Spurge

Synonym(s)

Codiaeum variegatum; Croton wonder bush; Garden spurge; Garden spurge milk; Ingenol; Ingenolmebutate; Ingenol Mebutate; Peplin

Definition
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Up to 1 m high growing plant with red, yellow and green coloured patterned leaves, which can also vary in shape, from the family Euphorbiaceae (spurge family). The plant produces a milky, cloudy juice.

Occurrence
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Originally from Southeast Asia (Indonesia, Polynesia, Malaysian Archipelago), introduced to Europe about 180 years ago. Today, it is planted in many tropical gardens all over the world and is one of the most popular indoor pot plants in many households, not only in Europe but also in the USA. More than 100 varieties are on sale, some of which even bear such well-known names as "Tsar Alexander III" or "Baron de Rothschild".

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Field of application/use
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The milky sap, raw or boiled, is used as a laxative, abortifacient, diaphoretic and cough remedy.
The milky sap of the garden spurge (Euphorbia peplus) has been used for centuries to treat warts. In a larger study (222 patients), the clinical efficacy of peplin (active ingredient ingenol mebutate) extracted from the sap of the spurge was demonstrated (ingenol mebutate gel 0.025-0.05%) and treatment was carried out over 3 days. The pathogenetic principle of this form of therapy is still unknown. Note: see under ingenol mebutate
Ingenolmebutateis an active substance from the garden spurge for the treatment of actinic keratoses.

Limited indication
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Verrucae vulgar, actinic keratoses

Dosage
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Ingenol mebutate gel: 0.025 - 0.05%

Cave: see under Ingenol mebutate

Undesirable effects
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Toxic parts of the plant: latex, bark, roots. The latex of most Euphorbiaceae is primarily irritating to the skin.
The terpenes and phorbol esters, which are widespread in this family and have a particularly strong irritant effect, are responsible for this. In addition, they have a proven co-carcinogenic effect.
Sensitizing potency: Medium. Frequency of sensitization: Rare.

Caution: see under ingenol mebutate

Trade names
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^Picato® Gel. The Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA ) has completed its review of Picato® with the conclusion that the medicine may increase the risk of skin cancer and that the risks outweigh the benefits.

Literature
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Anderson L et al (2009) Randomized, double-blind, double-dummy, vehicle-controlled study of ingenol mebutate gel 0.025% and 0.05% for actinic keratosis. J Am Acad Dermatol 60:934-43.
Cateni F et al (2003) Terpenoids and glycolipids from euphorbiaceae. Mini Rev Med Chem 3: 425-437
Hausen BM, Vieluf K (1997) Allergy plants, plant allergens. Ecomed publishing house, Landsberg/Munich