Euphorbia

Other Names

AdenopetalumAdenorimaAfrican spurgeAgalomaAklemaAlectoroctonumAllobiaAmandelwolfsmelkAnisophyllumAnthacanthaAplarinaArthrothamnusAsthma plantAsthma-weedAtatürk çiçeğiBird cactusBojeriaCây xương rồngCeraselmaChamaesyceChanlatCharaciasChathurakkaliChicken weedChristmas starChylogalaCrepidariaCrown of thornsCtenadenaCubanthusCyathophoraCystidospermumDactylanthesDarlington's glade spurgeDematraDesmonemaDevil's backboneDiadenariaDichrophyllumDichyliumDiplocyathiumDitritraDudhe jharDudhiDudhi khurdDudhiyaDugdhikaElaeophorbiaEndadeniumEndoisilaEpurgaEsulaEuforbiaEumecanthusEuphorbe des boisEuphorbe résinifèreEuphorbiaceae (family)EuphorbiastrumEuphorbiodendronEuphorbiopsisEuphorbiumFarfiumFarfiunFarfiyunGalarhoeusGarden spurgeGlade spurgeHairy spurgeHexadeniaHuo yang leIruru agwoJapanese poinsettiaKanopikonKeerooiKobiosisLacanthisLal dodhakLalupataeLathyrisLeafy spurgeLepadenaLeptopusLleteresa de boscLophobiosLortiaLyciopsisMadwoman's MilkMeduseaMexican flame leafMilkweedMonadeniumMoroccan moundMyrtle-leaved spurgeNagaphaniNisomenesNoche buenaOssifragaPascuaPatabaharPeccanaPedilanthusPetalandraPill-bearing spurgePillpod spurgePleuradenaPoinsettiaPurple spurgePyathalPythiusQian gen cao (千根草)Racta vinda chadaRang chitaRattlesnake weedRed caustic creeperRedbird flowerResin spurgeSclerocyathiumShadurakShwet keruiSimhundaSix-angled spurgeSlipper flowerSlipper plantSnakeweedSpurgeStenadeniumSterigmantheSun EuphorbiaSun spurgeSwetkanSynadeniumTawa-tawaThyme-leafed spurgeTithymaloidesTithymalopsisTithymalusTorfasadisTreisiaTriangular spurgeTricherostigmaTrichosterigmaTumalisVallarisVentenatiaWhite-margined sandmatWinter roseWolf's milkWood spurgeXamesikeXương rồng ba cạnhXương rồng ôngZaliteaZe qi (泽漆)Zig zag plantZigzag plantZygophyllidium

Synopsis

Euphorbia: A Comprehensive Encyclopedic Reference

1. Identity: Botanical Classification, Common Names, and Forms

Taxonomic Identity

Euphorbia is a large and diverse genus of flowering plants, commonly called spurge, in the family Euphorbiaceae. The genus has roughly 2,000 members, making it one of the largest genera of flowering plants. Species range from herbs to trees. Euphorbia antiquorum is the type species for the genus, first described by Carl Linnaeus in 1753 in Species Plantarum.

The genus name Euphorbia honours the Greek physician Euphorbus, who used these plants for their medicinal properties in the 1st century A.D. It became the official botanical name for the genus in 1753 when published by Carolus Linnaeus. More specifically, Linnaeus established the genus commemorating Euphorbus, the 1st-century physician to King Juba II of Mauritania, who is thought to have used plants such as euphorbias medicinally.

The common name "spurge" comes from the Latin expurgare, meaning "to purge," because some species have been traditionally used as a purgative or laxative.

Morphological Diversity

This diverse group of plants is found in various habitats and regions around the world, with the highest species diversity occurring in tropical and subtropical regions. The genus includes annual and perennial herbs, shrubs, trees, and succulents, many of which have distinctive and unusual forms. Euphorbias range from tiny annual plants to large and long-lived trees, with perhaps the tallest being Euphorbia ampliphylla at 30 m (98 ft) or more.

Succulent species are mostly confined to Africa and Madagascar, where many species with prominent thorns or spines resemble one another and are often confused with the cacti of North and South America. The inflorescence is called a cyathium, which is a cluster of both staminate and pistillate flowers surrounded by bracts and nectar glands. The cyathium functions like a single flower. True flowers are unisexual and lack petals or sepals; however, the bracts surrounding the cyathium may be showy.

The Latex

Euphorbias are known for their milky sap, which can be toxic or irritating to the skin and eyes. The milky latex (often poisonous) produced when the plant is damaged makes them easily recognizable. The white sticky latex sap they contain is highly toxic, although it may also have medicinal applications.

Medically and Commercially Notable Species

Among the 2,000-plus species, a smaller number are well-characterized in pharmacological and clinical contexts. The most important from a modern medicinal standpoint include:

Euphorbia hirta L. — commonly known as asthma plant or tawa-tawa; a small, prostrate herb widely used in tropical traditional medicine.
Euphorbia peplus L. — known as petty spurge or radium weed; the source of the pharmaceutical compound ingenol mebutate (Picato®).
Euphorbia resinifera Berg. — a cactus-like Moroccan species; source of resiniferatoxin and euphorbium resin.
Euphorbia tirucalli L. — pencil tree or milk bush; used in African and South Asian traditional medicine.
Euphorbia antiquorum L. — Indian spurge tree; used in Ayurvedic and Chinese traditional medicine.
Euphorbia neriifolia L. — Indian spurge tree or "sehund/thohar"; used in South and Southeast Asian traditional medicine.

Common Preparations and Dosage Forms

Stems, leaves, roots, and latex are widely used to treat various conditions across different traditions. Forms of preparation documented in traditional and research contexts include:

Aqueous decoctions and infusions of aerial parts (whole plant, leaves)
Expressed juice of fresh plant material
Hydroalcoholic and methanolic extracts used in research
Latex collected directly from cut stems
Standardized topical gels (e.g., ingenol mebutate gel derived from E. peplus)
Homeopathic mother tinctures of E. resinifera

2. Traditional and Historical Use

Geographic and Cultural Scope

Plants of the genus Euphorbia have long been used as traditional medicine in China, Europe, America, Turkey, India, Africa, Iran, and Pakistan for their great medicinal value and health benefits.

Africa and Southern Africa

A total of 35 Euphorbia species are used in traditional medicine in southern Africa. Plants of this genus are used around the world to treat different kinds of ailments such as skin diseases, migraine, gonorrhoea, and intestinal parasites. In Africa, E. tirucalli and related tree euphorbias were employed by traditional healers for conditions including edema and tuberculosis, and the latex has been used topically for skin lesions.

South and Southeast Asia — Ayurvedic and Related Systems

E. antiquorum has a long tradition of being utilized in Chinese, Ayurvedic, and other traditional systems for a variety of ailments. Euphorbia antiquorum Linn is used as a traditional folk medicine in ailments such as inflammation, arthritis, wounds, stomach ache, cutaneous infection, diabetes, and as a purgative. It is commonly found in village shrubberies throughout the tropical and warm temperate regions of India and Ceylon.

Euphorbia hirta is often used traditionally for female disorders, respiratory ailments (cough, coryza, bronchitis, and asthma), worm infestations in children, dysentery, jaundice, pimples, gonorrhea, digestive problems, and tumors.

E. neriifolia produces a milky latex that is traditionally used to treat a wide range of diseases, including skin diseases, digestive issues, wounds, and hemorrhages. It is commonly referred to as "sehund" or "thohar" in Hindi and Milk Hedge in English, and is found in the hilly regions of India, Bangladesh, Baluchistan, Burma, and the Malaysian Islands.

Traditional Use in the Philippines

Euphorbia hirta, commonly known as Tawa-Tawa, is a plant used in folklore medicine in the Philippines for the treatment of dengue. In these communities, it is prepared as a decoction of the whole plant, taken orally to address thrombocytopenia and fever associated with dengue hemorrhagic fever.

Africa and the Pacific — E. hirta

E. hirta is a popular herb among practitioners of traditional herbal medicine in Africa, Australia, Cambodia, China, India, Nepal, the Philippines, and other countries. It has long been used as a decoction or infusion for the treatment of various diseases. Uses include treating intestinal parasites, diarrhoea, peptic ulcers, heartburn, vomiting, amoebic dysentery, asthma, bronchitis, hay fever, laryngeal spasms, emphysema, coughs, colds, kidney stones, and menstrual disorders.

Morocco and North Africa — E. resinifera

Euphorbium is the air-dried latex of Euphorbia resinifera Berg. Historically, this resin was traded from Morocco into Europe during the classical and medieval periods as one of the oldest documented medicinal resins. It was used as a powerful purgative, counterirritant, and topical vesicant. Traditional uses documented in modern ethnobotanical surveys include treatment of cancer, diabetes, hypoglycemia, and wounds.

European Historical Use

The sap of Euphorbia peplus is a white, sticky irritant that has long been used in traditional medicine for the treatment of warts, corns, and non-melanoma skin cancers. An Australian survey from 1986 regarding the use of home remedies for skin cancers and actinic keratoses described support among respondents regarding the effectiveness of the sap of Euphorbia peplus.

Traditional Uses: Systemic Summary

Plant species in this genus are widely used in traditional medicine for the treatment of diseases, ranging from respiratory infections, body and skin irritations, digestion complaints, inflammatory infections, body pain, microbial illness, snake or scorpion bites, pregnancy, as well as sensory disorders.

3. Key Constituents and Active Compounds

Overview of Phytochemical Classes

It has been found that there exist triterpenoids, diterpenoids, flavonoids, phenolic acids, tannins, and other constituents in Euphorbia. Four hundred and two compounds (402) were identified across the genus, with dominant diterpenoids, triterpenoids, flavonoids, and phenols.

Diterpenoids

Diterpenoids represent the most pharmacologically studied chemical class in the genus. Key diterpenoid subgroups include:

Ingenane-type diterpenoids: The most clinically significant. Ingenol mebutate (ingenol 3-angelate, PEP 005) is extracted from the sap of Euphorbia peplus. Chemically, it is a hydrophobic macrocyclic diterpene ester with molecular formula C₂₅H₃₄O₆ and molecular weight 430.5.
Resiniferatoxin (RTX): Resiniferatoxin is a highly irritant diterpene ester isolated from Euphorbia resinifera. RTX is approximately 100 times more potent an agonist of the TRPV1 receptor than capsaicin.
Jatrophane-type diterpenoids: Found across multiple species; studied for multidrug resistance reversal and anti-inflammatory activities.
Lathyrane-type diterpenoids: Present in E. lathyris and related species.
Tirucallane-type diterpenoids: Tirucallane, euphane, and cycloartane triterpenoids have been identified and isolated in most of the species utilized for medicinal purposes, such as E. hirta, E. thymifolia, and E. milii, and could be considered marker compounds of the genus.

Triterpenoids

Key phytochemicals such as euphol, cycloartenol, tirucallol, and triterpenoids contribute to their therapeutic efficacy. Phytochemical studies have resulted in the isolation and identification of several compounds including 7-galloyl catechin, 3β-acetyloxy-olean-13, β-amyrin, caffeic acid, euphol, euphorbin, luteolin, and quercetin.

E. neriifolia contains euphol, monohydroxy triterpene, nerifoliol, taraxerol, β-amyrin, glut-5-(10)-en-1-one, neriifolione, and cycloartenol as leading secondary metabolites.

Flavonoids and Phenolic Compounds

E. hirta is reported to contain alkanes, triterpenes, phytosterols, tannins, polyphenols, and flavonoids. Notable flavonoids include quercitrin, quercetin, kaempferol, and luteolin. Phytochemical studies have shown that the major pharmacologically active constituents of E. antiquorum are flavonoids and triterpenoids.

More than 116 bioactive constituents were isolated from Euphorbia antiquorum, with diterpenoids being the most abundant.

Phorbol Esters and Co-Carcinogens

Certain Euphorbia species contain phorbol esters — potent activators of protein kinase C — which in some structural configurations function as tumor promoters. These are distinct from the therapeutically active diterpene esters and represent a significant toxicological concern discussed further in the safety section.

Mechanisms of Action: Established Pathways

Ingenol mebutate (from E. peplus): The medication is proposed to have a dual mechanism of action: rapid lesion necrosis followed by lesion-specific, neutrophil-mediated, antibody-dependent cellular cytotoxicity. Evidence was obtained that it may work by activating the protein kinase C pathway, thus inducing the interleukin decoy receptors IL1R2 and IL13RA2 and triggering apoptosis. Additionally, it promotes apoptosis of caspases, increases stability of p53 and promotes phosphorylation of signaling molecules.

Resiniferatoxin (from E. resinifera): Administration of the potent TRPV1 agonist resiniferatoxin (RTX) to neuronal perikarya or nerve terminals induces calcium cytotoxicity and selective lesioning of the TRPV1-expressing nociceptive primary afferent population. Activation and sensitization of TRPV1 leads to calcium influx and depolarization of the sensory neuron membrane followed by rapid desensitization of TRPV1, resulting in diminished action potential firing and desensitization results in analgesia.

Anti-inflammatory effects (general Euphorbia extracts): The anti-asthmatic effect may be due to its potent anti-inflammatory and anti-oxidative activities. The anti-hypertensive activity may be due to diuretic activity and ACE inhibition. The anti-infection activity may be due to direct bactericidal activity.

4. Scientific Evidence by Area of Use

4.1 Actinic Keratosis and Non-Melanoma Skin Cancer (E. peplus / Ingenol Mebutate)

This is by far the most robustly evidenced clinical use of any Euphorbia-derived compound, having progressed through the full drug development pipeline to regulatory approval.

Ingenol mebutate (Picato®), extracted from the sap of the Euphorbia peplus plant, is a small molecule with a unique mechanism of action involving direct cytotoxicity and immune stimulation. In 2012, ingenol mebutate was approved by the FDA and the EMA for the treatment of actinic keratosis.

Phase IIa evidence: A randomized, double-blind, vehicle-controlled, phase IIa study investigated the safety and efficacy of two applications of ingenol mebutate gel in 58 patients with biopsy-confirmed actinic keratosis. Five preselected lesions were treated with ingenol mebutate gel at 0.0025%, 0.01%, or 0.05%, or vehicle gel, on days 1 and 2 (Arm A) or days 1 and 8 (Arm B). Efficacy was greatest with ingenol mebutate gel 0.05%, which resulted in complete clinical clearance of 71% of treated lesions (P < 0.0001 vs. vehicle gel). In addition, 67% of patients treated with the 0.05% gel had clinical clearance of at least four of five treated lesions (P = 0.0185 vs. vehicle gel).

Phase III evidence and dosage: In phase III trials, ingenol mebutate gel applied topically once daily at 0.015% for 3 days or 0.05% for 2 days, respectively, significantly reduced head and non-head actinic keratosis lesions. Two different strengths of the gel were approved for use on either the face and scalp (0.015%) or the trunk and extremities (0.05%), respectively.

Long-term follow-up: A 12-month long-term follow-up study observed sustained lesion reduction rates of 87.2% for patients treated with ingenol mebutate 0.015% gel on the face or scalp for 3 consecutive days and 86.8% for patients treated with ingenol mebutate 0.05% gel on the trunk or extremities for 2 consecutive days. No significant adverse effects were noted during the 12-month follow-up period.

Regulatory status change: In 2020, the drug was withdrawn from the market in the EU. This was due to post-marketing safety signals, particularly concerns about squamous cell carcinoma risk in treated areas, underscoring that even an approved Euphorbia-derived pharmaceutical requires ongoing scrutiny.

Evidence strength: Strong clinical evidence (Phase II and III RCTs, FDA approval). The EU market withdrawal introduces an important safety caveat.

4.2 Chronic and Nociceptive Pain — Resiniferatoxin (from E. resinifera)

RTX is a chemical compound isolated from Euphorbia resinifera and Euphorbia poissonii, which are cactus-like plants. RTX is a super-agonist that binds pseudo-irreversibly to TRPV1; it is approximately 500 times more potent than capsaicin.

Clinical investigations of resiniferatoxin (RTX) analgesia are currently ongoing for several human pain indications. RTX is an agonist of the TRPV1 receptor cation ion channel which is activated by capsaicin, heat, and inflammatory conditions. RTX injection at peripheral sites of pain generation will produce a chemo-inactivation of local nerve terminals and axons and block the transmission of nociceptive signals to the spinal cord.

Clinical human studies with RTX to treat osteoarthritis (OA) pain were preceded by extensive animal and cell system testing which revealed mechanisms of action, range of potentially treatable pain problems, and the safety and efficacy of this interventional analgesic agent. Many studies have demonstrated the effectiveness of RTX in reducing cancer pain in various animal experiments. Currently, resiniferatoxin is under clinical investigation to examine its safety and analgesic effect for advanced cancer patients.

Animal data: Intrathecal injection of TNF induces mechanical allodynia and thermal hyperalgesia 24 h after administration. The additional intrathecal administration of RTX (1.9 μg/kg) alleviates TNF-induced mechanical allodynia and thermal hyperalgesia 24 h after injection.

Evidence strength: Preclinical evidence is substantial; human clinical trials are ongoing. No completed large-scale RCTs in humans are published to date for this indication.

4.3 Respiratory Disease — Asthma and Bronchitis (E. hirta)

Ethnopharmacologically, E. hirta is used to cure respiratory and bronchial disorders (hay fever, bronchitis, and asthma), conjunctivitis, and gastrointestinal diseases such as intestinal parasitosis, dysentery, and diarrhea.

E. hirta has a rich phytochemistry and exhibits remarkable activity against respiratory diseases, gastrointestinal disorders, and venereal diseases.

Animal evidence: Studies evaluated the anti-inflammatory and anxiolytic effects of E. hirta extract on neonatal asthmatic rats. Researchers have reported that the extract of E. hirta exerts various pharmacological effects, including acting as an anxiolytic, sedative, anti-inflammatory, analgesic, and antipyretic agent. The antipyretic effects of Euphorbia hirta were evaluated via yeast-induced hyperthermia and showed potential activity at 100–400 mg/kg. Writhing and hot plate tests showed anti-analgesic activity in a dose-dependent manner at 20 mg/kg and 25 mg/kg, respectively. Strong anti-inflammatory activity was observed in carrageenan-induced edema test rats at 100 mg/kg.

Evidence strength: Preclinical (animal and in vitro) evidence only for respiratory indications. No adequate, controlled human clinical trials have been conducted specifically for asthma or bronchitis. The proposed mechanisms of anti-inflammatory and antioxidant activity are plausible but remain unvalidated in human trials.

4.4 Dengue Fever and Thrombocytopenia (E. hirta)

Three animal studies conducted using rats and rabbits established that the subacute administration of E. hirta leaves/whole plant increases platelet counts. E. hirta has significantly increased platelet counts in rats treated with ethanol to induce thrombocytopenia.

Human clinical data: A clinical study conducted with dengue patients admitted to Sir Ganga Ram Hospital Lahore showed that oral treatment with herbal water of E. hirta had increased platelet and total leukocyte counts after 24 hours. A significant platelet increase was observed in the 30–55 age group following treatment with E. hirta, while the increment was not significant in the 14–25 age group, compared with the control group.

Over 70% of patients showed moderate increase in their platelet count. However, leukopenia improved significantly after the use of aqueous extract of E. hirta. A marked recovery in fever and flu-like symptoms was observed. In over 70% of patients there was improvement in platelet count, TLC, fever, and flu-like symptoms.

The observed reversal of thrombopenia in dengue patients subjected to E. hirta could be attributed to high concentrations of phytochemicals such as quercetin and other flavonoids that have been shown to facilitate platelet aggregation and decrease capillary fragility.

Evidence strength: There is preliminary human clinical evidence (small, non-randomized or poorly controlled studies) alongside supporting animal data. The clinical studies conducted lack rigorous randomization and controls, and the results are heterogeneous by age group. Larger, well-designed RCTs are needed before conclusions can be drawn for clinical use.

4.5 Antimicrobial Activity

Investigated species have exhibited a wide spectrum of pharmacological activities, including antibacterial, antifungal, antiviral, antiplasmodial, antioxidant, anticancer, larvicidal, and molluscicidal effects.

Different extracts of E. neriifolia exerted antimicrobial activities against various pathogens to different extents. E. hirta acts as a highly active antiviral agent against poliovirus and simian immunodeficiency virus. A clinical study showed its inhibitory responses against flu and fever in dengue patients.

Evidence strength: Predominantly in vitro and animal data. Antimicrobial properties are well documented at the laboratory level, but human clinical evidence for treating specific infections is sparse and preliminary.

4.6 Anticancer Activity

Euphorbia extracts exhibited cytotoxicity activities against various cell lines, including A549, CACO2, CS12, HELA, HrpG2, and MCF-7. Different extracts of E. hirta have shown significant preclinical anticancer propensity against an array of different cancer cell lines.

Researchers isolated ingenol as the active agent in E. peplus and showed that it was 100-fold more cytotoxic toward certain tumor cells in vitro than healthy cells.

Traditional reports also document use of specific species for cancer-related conditions: the traditional use of some species in the treatment of severe systemic diseases, including cancer and tumors, is recorded with E. resinifera in Morocco and E. milii in India and E. tirucalli in Brazil.

Evidence strength: Anticancer properties are primarily supported by in vitro cytotoxicity data and animal models. The exception is ingenol mebutate's clinical application in actinic keratosis (a premalignant condition). No Euphorbia species extract has demonstrated efficacy against internal malignancies in well-designed human clinical trials.

4.7 Gastrointestinal Applications

All plants of Euphorbia contain irritant latex and a great number of them are commonly used in the treatment of skin diseases, edema, and tuberculosis in folk medicine. Euphorbia has exhibited various biological properties, such as antitumor, antivirus, antidiarrheal, anthelmintic, wound healing, and vascular relaxant effects.

The purgative/laxative use of euphorbias is one of the oldest recorded indications in multiple traditions, attributable to the irritant action of latex diterpenoids on the gastrointestinal mucosa. This effect is physiologically real but is also a primary mechanism of toxicity in overdose, and its therapeutic use as a laxative is not supported by modern controlled clinical data.

Evidence strength: Mechanistically plausible and historically consistent; no modern controlled clinical trials on gastrointestinal efficacy.

5. Body Systems and Health Areas of Association

Integumentary (skin): Topical treatment of actinic keratosis, warts, corns, skin lesions, and wound healing — the most robustly evidenced area.
Respiratory system: Traditional and preliminary preclinical evidence for asthma, bronchitis, hay fever, and emphysema.
Nervous system / Pain: RTX is under active clinical investigation for chronic pain management via TRPV1-mediated chemo-ablation of peripheral nociceptors.
Haematological system: Preliminary human evidence for platelet augmentation in dengue-associated thrombocytopenia.
Immune / Antimicrobial: In vitro and animal evidence for antibacterial, antiviral, antifungal, and antiparasitic activity.
Gastrointestinal system: Historical use as purgative/laxative; traditional use for dysentery, parasites, peptic conditions.
Oncology (adjunct/experimental): Cytotoxicity data against multiple cancer cell lines; the pharmaceutical ingenol mebutate is the only clinically approved oncology-related product from this genus.
Endocrine / Metabolic: Traditional use for diabetes documented in several species (e.g., E. resinifera, E. antiquorum); preclinical antidiabetic activity reported but human clinical trials are lacking.

6. Dosages Reported in Studies

Dosages are reported here only as specified in cited research sources and apply to the particular species and preparations studied. These are not recommendations for use.

Ingenol mebutate gel (E. peplus): 0.015% applied topically once daily for 3 days (face/scalp) or 0.05% for 2 days (trunk/extremities) in phase III trials. A phase IIa study used 0.0025%, 0.01%, or 0.05% gel on days 1 and 2 (or days 1 and 8).
Resiniferatoxin (E. resinifera) — animal/experimental: Intrathecal administration of RTX at 1.9 μg/kg alleviated TNF-induced mechanical allodynia and thermal hyperalgesia in an animal model.
E. hirta — animal antipyretic/anti-inflammatory studies: Antipyretic activity demonstrated at 100–400 mg/kg in animal models; analgesic activity at 20 mg/kg and 25 mg/kg; anti-inflammatory activity at 100 mg/kg in carrageenan-induced edema.

No standardized dosage for oral human supplementation with any Euphorbia species extract has been established in peer-reviewed literature or by regulatory pharmacopoeial monographs.

7. Safety Considerations and Interactions

Latex Toxicity: Dermal and Ocular

The milky sap or latex of Euphorbia plant is highly toxic and an irritant to the skin and eye. The initial symptoms of ocular exposure include severe burning sensation with blurring of vision. Visual acuity can reduce from 20/60 to counting fingers. Clinical findings have ranged from kerato-conjunctivitis, mild to severe corneal edema, epithelial defects, anterior uveitis, and secondary elevated intraocular pressure.

A hypopyon has been noted in several cases and there is risk of corneal ulceration, with several case reports of subsequent blindness. One case resulted in a dense corneal opacity requiring penetrating keratoplasty.

A hallmark of Euphorbia myrsinites, a member of the widespread perennial Euphorbia species, is the extrusion of a poisonous latex-like sap irritant to skin and eye after contact. Patch testing with fresh E. myrsinites sap induced dermatitis in 100% of tested sites. The reported findings support the primarily toxic irritating nature of Euphorbia myrsinites sap.

Ocular Toxicity Management

All symptoms and signs of ocular exposure resolved by 10–14 days with active supportive medication. People who handle Euphorbia plants should wear eye protection.

Ingenol Mebutate (Picato®) — Approved Drug Safety Profile

Irritation of the application site is very common. The various types of irritation include redness, scaling, crusting, pain, severe itching, and sometimes infection. Adverse events in phase III trials were mostly mild or moderate.

The EU market withdrawal of ingenol mebutate gel (Picato®) in 2020 followed signals from post-marketing surveillance raising concern about squamous cell carcinoma risk in treated areas, illustrating that pharmacological activity of Euphorbia-derived compounds can have serious unintended consequences in clinical use.

Phorbol Esters and Co-Carcinogenicity

Phorbol esters present in some Euphorbia species are known co-carcinogens. They act as potent protein kinase C activators and tumor promoters, and their chronic topical application at sub-irritant doses has been associated with tumor promotion in animal models. This is an important distinction from the therapeutically active ingenane-type diterpenes in E. peplus and underscores the critical importance of species identification and preparation specificity.

Systemic Toxicity

Oral ingestion of raw Euphorbia latex in uncontrolled preparations carries risk of severe gastrointestinal irritation, nausea, vomiting, and — in significant doses — systemic toxicity. Euphorbia tirucalli, in particular, has documented toxic effects; its latex contains diterpenoid esters with mucosal irritant and cytotoxic properties. StatPearls documentation at the NCBI (via National Library of Medicine) catalogues cases of E. tirucalli toxicity.

Species-Specificity of Toxicological Profiles

Recent findings indicate that specific compounds found in Euphorbia plants exhibit significant biological and pharmacological properties. However, the white sticky latex sap they contain is highly toxic, although it may also have medicinal applications. The degree of toxicity varies substantially by species, part of plant used, preparation method, and dose — a critical consideration for any supplemental or traditional use.

Evidence on Drug Interactions

No specific, rigorously documented drug–drug interactions between oral Euphorbia preparations and pharmaceutical agents have been established in peer-reviewed clinical trials. The cytotoxic and protein-kinase-C-modulating properties of diterpenoid constituents raise theoretical concerns about interactions with immunosuppressants, protein kinase inhibitors, and drugs with narrow therapeutic windows, but these have not been characterized in controlled human studies.

Pregnancy and Paediatric Use

Some species are used in traditional medicine in relation to pregnancy and sensory disorders, but formal safety data for pregnant women or children are absent. The emmenagogue and purgative properties attributed to certain species create theoretical risks in pregnancy, and no human safety studies have been conducted to evaluate these populations.

8. Overall Assessment of Evidence Quality

The genus has 402 identified compounds, with dominant diterpenoids, triterpenoids, flavonoids, and phenols. Compounds have been found active against cancer cells, viruses, microbes, and inflammation. Clinical trials show members of the genus to be effective against hemorrhoids, varicose veins, and human non-melanoma skin cancers.

The clinical efficacy of Euphorbia-based therapies is a direct correlation of plentiful and heterogeneous phytochemistry. This demonstrates not only the validity of past ethnobotanical uses but also the prospect of Euphorbia species as sources of standardization of herbal treatments or of new molecular structures to be used as pharmaceutical agents in the future.

Although the medicinal uses of Euphorbia species have been well documented, the pharmacological and phytochemical studies are limited, and further studies to validate the use of Euphorbia species as traditional medicines and to isolate active compounds are needed.

In summary: one Euphorbia-derived compound (ingenol mebutate from E. peplus) has reached full regulatory approval and withdrawal in different markets, demonstrating both the pharmaceutical potential and the ongoing safety uncertainties inherent to this genus. Resiniferatoxin from E. resinifera is actively under clinical development for pain. For all other uses — respiratory, antimicrobial, gastrointestinal, antidiabetic, and general anti-inflammatory — the body of evidence remains at the preclinical or early-phase clinical level, and broader traditional use has not been validated in adequate, well-controlled human trials.

References

Health Conditions

Health conditions that Euphorbia may help support.

No conditions available.

Body Systems

Body systems that Euphorbia may help support.

No body systems available.