Witch Hazel

Metadata

Approved Indications

Commission E (Germany)

• Approved for external use
• Indications: Minor skin injuries; local inflammation of skin and mucous membranes; hemorrhoids; varicose vein complaints

ESCOP (European Scientific Cooperative on Phytotherapy)

• Approved for external and internal use
• External: Bruises, sprains, minor skin injuries, local inflammation of skin and mucous membranes
• Internal: Varicose veins, aching/heavy legs, hemorrhoids

EMA/HMPC (European Medicines Agency)

• Traditional Use classification
• Bark and leaf preparations assessed in separate monographs
• Indications: Minor skin inflammations, symptomatic relief of itching and burning associated with hemorrhoids, relief of heaviness/discomfort in legs related to minor venous circulatory disturbances

Agreement/Disagreement Between Bodies

• Good agreement across all three bodies on external skin inflammation and hemorrhoid indications
• ESCOP is broadest, including sprains and bruises
• EMA is most conservative, maintaining “traditional use” classification only
• All agree on hemorrhoid symptomatic relief

Conditions Treated

Primary (Monograph-Supported)

• Minor skin inflammations and injuries
• Hemorrhoids (symptomatic relief — itching, burning, discomfort)
• Varicose vein complaints
• Local inflammation of mucous membranes

Secondary (Clinical/Traditional Use)

• Atopic eczema/dermatitis [CONTESTED — see clinical evidence]
• Acne (mild)
• UV-induced erythema (sunburn)
• Sensitive/irritated scalp conditions
• After-shave irritation
• Insect bites

Mechanism of Action

Key Active Compounds

• Hamamelitannin (hydrolyzable tannin) — primary active in bark (up to 65% of hydroalcoholic bark extract); much lower in leaves (1.5%)
• Proanthocyanidins (condensed tannins) — dominant in leaves (88.5% of leaf tannin fraction)
• Gallic acid — 10% of leaf tannin fraction
• Flavonoids (quercetin, kaempferol, myricetin glycosides)
• Essential oil (in distillate — but tannins are largely absent from steam distillate)

Mechanisms

1. Astringent action: Tannins precipitate surface proteins on skin/mucosa, forming a protective layer that reduces permeability, inflammation, and secretion
2. Anti-inflammatory (NF-kB inhibition): Hamamelis bark extract inhibits NF-kB-driven transcription, reducing release of IL-6, IL-17C, TSLP, CCL26, and MMP-9 in keratinocytes (IC50 values < 25 microg/mL) [Source: PMC9408886]
3. Antioxidant: Polyphenol-mediated free radical scavenging
4. Antimicrobial: Moderate activity against common skin pathogens
5. Vasoconstrictive: Tannins reduce venous distensibility (relevant to hemorrhoid and varicose vein indications)

Critical Distinction: Extract vs. Distillate

• Hydroalcoholic extracts (bark or leaf): Rich in tannins; pharmacologically active
• Steam-distilled witch hazel water (Hamamelidis aqua): Largely devoid of tannins; the most commercially available form (especially in North America); significantly reduced pharmacological activity
• This distinction is crucial for interpreting clinical evidence and product efficacy

Clinical Evidence Summary

Key Clinical Trials

Evidence Assessment

• Atopic eczema: The Korting et al. trial is frequently cited; it found hamamelis distillate cream performed no better than vehicle and was inferior to hydrocortisone. However, this used a distillate (tannin-depleted), not a tannin-rich extract. This critical detail is often overlooked. [CONTESTED]
• UV erythema: Positive evidence for anti-inflammatory activity
• Hemorrhoids: Predominantly traditional use evidence; no high-quality RCTs identified [NEEDS-RESEARCH]
• Acne: In vitro evidence of anti-inflammatory effect; limited clinical data [NEEDS-RESEARCH]
• Overall: The disconnect between strong in vitro/pharmacological evidence and limited positive clinical trial data may be explained by the use of tannin-depleted distillates in trials rather than tannin-rich extracts

European vs US/Anglophone Consensus

Notable: Witch hazel is one of the few herbs where US/Anglophone acceptance is comparable to European recognition, though for different reasons (cultural familiarity vs. evidence-based monographs).

Safety Profile

Contraindications

• Known hypersensitivity to Hamamelis or other Hamamelidaceae
• Not for use on deep or infected wounds

Drug Interactions

• No significant drug interactions reported for topical use
• Internal use: theoretical interaction with anticoagulants due to tannin content (not relevant to topical)

Side Effects

• Rare: Contact dermatitis (very uncommon)
• Possible skin dryness with excessive use of distillate products (due to alcohol content, not the herb itself)
• Generally very well tolerated

Pregnancy/Lactation

• Topical use: Generally considered safe
• Internal use: Use with caution; insufficient data
• Topical hemorrhoid preparations commonly used during pregnancy without reported adverse effects

Clinical Dosage

Topical Preparations

Key Commercial Products (Europe)

• Hametum (ointment, suppositories) — contains hamamelis bark extract
• Various pharmacy-compounded preparations
• Widely available as Hamamelis water in pharmacies

Sources

• EMA Assessment Report on Hamamelis virginiana L., cortex / folium / destillatum
• EMA Community Herbal Monograph on Hamamelis virginiana L., cortex
• Commission E Monograph: Hamamelis (external use)
• ESCOP Monograph: Hamamelidis cortex / folium
• Korting et al. (1995). Comparative efficacy of hamamelis distillate and hydrocortisone cream in atopic eczema. Eur J Clin Pharmacol. PMID: 8582464
• PMC9408886: Unveiling the Ability of Witch Hazel Bark Extract to Impair Keratinocyte Inflammatory Cascade
• MDPI Molecules 30(13):2744 — Hamamelis virginiana in Skin Care: Review

Connections

• Compare with Chamomile for overlapping anti-inflammatory skin indications
• Compare with Calendula for wound healing
• The tannin-depletion issue parallels quality concerns with Tea Tree (oxidation)