BUXACEAE

(Box family)

• Medicinal / Folk-medicinal aspects: Reports of the dermatological use of members of this family in traditional medicine are sparse to non-existent. •
• Adverse effects: Skin reactions, possibly of allergic aetiology, following exposure to the leaves and the wood have been documented. The nickel accumulating properties of certain Buxus L. species may be of local dermatological significance. •
• Veterinary aspects: A report of the use of a paste prepared from the bark of one species in the treatment of fractures has been documented.  •

This is a small family of about 130 species of evergreen shrubs or small trees in 6 genera, found mostly in tropical and sub-tropical regions but also occurring in temperate regions.^a

The common box (Buxus sempervirens L.) has been grown as a hedging plant, often for topiary, for many centuries (Hunt 1968/70, Mabberley 2017). This species, and to a lesser extent Buxus macowanii Oliv., the Cape box,^b is a source of boxwood which is used for tool handles, musical instruments (especially recorders and flutes), rulers, and other such articles (Hausen 1981).

Boxwoods of commerce are derived from several botanically unrelated sources (Woods & Calnan 1976, Hausen 1981):

Buxus macowanii Oliv. — provides Cape boxwood and East London boxwood

Buxus sempervirens L. — provides Abassian boxwood, European boxwood, Iranian boxwood, and Turkey boxwood

Casearia praecox Griseb. (fam. Salicaceae) — provides Maracaibo boxwood, West Indian boxwood, and Venezuelan boxwood

[syn. Gossypiospermum praecox (Griseb.) P.Wilson]

Gonioma kamassi E.Mey. (fam. Apocynaceae) — provides South African boxwood, Kamassi boxwood, and Knysna boxwood

Nauclea diderrichii (De Wild.) Merr. (fam. Rubiaceae) — provides West African Boxwood

[syns Nauclea trillesii Merr., Sarcocephalus diderrichii De Wild.] 

^a https://powo.science.kew.org/taxon/urn:lsid:ipni.org:names:77126711-1; accessed February 2025
^b https://pza.sanbi.org/buxus-macowanii; accessed February 2025

Buxus L.

Box, Buis, Buchsbaum

Comprising about 100 species distributed around the world, the genus has a major centre of diversity in Cuba where 37 species occur, 30 of which are believed to be endemic to serpentine (nickeliferous) soils. Many of these are categorised as hyperaccumulators of nickel because they have been found to contain in excess of 1000 µg/g (ppm) dry weight (Baker & Brooks 1989, Reeves et al. 1996, Reeves 2003):

Buxus aneura Urb.

Buxus crassifolia (Britton) Urb.

[syn. Tricera crassifolia Britton]

Buxus excisa Urb.

Buxus foliosa (Britton) Urb.

[syn. Tricera foliosa Britton]

Buxus gonoclada (C.Wright ex Griseb.) Müll.Arg. subsp. gonoclada

[syns Buxus flaviramea (Britton) Mathou, Buxus heterophylla Urb., Tricera flaviramea Britton]

Buxus imbricata Urb.

Buxus moana Alain

Buxus pilosula Urb.

Buxus pseudaneura Eg.Köhler

Buxus retusa (Griseb.) Müll.Arg. subsp. retusa

[syns Buxus historica Borhidi & O.Muñiz, Tricera retusa Griseb.]

Buxus revoluta (Britton) Mathou

[syn. Tricera revoluta Britton]

Buxus serpentinicola Eg.Köhler

Buxus shaferi (Britton) Urb.

[syns Buxus baracoensis Borhidi & O.Muñiz, Tricera shaferi Britton]

Buxus vaccinioides (Britton) Urb.

[syn. Tricera vaccinioides Britton]

The contact sensitising capacity of nickel and its salts is well documented (Malten et al. 1976, Cronin 1980, Spruit et al. 1980, Fowler 1990, Uter et al. 2016) but it remains to be determined whether the nickel compounds in this plant present a dermatological hazard.

Buxus sempervirens L.

[syns Buxus hyrcana Pojark., Buxus suffruticosa Mill.]

Abassian Boxwood, Common Box, Edging Box, European Box, Immergrüner Buchs

Describing the box tree, Gerarde (1636) wrote:

[…] the root is likewise yellow, and harder than the timber, but of g[r]eater beauty, and more fit for dagger hafts, boxes, and such like [u]ses, whereto the trunke or body ser[v]eth, than to make medicines; though foolish emperickes and Women leaches, doe minister it against the Apoplexie, and such diseases […]

Stuart (1911) noted that in traditional Chinese medicine, the powdered leaves of boxwood (huang yang mu; 黄杨木) are rubbed on prickly heat and summer boils. Use in other medical conditions including dandruff, hair loss, and haemorrhoids has been documented whilst it also being recognised that the whole plant is poisonous, especially the bark and the leaves.^a

White (1887) received a report from a dealer in vegetable drugs that the juice of the plant can cause irritation and intense itching. Acute dermatitis of the face of a young woman followed application of a decoction of a plant, identified by the patient as garden box, to her scalp 24 hours earlier for the purpose of preventing her hair from falling out (White 1889). Interestingly, the scalp was not at all affected.

A watch maker who used box sawdust to clean gold developed asthma; a positive scratch test to the dust was observed, producing an enormous amoeboid wheal. On then testing with sawdust from a commercial sample of boxwood, a more marked positive reaction was observed (Markin 1930). Dermatitis on the face and hands of a gardener who had been trimming box hedges, referred to as Buxus suffruticosa, was reported by Oppenheim (1913). Nestler (1929) referred to Oppenheim's report, adding that he was aware of a case of a flute player who had attributed a skin rash to the use of his flute, which was thought to be made of boxwood, but it was not possible to carry out any testing because the flute player had sold his flute. Occupational dermatitis in the manufacture of boxwood rulers was noted by Nordin (1947).

Perhaps the first well-documented report of allergic contact dermatitis to boxwood was provided by van Neer & van Ginkel (1997) who described a case of a 65-year old male who played the recorder and who developed a hyperkeratotic eczema on his fingers with painful fissures. He played recorders made from boxwood, cedarwood, and rosewood. Samples of these woods obtained from the recorder manufacturer were filed into sawdust and diethyl ether extracts prepared for patch testing. The patient reacted only to the boxwood extract. Tests in 6 healthy control subjects were all negative. The authors noted that European boxwood was derived from Buxus sempervirens but the botanical sources of the three wood samples were not formally determined.

A methanolic extract of Buxus hyrcana formulated as an ointment for topical application increased the rate of cutaneous wound healing in rats (Amiri et al. 2023).

Buxus Sempervirens Leaf Extract [INCI; CAS RN 84012-17-9; of uncertain composition (see Schmidt 2017)],^b is a recognised cosmetic product ingredients purported to have skin conditioning properties (Standing Committee on Cosmetic Products 2019, CosIng 2023/4).

^a http://www.herbs4u.cn/zyml-2661.html; accessed February 2025
^b CAS Registry Number is a Registered Trademark of the American Chemical Society

Buxus wallichiana Baill.

Himalayan Box

Gaur et al. (1992), repeated by Jaiswal et al. (2004), documented the ethnobotanical use in remote localities of Uttar Pradesh Himalaya of a paste prepared from the bark as a plaster on fractures in goats and sheep.

References

• Amiri F, Mirzaee F, Fadaee Heydarabadi P, Enayatifard R, Goli HR, Shahani S (2023) The effect of a topical ointment containing methanol extract of Buxus hyrcana Pojark. leaves on cutaneous wound healing in rats. Koomesh 25(1): e152801; 48-56 [url] [url-2]
• Baker AJM, Brooks RR (1989) Terrestrial higher plants which hyperaccumulate metallic elements — a review of their distribution, ecology and phytochemistry. Biorecovery 1(2): 81-126
• CosIng (2023/4) COSING Ingredients-Fragrance Inventory. [online article]: https://ec.europa.eu/growth/tools-databases/cosing/pdf/COSING_Ingredients-Fragrance%20Inventory_v2.pdf ; accessed March 2023 [url] [url-2]
• Cronin E (1980) Contact Dermatitis. Edinburgh: Churchill Livingstone [WorldCat]
• Fowler JF (1990) Allergic contact dermatitis to metals. American Journal of Contact Dermatitis 1(4): 212-223 [doi] [url] [url-2]
• Gaur RD, Bhatt KC, Tiwari JK (1992) An ethnobotanical study of Uttar Pradesh Himalaya in relation to veterinary medicines. Journal of the Indian Botanical Society 72(1-2): 139-144 [url] [url-2]
• Gerarde J (1636) The Herball or Generall Historie of Plantes. Very much enlarged and amended by Thomas Johnson citizen and apothecarye of London, 2nd edn. London: A Islip, J Norton and R Whitakers [WorldCat] [url] [url-2]
• Hausen BM (1981) Woods Injurious to Human Health. A manual. Berlin: Walter de Gruyter [WorldCat]
• Hunt P (Ed.) (1968/70) The Marshall Cavendish Encyclopedia of Gardening. London: Marshall Cavendish [WorldCat]
• Jaiswal S, Singh SV, Singh B, Singh HN (2004) Plants used for tissue healing of animals. Natural Product Radiance 3(4): 284-292 [url] [url-2]
• Mabberley DJ (2017) Mabberley's Plant-Book. A portable dictionary of plants, their classification and uses, 4th edn. Cambridge: Cambridge University Press [WorldCat] [doi] [url]
• Malten KE, Nater JP, van Ketel WG (1976) Patch Testing Guidelines. Nijmegen: Dekker & van de Vegt [WorldCat]
• Markin LE (1930) Boxwood sensitiveness. Journal of Allergy 1(4): 346-349 [doi] [url]
• Nestler A (1929) Hautreizende Pflanzen. [Skin-irritant plants]. Die Umschau – Illustrierte Wochenschrift über die Fortschritte in Wissenschaft u. Technik 33(31): 611-613 [url] [url-2]
• Nordin JV (1947) Yrkessjukdomar II [Occupational Diseases II]. Upsalla: Almqvist & Wiksells Boktryckeri [WorldCat]
• Oppenheim M (1913) Drei noch nicht beobachtete Gewerbekrankheiten der Haut. 1. Buchsbaumdermatitis bei einem Gärtner, hervorgerufen durch die Zurichtung der Blätter des heimischen Buchbaumes. 2. Typische Nagelveränderungen bei Kapsel- und Patronenarbeiterinnen. 3. Progrediente Ätznatronwirkung auf die Nägel eines Glasergehilfen. [Three previously unobserved industrial diseases of the skin. 1. Boxwood dermatitis in a gardener, caused by the preparation of the leaves of the native boxwood. 2. Typical nail changes in capsule and cartridge workers. 3. Progressive effect of caustic soda on the nails of a glazier's assistant.]. Das Österreichische Sanitätswesen 25(38) [url] [url-2]
• Reeves RD (2003) Tropical hyperaccumulators of metals and their potential for phytoextraction. Plant and Soil 249(1): 57-65 [doi] [url]
• Reeves RD, Baker AJM, Borhidi A, Berazaín R (1996) Nickel-accumulating plants from the ancient serpentine soils of Cuba. New Phytologist 133(2): 217-244 [doi] [url] [url-2]
• Schmidt RJ (2017) Regulation (EC) No 1223/2009 – a recast of the Cosmetic Products Directive 76/768/EEC – in regard to the safety of plant-derived cosmetic product ingredients. The Expert Witness (20): 35-37 [doi] [url] [url-2]
• Spruit D, Bongaarts PJM, Malten KE (1980) Dermatological effects of nickel. In: Nriagu JO (Ed.) Nickel in the Environment, pp. 601-609. New York: John Wiley [WorldCat]
• Standing Committee on Cosmetic Products (2019) Commission Decision (EU) 2019/701 of 5 April 2019 establishing a glossary of common ingredient names for use in the labelling of cosmetic products. Official Journal of the European Union 62(L 121): 1-370 [url] [url-2]
• Stuart GA (1911) Chinese Materia Medica. Vegetable Kingdom. Extensively revised from Dr. F. Porter Smith's work. Shanghai: American Presbyterian Mission Press [doi] [WorldCat] [url] [url-2]
• Uter W, Larese Filon F, Rui F, Balato A, Wilkinson M, Kręcisz B, Chomiczewska-Skora D, Kieć-Świerczyńska M, Schuttelaar M-LA, Frosch PJ, Bircher AJ (2016) ESSCA results with nickel, cobalt and chromium, 2009–2012. Contact Dermatitis 75(2): 117-121 [doi] [url] [url-2] [pmid]
• van Neer FJMA, van Ginkel CJW (1997) Allergic contact dermatitis from a boxwood recorder. Contact Dermatitis 36(6): 305 [doi] [url] [url-2] [pmid]
• White JC (1887) Dermatitis Venenata: an account of the action of external irritants upon the skin. Boston: Cupples and Hurd [doi] [WorldCat] [url] [url-2]
• White JC (1889) Some unusual forms of dermatitis venenata. Boston Medical and Surgical Journal 121(24): 583-584 [doi] [url] [url-2]
• Woods B, Calnan CD (1976) Toxic woods. British Journal of Dermatology 95(Suppl 13): 1-97 [doi] [url] [url-2] [pmid]

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