Witch Hazel

Scientific Name(s): Hamamelis virginiana L.
Common Name(s): Cortex Hamamelis, Folium Hamamelis, Hamamelis, Hamamelis water, Magician's rod, Snapping hazel, Spotted alder, Tobacco wood, White hazel, Winter bloom, Witch hazel

Medically reviewed by Drugs.com. Last updated on Aug 16, 2023.

Clinical Overview

Use

Hamamelis preparations are commonly used for dermatological conditions, including diaper-related dermatitis; however, clinical studies supporting these uses are generally lacking. Witch hazel has been evaluated for uses including analgesic, antiseptic, antioxidant, and antitumor activity.

Dosing

Topical — Steam distillates of Hamamelis are used diluted (1:3 with water) or undiluted, and in semisolid preparations at 5% to 10% of crude drug. Rectal — Suppositories containing witch hazel contain from 0.1 to 1 g/dose. Oral — Not recommended.

Contraindications

Internal use of extracts is not recommended because of the tannin content.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

Allergic contact dermatitis has been reported from topical applications.

Toxicology

Although extracts of witch hazel are available commercially, it is not recommended that they be taken internally because the toxicity of the tannins has not been well defined.

Scientific Family

• Hamamelidaceae (witch hazel)

Botany

Witch hazel grows as a highly branched deciduous bush or small tree, often reaching approximately 6 m in height. The plant is indigenous to the Atlantic coast and found in damp woods throughout most of North America. Its broad, toothed leaves are ovate, and the threadlike golden-yellow flowers bloom in the fall. Brown fruit capsules appear after the flowers and, when ripe, eject 2 seeds away from the tree. The dried leaves, bark, and twigs are used traditionally.USDA 2011, WHO 2004 A synonym is Hamamelis macrophylla.

History

Witch hazel is a widely known plant with a long history of use in the Americas. The plant, including the crude leaf and bark, is used in a variety of forms; fluid extracts, poultice, and commonly as witch hazel water. The latter, also known as Hamamelis water or distilled witch hazel extract, is obtained from recently cut, partially dormant twigs. This plant material is soaked in warm water, followed by distillation and the addition of alcohol to the distillate. Witch hazel water is the most commonly found commercial preparation, usually kept in most homes as a topical cooling agent or astringent.

Traditionally, witch hazel was known to native North American people as a treatment for tumors and eye inflammations. It was used internally for hemorrhage. Other uses include treatment of hemorrhoids, burns, cancers, tuberculosis, colds, and fever. Preparations have been used topically for symptomatic treatment of itching and other skin inflammation, and in ophthalmic preparations for irritation.Bisset 1994, Chevallier 1996, Duke 1985, WHO 2004

Related/similar drugs

Calmoseptine, camphor topical, Caladryl Clear, Tucks, A+D

Chemistry

H. virginiana bark primarily contains polyphenols, including tannins, phenolic acids, and flavonoids. At least 27 phenolic constituents have been identified using high-pressure liquid chromatography, liquid chromatography, and mass spectrometric methods. Methods for quantifying gallic acid, hamamelitannin (approximately 1.5% in leaves and up to 65% in bark), and the proanthocyanidins have been described. The gallotannins are heat labile.Bernard 1971, Duckstein 2011, González 2010, Vennat 1988, Wang 2003, WHO 2004 Because witch hazel water is a steam distillate of the extract, it does not contain tannins.Chevallier 1996, Newall 1996

Other components include kaempferol, quercetin, chlorogenic acid isomers, and hydroxycinnamic acids. The volatile oil contains small amounts of safrole and eugenol as well as numerous other minor components, such as resin, wax, and choline.Duckstein 2011, WHO 2004

Uses and Pharmacology

Antimicrobial

Animal data

In vitro studies have shown antibacterial properties of the plant extract (both leaf and bark) versus Escherichia coli, Staphylococcus aureus (including resistant strains), Bacillus subtilis, and Enterococcus faecalis.Kiran 2008, WHO 2004 Activity against periodontopathic bacteria has also been reported.Iauk 2003

Clinical data

Clinical trials are lacking. In healthy volunteers, a distillate of Hamamelis demonstrated weak topical antibacterial activity.Gloor 2002 Antiviral effects in herpes labialis were reported in a clinical trial of Hamamelis ointment compared with placebo; however, a reduction in inflammation was only noted on day 8.WHO 2004

Dermatological uses

Hamamelis preparations are commonly used for dermatological conditions in several countries; however, quality clinical studies supporting these uses are lacking.Chevallier 1996, WHO 2004

Animal data

Animal models have been used to demonstrate astringent and hemostatic properties of the plant extracts. At lower concentrations, Hamamelis extracts decreased cell permeability, while at higher concentrations, a healing effect was produced by influence on proteins and colloidal tissue.Bate-Smith 1973, WHO 2004 Fluid extracts administered parenterally to rabbits were also vasoconstrictive, Bernard 1972, WHO 2004 reducing suppuration in purulent skin.WHO 2004

Clinical data

Older, uncontrolled clinical studies evaluated the efficacy of Hamamelis preparations in anorectal conditions (eg, hemorrhoids). Equivalence with bismuth subgallate has been shown.Weiner 1983, WHO 2004

In healthy volunteers, topical extracts of Hamamelis reduced the erythema consequent to ultraviolet (UV) and chemical irritation to a lesser extent than hydrocortisone 1%, but greater than the antihistamine (dimethindene).Deters 2001, Hughes-Formella 2002, Reuter 2010, WHO 2004 In an open-label study, Hamamelis 6.25% ointment was effective in reducing symptoms related to minor skin injuries, diaper dermatitis, and localized inflammation of the skin in children.Wolff 2007

Limited clinical studies exist on the use of Hamamelis ointment in managing eczema. Results of these studies are equivocal, with some reporting no difference in Hamamelis ointment over placebo.WHO 2004, Yates 2009 Polyphenols from Hamamelis have been used in collagen sponges in studies on long-term wound healing.Francesko 2011

Other uses

Witch hazel was one of the 3 most common herbs used by certified or licensed midwives for perineal healing and discomfort based on state-wide surveys in California, Texas, and North Carolina.Dennehy 2010 Hamamelis cream has been used as an analgesic following episiotomy or perineal trauma following childbirth; no difference in pain relief or additional analgesic use was observed between use of witch hazel and an ice pack.East 2007, East 2012, WHO 2004

Antioxidant properties have been described for Hamamelis extracts.Choi 2002, WHO 2004 This line of study is in the context of antiaging dermatological preparations; however, the activity of witch hazel appears lower compared with other preparations.Thring 2009, Touriño 2008

H. virginiana mouthwash was much less effective at reducing tooth biofilm and plaque compared to other agents tested in a 4-week randomized blind study (n=50). Chlorhexidine gluconate, cetylpyridinium chloride, and triclosan reduced mean plaque index values significantly (range, 66% to 69% at baseline to 13% to 32%), whereas H. virginiana produced a much smaller reduction (71% to 59%).Mouchrek 2015

Fractions of Hamamelis extracts have been evaluated in vitro for antitumor and UV protective activity.Dauer 2003, Habtemariam 2002, Lizárraga 2008

Prevention of purpuric lesions associated with tattooed skin by incorporating witch hazel into tattoo ink has also been suggested in a case study.Pinal-Fernandez 2014

Dosing

Topical

Steam distillates of Hamamelis are used diluted (1:3 with water) or undiluted, and in semisolid preparations at 5% to 10% of crude drug.Blumenthal 2000, WHO 2004

Rectal

Suppositories containing witch hazel contain 0.1 to 1 g/dose.Blumenthal 2000, WHO 2004

Oral

Not recommended.Blumenthal 2000, WHO 2004

Pregnancy / Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.WHO 2004

Interactions

None well documented.

Adverse Reactions

Although tannins are not usually absorbed following oral administration, doses of Hamamelis extracts 1 g have caused nausea, vomiting, or constipation. Hepatic damage may occur if the tannins are absorbed to an appreciable extent.Bisset 1994, Spoerke 1980 Witch hazel water is not intended for internal use. Teas can be brewed from leaves and twigs commercially available in some health food stores, but their safety is unknown.

Allergic contact dermatitis has been reported, and cross-sensitivity to Compositae plants (including arnica and chamomile) is possible.Granlund 1994, Paulsen 2008, WHO 2004

Toxicology

Information is generally lacking. Aqueous extract of Hamamelis leaves were not carcinogenic to rodents when administered subcutaneously.WHO 2004 Although the volatile oil contains the carcinogen safrole, it is found in much smaller quantities than in sassafras.Duke 1985 Extracts of witch hazel are available commercially; however, it is not recommended that they be taken internally because the toxicity of the tannins has not been well defined.Newall 1996 Witch hazel accounted for 6% of reported adverse events to the California Poison Control System from January 1997 to June 1998.Yang 2002

Index Terms

• Hamamelis macrophylla

References

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