulate inflammatory responses, and stimulation of granulation tissue proliferation. The preparation is widely utilized in topical therapy for chronic wounds, including pressure ulcers in bedridden patients, poorly healing leg ulcers of varying etiologies, necrotic lesions resulting from frostbite, and in the symptomatic management of hemorrhoids—both external and internal—owing to its astringent effects and acceleration of epithelialization processes [2, 5, 8].

During the era of the Inca Empire, Peruvian balsam served as a cornerstone remedy for an extensive array of medical conditions, including its use as a therapeutic agent for bronchitis, respiratory infections, cough suppression, febrile states, and common colds. Concurrently, within Aztec medical traditions, it functioned as a topical application designed to accelerate tissue repair and facilitate the healing of cutaneous wounds [2]. In contemporary pharmaceutical practice, this botanical extract remains a vital component in numerous formulations, such as anti-inflammatory, antiseptic, and protective ointments intended for external use. Furthermore, it is incorporated into rectal suppositories and ointments exhibiting astringent and anti-inflammatory properties, specifically formulated for hemorrhoid treatment. Additionally, Peruvian balsam constitutes an active ingredient in warming gels that promote respiratory ease, as well as in inhalation therapies [3]. Its clinical applications extend to adjunctive treatment for trophic alopecia [1].

Peruvian balsam represents a chemically complex resin comprising numerous naturally occurring and synthetic fragrance compounds, functioning as a significant contact allergen within cosmetic formulations and essential oil compositions [2]. The principal sensitizing agent is coniferyl benzoate, which metabolizes into eugenol, cinnamic acids, and aromatic alcohols [1]. In the cosmetic sector, approximately 5,000 fragrance substances exhibit allergenic potential, with oakmoss absolute, isoeugenol, cinnamaldehyde, and hydroxycitronellal serving as primary triggers. Patients diagnosed with this hypersensitivity frequently eliminate perfumed products; however, comprehensive management often necessitates dietary exclusion of balsam derivatives—specifically eugenol, vanillin, benzoic acid compounds, and cinnamic acid derivatives [1,2]. Dietary sources include citrus fruits, spices (cinnamon, cloves, chili), chocolate, flavored alcoholic beverages, tomatoes, and cola-containing products. Notably, traces may be present in premium-grade toilet paper [1,2].