Volume 37, Issue 11, Page 17 (November 2006)

LESLIE S. BAUMANN, M.D.

DR. BAUMANN is director of cosmetic dermatology at the University of Miami. To respond to this column, or to suggest topics for future columns, write to Dr. Baumann at our editorial offices via e-mail at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

The Boswellia serrata tree is native to central and western India, where it is known as salai guggal. It is a member of the Burseraceae family, which comprises roughly 30 tree and bush species found in India, the Middle East, and East Africa. Boswellia is one of several plants whose components are known to alleviate swelling (Phytomedicine 2003;10:3–7; Phytother. Res. 2004;18:343–57).

The B. serrata exudate or gum (known in India as “guggulu”) forms the aromatic resin frankincense, which has been traditionally used as incense. This exudate has been known for thousands of years to possess therapeutic properties. It is used in Ayurvedic medicine to treat inflammatory and arthritic conditions (Phytomedicine 2003;10:3–7; Wien Med. Wochenschr. 2002;152:373–8; Biofactors 2000;13:225–30).

The gum resin extract of B. serrata has recently gained attention in Western medicine for its anti-inflammatory, antiarthritic, and analgesic properties. Anticarcinogenic, antitumorigenic, and antihyperlipidemic activities also have been reported (Phytomedicine 2003;10:3–7; Carcinogenesis 2002;23:2087–93; Biofactors 2000;13:225–30).

The use of compounds isolated from the gum resin to treat inflammatory conditions comports with evidence that leukotrienes, which are associated with various chronic inflammatory conditions, are inhibited by the primary constituents of B. serrata, boswellic acids (Wien Med. Wochenschr. 2002;152:373–8; Eur. J. Med. Res. 1998;3:511–4). One such condition is irritable bowel disease, which the gum resin of B. serrata has been found to positively affect (Int. J. Colorectal Dis. 2001;16:88–95).

Boswellic acids have been shown to inhibit leukotriene biosynthesis in neutrophilic granulocytes by hindering 5-lipoxygenase as a result of binding to the enzyme. In addition, boswellic acids have been noted for inhibiting elastase in leukocytes, and for having wide-ranging effects on human leukemia and glioma cell lines, particularly inhibiting proliferation, inducing apoptosis, and impairing topoisomerases (Wien Med. Wochenschr. 2002;152:373–8; Anticancer Res. 2002;22:2853–62). Moreover, boswellic acids have exhibited antiproliferative properties against various types of malignant cells.

Antineoplastic Action

In a study evaluating the ethanolic extract of B. serrata gum resin containing a defined amount of boswellic acids for its cytotoxic, cytostatic, and apoptotic effects on human malignancies, the extract dose-dependently induced antiproliferative effects on all five leukemia and two brain tumor cell lines tested. The total extract was more than twice as potent as the boswellia constituent 3-O-acetyl-11-keto-ß-boswellic acid (AKBA) in three hematologic cell lines (Anticancer Res. 2002;22:2853–62). AKBA is a naturally occurring pentacyclic triterpene that exerts antiproliferative effects against various types of tumors.

Anticancer activity also is exhibited by other B. serrata components. ß-Boswellic acid, keto-ß-boswellic acid (KBA), and AKBA—particularly the last two—have demonstrated antiproliferative and apoptotic effects on human colon cancer HT-29 cells (Carcinogenesis 2002;23:2087–93). KBA and AKBA also exert antiproliferative and anticancer effects on liver cancer Hep G2 cells (Int. J. Mol. Med. 2002;10:501–5).

In a two-stage mouse study, boswellin, a methanol extract of B. serrata containing triterpenoids, ß-boswellic acid, and related derivatives, was topically applied to the backs of mice treated with 7,12-dimethylbenz[a]anthracene (DMBA) to initiate and 12-O-tetradecanoylphorbol-13-acetate (TPA) to promote tumors. The extract was found to inhibit skin inflammation, epidermal proliferation, the number of epidermal cell layers, and tumor promotion induced by DMBA and TPA. The investigators also found that DNA synthesis in human leukemia HL-60 cell culture was dose-dependently suppressed by ß-boswellic acid, KBA, or AKBA (Biofactors 2000;13:225–30).

Anti-Inflammatory Action

If there is a consensus on the primary health effects of B. serrata, it is that the herb inhibits the proliferation of tissue in and around inflamed areas and hinders connective tissue deterioration. Such effects can have far-reaching implications for treatment indications. Promising results have been reported from clinical trials using boswellic acids to treat bronchial asthma, Crohn's disease, chronic and ulcerative colitis, peritumoral brain edema, and rheumatoid arthritis (Wien Med. Wochenschr. 2002;152:373–8), as well as anaphylaxis. In a study evaluating antianaphylaxis activity in rats, a B. serrata formulation containing 60% AKBA as well as KBA was found to dose-dependently inhibit passive paw anaphylaxis and confer mast cell stabilizing activity (Indian J. Exp. Biol. 2003;41:1460–2).

B. serrata extract was evaluated in a randomized, double-blind, placebo-controlled crossover study of 30 patients with osteoarthritis of the knee. Fifteen patients received boswellia and 15 received placebo for 8 weeks, followed by washout and then the opposite intervention for 8 weeks.

Although no changes were noted in x-rays, all patients reported reduced pain, increased flexion, and increased walking distance in association with B. serrata treatment; the differences between drug treatment and placebo were statistically significant. Aside from minor gastrointestinal reactions, the B. serrata extract was well tolerated. The investigators concluded that the extract is a suitable treatment for osteoarthritis of the knee and has potential for application to other kinds of arthritis (Phytomedicine 2003;10:3–7).

A recent study conducted with Sprague-Dawley rats revealed that oral administration of boswellia extract or AKBA dosedependently conferred significant improvements in an inflammatory bowel disease model. Specifically, ileitis was induced by indomethacin administration. The resultant leukocyte-endothelial cell adhesive interactions and severe tissue injury were significantly diminished by boswellia extract or AKBA treatment (Int. J. Colorectal Dis. 2001;16:88–95).

In a 6-week study of the effects of B. serrata on 30 patients (17 men and 13 women) aged 18–48 years with chronic colitis, 20 patients were given a B. serrata preparation and 10 patients treated with sulfasalazine served as controls. In all, 18 of the B. serrata patients (90%) exhibited improvement in several symptoms, while 6 control patients (60%) improved. The investigators concluded that B. serrata has potential as a safe and effective treatment of chronic colitis (Planta Med. 2001;67:391–5), which supports previous findings for ulcerative colitis (Eur. J. Med. Res. 1997;2:37–43).

A randomized, double-blind, parallel group study compared the efficacy and safety of mesalazine with those of the B. serrata extract H15 for treating Crohn's disease, an indication for which H15 has been approved in Germany. H15 was found to be as efficacious as the established drug. It resulted in significantly larger reductions in the Crohn's Disease Activity Index, suggesting that the extract has a superior benefit-risk profile (Z. Gastroenterol. 2001;39:11–7).

In a double-blind, placebo-controlled 6-week study of the effects of the gum resin of B. serrata on asthma in 23 men and 17 women aged 18–75 years, 70% of patients showed improvement as evidenced by disappearance of dyspnea, rhonchi, and other symptoms, and a reduction in number of attacks; in comparison, only 27% of controls showed improvement. The investigators concluded that B. serrata gum resin is a viable treatment for bronchial asthma (Eur. J. Med. Res. 1998;3:511–4).

Others note, though, that although boswellia has been found to be a safe and effective treatment, alone or in combination, for asthma, no longitudinal data exist to support or contraindicate this approach (Prim. Care 2002;29:231–61).

Finally, B. serrata is a key component of BHUx, a polyherbal formulation that has been shown to be a potent antioxidant and a suppressant of important inflammatory mediators in the arachidonic acid cascade (Inflammopharmacology 2004;12:131–52).

Conclusions

There is evidence demonstrating B. serrata's anti-inflammatory efficacy and promising research indicating its potential for treating various indications, including cancer.

Interestingly, boswellia is found in many skin creams, especially the expensive ones (e.g., Estée Lauder Body Performance Toning Bust Serum, 1.7 oz/$45, and Estée Lauder Re-Nutriv Ultimate Lifting Crème, 1.7 oz/$250). However, no studies looking at efficacy in the skin have been published.

We have no idea if boswellia is stable in a skin product and if it can penetrate the skin to have an effect. I encourage the companies that have incorporated it into their products to perform a well-designed trial to look at efficacy before consumers throw more dollars away on the hope that this ingredient is effective in the skin.

PII: S0037-6337(06)71653-9

doi:10.1016/S0037-6337(06)71653-9

© 2006 Elsevier Inc. All rights reserved.