Opinion Article
Guarumbo (Cecropia obtusifolia) for Warts in Zapotec Medicine
El tratamiento de las verrugas con guarumbo por los zapotecos
a Servicio de Anatomía Patológica, Hospital El Bierzo, Ponferrada, León, Spain
b Instituto de Investigación Biomédica de A Coruña, Grupo de Investigación CellCOM-SB, A Coruña, Spain
c Servicio de Anatomía Patológica, Hospital de la Reina, Ponferrada, Spain
d Departamento de Dermatología, Hospital de La Princesa, Madrid, Spain
e Departamentos de Dermatología y Dermatopatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
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Fernandez-Flores, M. Llamas Velasco, M. Saeb Lima" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Fernandez-Flores" "email" => array:1 [ 0 => "dermatopathonline@gmail.com" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Llamas Velasco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Saeb Lima" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital El Bierzo, Ponferrada, León, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto de Investigación Biomédica de A Coruña, Grupo de Investigación CellCOM-SB, A Coruña, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital de la Reina, Ponferrada, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Departamento de Dermatología, Hospital de La Princesa, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Departamentos de Dermatología y Dermatopatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El tratamiento de las verrugas con guarumbo por los zapotecos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1559 "Ancho" => 950 "Tamanyo" => 353685 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Example of guarumbo from the Zapotec settlement of Monte Albán in Oaxaca, Mexico. B, Milky exudate similar to that of the fig tree, with curative properties in warts.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Approaches to treatment of viral warts have varied throughout history. In addition to practices that may have some pathophysiological basis, such as rubbing the wart with various foods or substances,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> other, irrational approaches continue to be used. These include “selling” the wart to another person, reciting phrases, or rubbing the wart with a widow’s wedding ring.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, some exotic remedies, such as duct tape, have been validated in comparative scientific studies.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In any case, it is important to remember that a considerable number of warts remit spontaneously without treatment.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Phytotherapy has played a key role in the treatment of warts among various cultures. <span class="elsevierStyleItalic">Euphorbia hirta</span> is used for this purpose in India,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and <span class="elsevierStyleItalic">Qu You Ding,</span> a solution comprising several medicinal plants, has been used in traditional Chinese medicine.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Oil of <span class="elsevierStyleItalic">Tropidurus hispidus</span> is used in Brazil,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> as is <span class="elsevierStyleItalic">Hancornia speciosa</span>.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In Iran, some studies have shown the efficacy of myrtle <span class="elsevierStyleItalic">(Myrtus communis)</span>. In Italy <span class="elsevierStyleItalic">Arum italicum, Tamarix gallica</span>, and <span class="elsevierStyleItalic">Ficus carica</span> are used to treat warts,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> often in the context of a magic ritual. The approaches used in Japan include <span class="elsevierStyleItalic">shokenchuto</span> and <span class="elsevierStyleItalic">makyoyokukanto</span>.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The mechanism by which these natural remedies act against human papillomavirus has been studied in vivo and in vitro.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> We know that some of their active ingredients can induce apoptosis,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> act as modulators of gene transcription and protein synthesis,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> regulate cell signaling translation pathways,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and/or stimulate general immunity.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Clinically, the effects of destruction of the wart manifest early as pruritus, reddening, or edema of the basal part, followed by roughness of the surface and desquamation after a few days.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In terms of histopathology, spontaneous regression of warts is accompanied by intense lymphohistiocytic infiltrate with satellite metastasis and apoptosis.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> A similar reaction can be seen in the regression induced by drugs such as imiquimod.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">One of the plants used in the treatment of warts is guarumbo <span class="elsevierStyleItalic">(Cecropia obtusifolia),</span> which is also known as <span class="elsevierStyleItalic">chancarro</span>, <span class="elsevierStyleItalic">guarumo</span>, <span class="elsevierStyleItalic">hormigo</span>, <span class="elsevierStyleItalic">hormiguillo</span>, <span class="elsevierStyleItalic">palo de hormigas</span>, <span class="elsevierStyleItalic">trompeta</span>, or <span class="elsevierStyleItalic">trompetillo</span> (trumpet tree).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Guarumbo is from the tropical areas of the American continent. It has hypoglycemic,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> diuretic,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> and hypotensive properties<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> and is abundant in the south of Mexico in the state of Oaxaca. Consequently, it is found in numerous pre-Columbian Meso-American settlements, such as Monte Albán (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), the main Zapotec enclave of Mexico.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The Zapotecs mostly inhabited the areas of Oaxaca, Guerrero, and Puebla. Monte Albán reached its greatest splendor around 700 AD, after which time, for different reasons, this and other settlements were gradually abandoned by their settlers.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The Zapotecs developed an extensive culture of hygiene measures and therapy covering various diseases. This was based on plants and other remedies applied by the <span class="elsevierStyleItalic">colanij,</span> a low-ranking group among Zapotec priests,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> generally in the context of a magic ritual preceded by abstinence and fasting and often accompanied by hallucinogenic agents such as yerua and pèyaçòo.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Informants from the Spanish colonial administration characterized the <span class="elsevierStyleItalic">colanij</span> as being knowledgeable about medicinal wild plants and often referred to them—erroneously—using the Mexica term <span class="elsevierStyleItalic">ticitl</span> (physician), which was much more familiar to them.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The main elements of Zapotec dermatological knowledge centered on various practices for skin care and hygiene, including soap, baths (probably in the sulfurous waters of the area), or saunas that were constructed in the shape of tents (<span class="elsevierStyleItalic">temazcales</span>).<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> They used guarumbo as a skin remedy against warts. Specifically, they used the milky substance released by the plant when its appendices were cut (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><p id="par0045" class="elsevierStylePara elsevierViewall">As for the mechanism of action, evidence for the use of guarumbo to treat several diseases is currently considered grade C (unclear scientific evidence). Its active ingredients include chlorogenic acid, iso-orientin, and quercetin. However, while these have antifungal properties, they do not have antiviral properties, mainly owing to the fact that polyphenols do not mix with cytoplasm in the epithelial cells of warts, thus leaving no place for the action of the polyphenol-polyphenol oxidase system.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The mechanism of action of guarumbo milk may be similar to that induced by latex from the fig tree (<span class="elsevierStyleItalic">Ficus carica</span>) which was already mentioned by Avicenna in his <span class="elsevierStyleItalic">Canon of Medicine</span>.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Thus, in studies comparing treatment of warts with fig tree latex and with cryotherapy, the former was only slightly inferior to the latter in terms of outcomes, although it was free from adverse effects, unlike the latter.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Furthermore, it has shown similar effectiveness to that of other therapeutic approaches used in our daily clinical practice, such as acetylsalicylic acid, topical 5-fluorouracil, intralesional interferon, and imiquimod.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> While the mechanism of action of fig tree latex is not completely known, it seems to be associated with its proteolytic and keratolytic activity,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> as well as its antiviral activity,<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25,26</span></a> and some of its extracts have proven able to inhibit viral replication in vitro.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> It can also induce phytophotodermatitis through its furocoumarins, thus triggering local skin injury and an inflammatory response.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-08-23" "fechaAceptado" => "2018-10-28" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernandez-Flores A, Llamas Velasco M, Saeb Lima M. El tratamiento de las verrugas con guarumbo por los zapotecos. Actas Dermosifiliogr. 2020;111:189–191.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1559 "Ancho" => 950 "Tamanyo" => 353685 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Example of guarumbo from the Zapotec settlement of Monte Albán in Oaxaca, Mexico. B, Milky exudate similar to that of the fig tree, with curative properties in warts.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Wart charming practices among patients attending wart clinics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K. 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| año/Mes | Html | Total | |
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| 2022 Noviembre | 70 | 35 | 105 |
| 2022 Octubre | 44 | 28 | 72 |
| 2022 Septiembre | 44 | 36 | 80 |
| 2022 Agosto | 29 | 35 | 64 |
| 2022 Julio | 40 | 42 | 82 |
| 2022 Junio | 35 | 39 | 74 |
| 2022 Mayo | 90 | 46 | 136 |
| 2022 Abril | 66 | 35 | 101 |
| 2022 Marzo | 78 | 39 | 117 |
| 2022 Febrero | 66 | 22 | 88 |
| 2022 Enero | 81 | 49 | 130 |
| 2021 Diciembre | 57 | 32 | 89 |
| 2021 Noviembre | 66 | 38 | 104 |
| 2021 Octubre | 72 | 36 | 108 |
| 2021 Septiembre | 58 | 36 | 94 |
| 2021 Agosto | 56 | 30 | 86 |
| 2021 Julio | 40 | 24 | 64 |
| 2021 Junio | 32 | 14 | 46 |
| 2021 Mayo | 35 | 28 | 63 |
| 2021 Abril | 70 | 39 | 109 |
| 2021 Marzo | 71 | 17 | 88 |
| 2021 Febrero | 44 | 15 | 59 |
| 2021 Enero | 50 | 11 | 61 |
| 2020 Diciembre | 35 | 14 | 49 |
| 2020 Noviembre | 38 | 20 | 58 |
| 2020 Octubre | 20 | 8 | 28 |
| 2020 Septiembre | 42 | 19 | 61 |
| 2020 Agosto | 71 | 16 | 87 |
| 2020 Julio | 34 | 9 | 43 |
| 2020 Junio | 36 | 22 | 58 |
| 2020 Mayo | 78 | 47 | 125 |
| 2020 Abril | 13 | 12 | 25 |
| 2020 Marzo | 2 | 0 | 2 |
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