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Fifty shades of black salve


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By Warren R. Heymann, MD
May 4, 2016

Diet and acne has always been controversial. When I was a child I heard that pizza and chocolate could lead to break-outs; over time that was relegated to be a myth (thank goodness).

The latest foods that have may possibly lead to acne flares are those with a high glycemic content and dairy products, notably skim milk (1).

Vongraviopap and Asawanonda studied 25 acne-prone men who consumed 25 grams of 99% dark chocolate (Lindt) daily for 4 weeks. They were assessed by the Leeds revised acne scores and lesion counts on a weekly basis. Statistically significant worsening of comedones and inflammatory papules was observed, with the most dramatic increases during the first 2 weeks.

This was an open study with no placebo control. On the plus side, though, as you can imagine, compliance was outstanding!

The authors make some important points in their discussion: 1) milk was not a factor as only one brand of dark chocolate was utilized; 2) all of the patients alreClark JJ, et al. Community perceptions about the use of black salve. J Am Acad Dermatol 2016; 74: 1021-3.

The authors interviewed 18 of 23 patients that utilized black salve in a manner that allowed the exploration of themes raised by the participants. They found that “the perceived success of treatment had a greater contribution to the overall experience of using black salve than pain or scarring…Participants most commonly cited motivation to use black salve was a desire to avoid surgical treatment”. According to Eastman et al (A review of topical corrosive black salve. J Altern Complement Med 2014; 20: 284-9):

“Black salve is a compound derived from various inert ingredients, but it can be transformed into a corrosive ointment by the addition of bloodroot (Sanguinaria canadensis) or zinc chloride. Black salve products have been advertised as a natural remedy for many ailments, ranging from bee stings to skin cancer. This article reviews the current literature surrounding this compound, which in its corrosive form can be dangerous for use without medical supervision. Patients should be educated about the lack of objective evidence supporting the clinical efficacy of black salve as a skin cancer treatment, as well as the possible cosmetic defects resulting from tissue necrosis secondary to the effects of bloodroot and zinc chloride.”

The literature is replete with articles appropriately warning patients about destroying their skin lesions (and surrounding normal tissue) without having sought medical advice. While it is easy for us to warn and scold patients about what seems to be a ludicrous decision, imagine being scared while knowing that you must do something. I recall my late aunt who was so afraid about being diagnosed with breast cancer that she never mentioned it to anyone until it was far too late. I can almost (I repeat almost) understand how such a person might look for a “natural” treatment for their lesion. The lessons here are clear — we need to reach out to our patients educationally but also respect their concerns. We have all had experiences with patients (such as the elderly and infirm) who do not, and probably should not, undergo surgical procedures for their non-melanoma skin cancers. Maybe a standardized black salve could be developed that could be used appropriately in select patients after the diagnosis was secured by biopsy.

Kuklinski L, Kim J. Expression of PD-L1 in mastocytosis. J Am Acad Dermatol 2016; 74: 1010-2.


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