Assessing the risk of epidemic dropsy from black salve use

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. Exposure to sanguinarine containing topical oils has been associated with the development of epidemic dropsy, a potentially fatal condition that can result in multisystem organ failure. Black salve, an alternative therapy used to treat skin malignancies, in some formulations contains sanguinarine in high concentrations. This suggests black salve use may place patients at risk of epidemic dropsy. This mini-review investigates the pathophysiological link between sanguinarine and epidemic dropsy, determining the potential for it to be caused by black salve therapies.