Heartsease

What is Heartsease?

As recently as 2015, Bombastus-Werke's German pharmacy tea of heartsease was labeled for compresses on children's cradle cap, and its leaflet said plainly: "Nicht zur innerlichen Anwendung," not for internal use. That leaflet (revised January 2015) also said there were not enough studies of the herb in children under 12, and that it must not be used by anyone hypersensitive to salicylates. Its September 2021 revision follows the EU monograph instead: a 3 g drinking tea for adults, no cradle cap, no oral use under 18 and no skin use under 12. Meanwhile, a UK tincture of the same plant, A.Vogel's Viola tricolor, is sold as a food supplement with oral drops for children from age 2, an age the EU monograph does not recommend for oral use.

Heartsease is Viola tricolor L., a small annual or short-lived perennial of the violet family, Violaceae, native to Europe and to Asia as far east as Central Asia, and now also found across the United States. Its flowers usually combine purple, yellow and white, which gives the species its name. The large-flowered garden pansy, Viola × wittrockiana, was bred from it and is grown as an ornamental only (Vukics and colleagues, Journal of Chromatographic Science, 2008). Shakespeare's "love-in-idleness," the flower whose juice drives the plot of A Midsummer Night's Dream, is usually identified as this plant.

The medicinal material is the dried flowering aerial part, sold in Europe as Violae tricoloris herba or Violae herba cum flore. The European Pharmacopoeia accepts it from V. tricolor or from the closely related field pansy, Viola arvensis, and requires at least 1.5% flavonoids, expressed as violanthin and calculated on the dried herb. In Europe heartsease is sold mainly as a registered pharmacy tea and in a few tablet and capsule products. In the United States it is sold as a dietary supplement, mostly as loose herb and tinctures.

Common Names

Heartsease, heart's ease, wild pansy, Johnny-jump-up, field pansy (strictly V. arvensis), love-in-idleness, Stiefmütterchen (German), pensée sauvage (French), Violae tricoloris herba, wild pansy (flowering aerial parts). Sweet violet, Viola odorata (banafsheh in Persian medicine), is a different species with its own chemistry and its own literature, and studies on it do not transfer to heartsease. Neither do studies on ornamental garden pansies.

Primary Active Compounds

The European Medicines Agency's 2010 assessment report (EMA/HMPC/131735/2009) gives these figures for the herb:

• Flavonoids: 2.1% in V. tricolor herb and 1.3% in V. arvensis. The two main flavonoids are violanthin (an apigenin C-glycoside) and rutin (Vukics and colleagues, Analytical and Bioanalytical Chemistry, 2008).

• Mucilage: about 10%.

• Tannins: 2.4% to 4.5%.

• Phenolcarboxylic acids: about 0.18%, including caffeic, p-coumaric, gentisic and protocatechuic acids.

• Salicylic acid and its derivatives: 0.06% to about 0.3%, including methyl salicylate, violutoside and monotropitoside.

• Volatile oil: 0.0086%, with methyl salicylate as the main component.

• Carotenoids: 9.69 mg per gram dry weight in yellow blossoms, about 75% of it violaxanthin.

The plant also makes cyclotides, small ring-shaped peptides locked by three disulfide bonds. Hellinger and colleagues (Journal of Proteome Research, 2015) identified 164 different cyclotides in V. tricolor.

Key Note

Germany approved heartsease only for use on the skin; the EU later added an oral tea for adults as a traditional remedy, and the salicylate content behind the EU's contraindication is a fact most buyers never see (Sections 7 and 19).

What follows: the two monographs, the two combination trials, the salicylate arithmetic, the peptides and the infant questions.

Scan any Heartsease product in seconds with the free NutrientWise app: App Store · Google Play

Primary Functions & Benefits

What the regulators accepted, and on what basis

Three European bodies have written heartsease monographs, and none of them rests on a controlled trial.

• Commission E (1986) approved external use for mild seborrheic skin conditions and cradle cap ("Milchschorf der Kinder"), listing no contraindications and no side effects.

• The EMA's herbal committee (2010) accepted one indication, symptomatic treatment of mild seborrheic skin conditions, for oral tea or skin compresses, on the strength of traditional use alone. A traditional-use registration requires evidence that a product has been in medicinal use for at least 30 years, 15 of them in the EU; it does not require proof of efficacy.

• ESCOP's 2015 monograph lists eczema, seborrhea, impetigo, acne, cradle cap and infant diaper rash, on traditional use.

The 2010 assessment report lists registered products from several member states, and their indications show how far apart national traditions run. Polish teas (on the market for more than 30 years) cover seborrheic skin and mild urinary complaints. Spanish capsules (since 1991) are indicated for dry cough and the common cold. A UK tablet registered for more than 40 years is a traditional remedy for spots, skin blemishes and dry eczema. Czech multi-herb teas (since 1999) are indicated as an adjuvant in rheumatic and flu-like complaints. Urinary claims belong to another issue in this series and are not assessed here.

The ointment trial

Klövekorn, Tepe and Danesch (International Journal of Clinical Pharmacology and Therapeutics, 2007) enrolled 88 adults aged 18 to 65 with mild to moderate atopic dermatitis in a randomized, double-blind, half-side comparison. Each patient applied an ointment containing extracts of Oregon grape (Mahonia aquifolium), heartsease and gotu kola (Centella asiatica) to one side of the body and the plain base cream to the other, for 4 weeks.

• Primary endpoint (a summed score for redness, swelling, oozing, scratch marks and skin thickening): the herbal side improved slightly more than the base-cream side; the difference was not statistically significant.

• Itch (10 cm visual scale) and global assessment: same pattern, no significant difference.

• A post hoc analysis of the 64 patients treated while the mean outdoor temperature was 10 °C or less found a significant difference on the primary endpoint. The authors' own conclusion was that the ointment "could not be proven to be superior to a base cream."

The abstract notes that the same ointment had earlier been tested in children, in open, uncontrolled trials. Even if the cold-weather subgroup were confirmed, three herbs were in the jar, and the trial cannot say which of them did anything.

The capsule trial

Kirichenko and colleagues (Biology, 2020) gave 60 men aged 42 to 67, all smokers with moderate chronic obstructive pulmonary disease, either Inflaminat or an identical placebo capsule for 6 months, 30 per group, with no dropouts. Inflaminat is a Russian dietary supplement: each 500 mg capsule holds 165 mg each of black elderberry, heartsease herb and calendula flower, taken as 3 capsules a day.

• Breathlessness, cough and sputum score: fell from 3.0 to 1.9 in the Inflaminat group over 6 months (p = 0.002 for the within-group change). Nothing changed in either group during the first 3 months.

• FEV1, the volume of air forcibly exhaled in 1 second, as a percentage of predicted: rose from 66% to 73% in the Inflaminat group (p = 0.042, within group).

• Exacerbations per month: 0.15 to 0.12, not significant (p = 0.057). FEV1/FVC ratio: 61% to 66%, not significant.

The paper reports changes within each group, not a direct comparison between groups. It is also a prespecified subgroup of a larger atherosclerosis trial of the same capsule. When the EMA's rapporteur reviewed it in 2021, the assessment noted that the placebo group showed the same upward FEV1 trend, that the paper described neither its randomization nor its blinding, and that any effect could not be attributed to heartsease. The capsule's developers also describe carotid artery results in their own review articles (Orekhov, Current Pharmaceutical Design, 2013); those trials tested the same three-herb mixture.

Laboratory and animal findings

• Immune cells: Hellinger and colleagues (Journal of Ethnopharmacology, 2014) made a dichloromethane and methanol extract of heartsease herb, purified it on a solid-phase column and dissolved it in buffer. At 300 µg/mL it cut the proliferation of activated human lymphocytes to 13% of control, without a significant rise in cell death, by reducing interleukin-2 release. Fractions rich in cyclotides carried the activity.

• Hot water: Retzl and colleagues (Planta Medica, 2023) found that hot-water decoctions of the herb suppressed human T-cell proliferation and interferon-gamma secretion more strongly than a solvent extract enriched in cyclotides, and that boiling longer increased the effect. The cyclotide kalata S appeared to be one of the active components.

• Microbes: an infusion inhibited Staphylococcus aureus, Bacillus cereus and Candida albicans at a minimum inhibitory concentration of 0.15 mg/mL (Witkowska-Banaszczak and colleagues, 2005, as summarized by the EMA).

• Skin inflammation in rats: a gel made from heartsease flower extract reduced paw swelling by up to 61% and neutrophil infiltration, measured as myeloperoxidase activity, by up to 89% after ultraviolet B burns (Piana and colleagues, Journal of Ethnopharmacology, 2013).

None of these has been tested in people at the concentrations used.

Forms & Standardization

Cut herb for tea and compresses

This is the only form either European monograph covers. The pharmacopoeia grade must contain at least 1.5% flavonoids as violanthin, and the EMA's own constituent data put V. tricolor herb at 2.1%, so a compliant lot can sit close to the floor. The specification summarized by the EMA is a flavonoid assay only; it says nothing about salicylate or cyclotide content.

Strength varies more than the label suggests:

• EMA monograph (2010), adults, oral: 3 g of herb as an infusion, 1 to 3 times a day.

• Commission E (1986), external: 1.5 g per cup of water as an infusion, applied 3 times a day.

• Hänsel and colleagues (1994), cited by the EMA: 1 g in 250 mL of boiling water, one cup 3 times a day.

A cup made by the Hänsel method uses a third of the herb in one EMA dose. Two recipes for "heartsease tea" can differ threefold before the drinker adds any variation of their own.

Fresh-plant tincture

A.Vogel's Viola tricolor (50 mL) is a tincture of organically grown fresh aerial parts extracted in 50% v/v alcohol. The page states no herb-to-extract ratio, so the herb dose per drop cannot be worked out. Adult directions: 15 to 20 drops twice a day. Children 2 to 12: 1 drop per year of age, twice a day. It is sold in the UK as a food supplement, not as a registered herbal medicine, which is why it can carry pediatric oral directions that the EMA monograph does not support (Section 19). Its product page warns against use in pregnancy and breastfeeding but says nothing about salicylates.

Dry extract tablets and capsules

• UK registered tablets (on the market for more than 40 years, per the EMA): 62.5 mg of a 6:1 dry aqueous extract, equivalent to 375 mg of herb, 2 tablets 3 times a day, or 2.25 g of herb a day. These are combination products with burdock root as the main co-ingredient, so they are not heartsease monopreparations.

• Spanish capsules (since 1991): 200 mg, 1 to 2 capsules 3 times a day.

• Danish food supplements: the EMA recorded that Denmark accepted doses of "at least 100 mg."

• Inflaminat (Russia): 165 mg of heartsease herb per capsule alongside elderberry and calendula, 495 mg a day at the label dose used in the trial above.

Topical products

The trial ointment combined extracts of Mahonia, heartsease and Centella at 5 g each per 100 g (EMA summary). Bath additives and compresses use the cut herb (5 to 20 g per liter). Cosmetic creams list "Viola Tricolor Extract" by its ingredient name only, because ingredient labeling requires order of predominance, not a percentage.

What extraction pulls out

Water extracts the flavonoid glycosides, mucilage and tannins well. The volatile fraction, which carries most of the methyl salicylate, is only 0.0086% of the herb, so a 3 g dose contains about 0.26 mg of volatile oil in total. Cyclotides survive boiling: in Retzl's 2023 work, longer boiling made the decoction more active against T cells, not less.

Flowers versus whole herb

Rutin is concentrated in the flowers. The EMA cites 4.5% to 10.5% rutin in flowers and 1.7% in herb without flowers, while Vukics and colleagues (Journal of Chromatographic Science, 2008) measured only 420 µg/g, about 0.04%, in a heartsease herb sample by HPLC. The EMA also records 15.96% rutin in yellow flowers of one large-flowered variety versus 4.63% in white ones. A flower-heavy lot and a stem-heavy lot are chemically different products under the same name.

Which form the human trials used

Neither controlled trial used heartsease alone: one used a three-herb ointment, the other a three-herb capsule. No human trial of the tea, the tincture or a standardized heartsease extract was located for this issue.

Food Sources

Heartsease is not a nutrient, and no food supplies it in a meaningful dietary sense. Its only food role is as an edible flower: the fresh blossoms are used as a garnish in salads, desserts, drinks and ice cubes, and food chemists treat it as "a typical edible flower" (Koike and colleagues, Food Chemistry, 2015).

What the food research shows:

• Storage: Fernandes and colleagues (Journal of Food Science, 2020) froze heartsease flowers alone or in ice cubes. Flowers frozen in ice cubes looked like fresh ones for 3 months but had the lowest flavonoid and antioxidant values; plain frozen flowers kept or increased their bioactive content for 1 month.

• Irradiation: in Koike's study, flowers given 1 kGy, a dose used to extend the shelf life of fresh produce, showed the highest phenolic content and antioxidant activity of the samples tested.

• Digestion: Teixeira and colleagues (Food Chemistry, 2026) ran simulated digestion on wild pansy, cosmos and cornflower. Anthocyanin recovery fell by up to 62.69% after the intestinal phase, and digested extracts crossed a model gut lining less efficiently than undigested ones, by up to 67.53%. Those maxima are for the three flowers together, not heartsease alone.

A garnish of a few fresh flowers delivers far less plant material than a 3 g dose of dried herb, and no study has measured salicylate or cyclotide intake from eating the flowers. Gardeners should know the plant colonizes zinc and lead mining spoil in Central Europe (Section 18), so flowers picked from such ground are not equivalent to cultivated ones.

Who Should Take Heartsease

On the European record, the realistic candidates are narrow:

• Adults with mild seborrheic dermatitis (flaking, greasy scale on the scalp, eyebrows or sides of the nose) who want to try a traditional tea compress alongside, not instead of, an established treatment. This is the one use both German and EU monographs share.

• Adults who want to try the oral tea, at the EMA dose, for the same skin indication, understanding that it is registered on tradition and that no trial has tested it.

• Adults with mild atopic dermatitis curious about the herbal ointment studied by Klövekorn: that trial did not show a significant benefit, so this is an experiment, not a treatment.

People who should not count themselves as candidates: anyone under 18 for oral use and under 12 for skin use (by the EMA's wording), anyone pregnant or breastfeeding, anyone who reacts to aspirin or other salicylates, and anyone with a deficiency of glucose-6-phosphate dehydrogenase (G6PD). Cough, cold and lung claims rest on combination products and national traditions only.

Who Should AVOID or Use Caution

Contraindications

• Hypersensitivity to heartsease or to salicylates. This is the EMA monograph's wording, and the Bombastus pharmacy tea repeats it. It covers a person with a known aspirin or salicylate reaction, whether the herb is drunk or applied.

• Skin use on open wounds or large areas of damaged skin (EMA).

• Oral use under 18 and skin use under 12: "not recommended" in the EMA monograph because safety "has not been established due to lack of data."

• Pregnancy and breastfeeding: not recommended (EMA), since no safety data exist. A.Vogel's label also says to avoid it.

• Known G6PD deficiency, for oral use. The EMA monograph lists one case of hemolysis, the destruction of red blood cells, in a G6PD-deficient child after oral use (Section 12).

Use Caution

• Asthma with nasal polyps or aspirin sensitivity. In a meta-analysis of 27 studies, aspirin-exacerbated respiratory disease affected 7.15% of adults with asthma and 14.89% of those with severe asthma (Rajan and colleagues, Journal of Allergy and Clinical Immunology, 2015). Aspirin triggers attacks mainly by blocking the COX-1 enzyme, and salicylic acid itself is a weak COX-1 blocker, so plant salicylates provoke reactions less often than aspirin. Less often is not never: when Stevenson and colleagues (1990) challenged 10 aspirin-sensitive asthmatics with 2 g of salsalate, a non-acetylated salicylate, 2 of the 10 had asthmatic reactions.

• Daily salicylate users. Anyone already taking aspirin, salsalate, bismuth subsalicylate or methyl salicylate rubs is adding to an existing load; see Section 17 for the arithmetic.

• Hot herbal baths: the EMA advises against them during fever or infection, and in people with heart failure or high blood pressure.

• Immune suppression. The authors of the 2014 lymphocyte study wrote that "attention should be paid for potential side effects" in people with a weakened immune system. That warning rests on cell work only.

• Allergy to plants of the violet family: the EMA assessment says reactions to Violaceae "should be considered."

• Alcohol: the fresh-plant tincture is made with 50% alcohol, relevant to anyone avoiding alcohol and to the pediatric directions on the label.

Critical Safety Point

The German approval for cradle cap is for compresses on the skin, and German pharmacy teas labeled for cradle cap said the tea was not for drinking. The only adverse event the EMA monograph itself lists followed a drink: a 9-month-old with G6PD deficiency developed hemolysis after half a cup of boiled heartsease extract (Behmanesh and Abdollahi, 2002, as summarized in the EMA's 2010 assessment). Do not give heartsease to an infant by mouth.

Recommended Dosages

These are the doses in the two official monographs, for adults. They are traditional-use doses, not doses shown to work in a trial.

Oral tea (adults 18 and over)

3 g of cut dried herb as an infusion, 1 to 3 times a day (EMA monograph, 2010). That is 3 to 9 g of herb a day.

Compress or wet dressing (adults and adolescents 12 and over)

An infusion of 5 to 20 g of herb per liter of water, applied as a wet dressing 2 to 3 times a day (EMA). Commission E's version is 1.5 g of herb per cup, applied 3 times a day.

Bath additive (adults and adolescents 12 and over)

An infusion of 5 to 10 g per liter, with 1 liter of the infusion added to the bath (EMA).

Tinctures, tablets and capsules

No EU monograph dose exists. Follow the label of a registered product where one is sold; for food-supplement tinctures with no stated ratio, there is no way to convert the drops into grams of herb.

Children

No dose. The EMA does not recommend oral use under 18 or skin use under 12, and Commission E's cradle cap approval was for external use.

Duration

If symptoms last longer than 4 weeks of use, the EMA monograph says to see a doctor.

Timing & Administration

Making the tea

The current Bombastus leaflet (September 2021) directs 3 g of cut herb into 150 mL of boiling water, covered for 10 to 15 minutes, then strained. That is about two heaped teaspoons, going by the 1.5 g per heaped teaspoon in the company's 2015 leaflet. The EMA lists no interactions of any kind.

Making a compress

Bombastus's 2015 compress leaflet directed one heaped teaspoon (about 1.5 g) into about 150 mL of boiling water, strained after 10 to 15 minutes, and used for compresses 3 times a day; its 2021 leaflet uses the EMA's 5 to 20 g per liter instead. Let the infusion cool to skin temperature, soak a clean cloth, and lay it on the affected skin.

Spacing

The EMA schedule of 1 to 3 doses allows spreading the tea across the day. No pharmacokinetic study of any heartsease constituent in humans was located, so there is no evidence-based reason to prefer morning or evening.

Combining routes

The EMA monograph covers oral and skin use separately. Anyone with salicylate sensitivity should count both routes together, because salicylic acid is absorbed through skin as well as gut.

Timeline of Effects

Trial durations

• Three-herb ointment (atopic dermatitis trial): 4 weeks on one side of the body. No significant difference from base cream at 4 weeks (Klövekorn, 2007).

• Three-herb capsule (COPD trial): 6 months. No change in either group at 3 months; within-group improvements in symptom score and FEV1 appeared only at 6 months (Kirichenko, 2020).

What counts as a fair trial

For skin use, the EMA's 4-week line is the practical trial length: if a mild seborrheic condition has not improved by then, the monograph says to see a doctor rather than continue. Neither monograph gives an onset time, and no study has measured one for the tea.

When to conclude it is not working

At 4 weeks with no change in a mild skin condition. For anything that is getting worse, spreading, weeping or infected (the current Bombastus leaflet names complaints lasting more than 4 weeks, recurring complaints, and weeping or infected skin as reasons to see a doctor), stop and get it assessed.

Cradle cap specifically

Infant cradle cap usually clears without any treatment, over weeks to months and rarely years (Victoire and colleagues, Cochrane review, 2019). Improvement during a course of compresses is therefore not evidence that the compresses did it.

Benefits of Taking Heartsease

Ranked by the strength of what supports each one:

• Mild seborrheic skin conditions (compress or tea): registered in the EU as a traditional use and approved by Commission E for external use. Support is long use, not trial data.

• Atopic dermatitis (topical, in combination): one randomized trial of 88 adults, null on its primary endpoint; a post hoc cold-weather subgroup of 64 was positive.

• Chronic obstructive pulmonary disease symptoms (oral, in combination): one 60-patient trial with within-group improvements at 6 months and a methods critique from the EMA.

• Cough and colds (oral): a Spanish national tradition since 1991 and older handbook use as an expectorant; no trial.

• Immune-modulating and antimicrobial effects: cell and test-tube work only, with no human dose established.

• Antioxidant capacity: leaf and flower extracts measured 1.46 and 1.43 mM Trolox equivalents per gram dry weight, against 0.62 and 0.61 for ginkgo in the same assay (Mantle and colleagues, 2000, as cited by the EMA). Antioxidant capacity in a test tube has not been linked to any clinical outcome for this herb.

The supportable claim is that heartsease is an inexpensive, long-used compress herb for mild flaky skin, with a plausible but untested mechanism. Claims for acne, psoriasis, eczema cures, "blood cleansing" or heart health go beyond anything in the European files.

Potential Negatives & Side Effects

Documented reactions

• Hemolysis in a G6PD-deficient infant after oral use: the only undesirable effect in the EMA monograph, frequency unknown.

• WHO VigiBase, 2010 to 2020 (EMA addendum, 2021): two reports. A 46-year-old man treated for an abscess with powdered burdock root and heartsease for 3 days developed itching and acne, a non-serious reaction with heartsease listed as a suspected cause. A 31-year-old man with psoriasis took a 37-herb product for 121 days and was hospitalized in Britain with nausea, jaundice and stomach pain; drug-induced hepatitis or heavy-metal poisoning was suspected, and no single ingredient could be blamed.

• The EMA's 2021 literature review found no published reports of adverse events from V. tricolor or V. arvensis between 2010 and 2020.

Reactions that follow from the chemistry

• Salicylate reactions in sensitized people (Section 7), by mouth or through inflamed skin.

Laboratory signals that have not shown up in people

• Red-cell damage: Tamas and colleagues reported a hemolytic index of 4,000 in 1981, a figure Schöpke and colleagues did not confirm in 1993. Tang and colleagues (Peptides, 2010) measured hemolytic activity alongside cancer-cell toxicity for 14 cyclotides purified from heartsease; whether intact cyclotides are absorbed from tea has not been measured.

• Gut muscle: an extract made guinea pig intestine contract at 25 to 800 µg/mL (Izzo and colleagues, 1996).

What the record does not include

No repeated-dose toxicity, genotoxicity, carcinogenicity or reproductive toxicity testing has been done, according to the 2010 assessment (the monograph names the last three), which for that reason declined to add heartsease to the EU's list of herbal substances eligible for simplified registration. A clean case record for a little-used herb partly reflects how few people take it by mouth.

Deficiency Symptoms

There is no heartsease deficiency. None of its constituents is an essential nutrient, and no human requirement for flavonoids, salicylates or cyclotides exists.

What heartsease addresses

The registered indication is mild seborrheic skin: flaking, scaling and mild inflammation in oil-rich areas, and, in the German approval, cradle cap. That is a skin condition, not the absence of something heartsease supplies. Adult seborrheic dermatitis is linked to Malassezia skin yeasts, and the usual first-line treatments are antifungal or anti-inflammatory topicals; nothing in the heartsease record shows it can replace them.

Bottom line

Nobody needs heartsease. Its case is as an optional traditional compress for mild flaky skin.

Toxicity Symptoms

At high intake

No overdose case has been reported (EMA). The realistic concern at high oral intake is salicylate load in sensitive people, not classic salicylate poisoning. The arithmetic:

• At 0.06% to 0.3% salicylic acid and derivatives, 3 g of herb holds 1.8 to 9 mg, and the EMA's maximum of 9 g a day holds 5.4 to 27 mg. How much of that reaches the cup has not been measured.

• For scale, a single US low-dose aspirin tablet contains 81 mg of acetylsalicylic acid, a different and more potent COX-1 inhibitor.

So the herb's salicylates cannot reasonably poison a healthy adult; they can matter to someone whose airway or skin reacts to small amounts.

Signs to reduce or stop

• Wheeze, chest tightness, nasal congestion or flushing within hours of a cup, especially in someone with asthma or nasal polyps.

• Hives, swelling of the lips or eyelids, or worsening redness or itching under a compress.

• In anyone with G6PD deficiency, or in a child who has swallowed the tea: dark urine, pallor, yellowing of the skin or eyes, or unusual tiredness. These need same-day medical attention.

General note

The real toxicology gap is that the EMA found none of the standard safety studies on file. The absence of reported harm comes from a herb mostly used on the skin.

How Heartsease Works

No mechanism has been demonstrated in a human taking heartsease. What exists is a set of constituents with known properties and a set of laboratory results.

Mucilage and tannins on the skin

At about 10% mucilage, a heartsease infusion is mildly slippery and film-forming, which fits its traditional use as a soothing wet dressing. The 2.4% to 4.5% tannins are astringent: they bind surface proteins and can dry a weeping or greasy patch. These are physical effects of a compress, not drug effects, and they are the most plausible explanation for the traditional skin indication.

Flavonoids

Violanthin and rutin dominate. In Vukics's 2008 fractionation, the rutin fraction had the highest electron-donor antioxidant capacity. Rutin has poor oral bioavailability as the intact glycoside; gut bacteria cleave it to quercetin before absorption. No study has measured flavonoid levels in skin or blood after heartsease use.

Salicylates

Salicylic acid is a keratolytic, which loosens scale, at concentrations used in dermatology products of 0.5% to 2% or more. A 20 g per liter compress (the EMA maximum) made from herb at 0.06% to 0.3% salicylates contains at most 12 to 60 mg per liter, roughly 0.001% to 0.006%, if every bit were extracted. That is far below a keratolytic concentration, so the scale-loosening effect of medicated salicylic acid products should not be assumed for a heartsease compress. The same salicylates are still enough to matter to a sensitized person.

Cyclotides

Cyclotides are chains of roughly 28 to 37 amino acids joined head to tail into a ring and braced by a cystine knot, which makes them unusually resistant to heat and digestive enzymes. Heartsease makes at least 164 of them. In laboratory work they:

• reduce interleukin-2 release and proliferation of activated human T cells (Hellinger, 2014; Retzl, 2023);

• kill some cancer cell lines: vitri A had IC50 values of 0.6 µM against a lymphoma line and 1 µM against a myeloma line (Svangård and colleagues, Journal of Natural Products, 2004);

• inhibit HIV-1 infection in cell culture at 0.6 to 11.2 µg/mL for cyclotide-rich subfractions (Conzelmann and colleagues, Frontiers in Pharmacology, 2022).

Their stability is the reason pharmacologists are interested, and also the reason caution is reasonable: a peptide that survives boiling could in principle survive the gut. Absorption from a heartsease tea has never been measured.

Antimicrobial activity

The infusion's minimum inhibitory concentration of 0.15 mg/mL against S. aureus and Candida is modest by antibiotic standards. It is consistent with, but does not prove, a role in impetigo-type uses.

Synergistic Supplements

No synergy has been shown for any heartsease combination. The combinations that have actually been tested or sold:

• Oregon grape (Mahonia aquifolium) and gotu kola (Centella asiatica), in the trial ointment. The combination was not proven better than base cream.

• Black elderberry and calendula, in Inflaminat. The trial could not separate the herbs, and the EMA assessment said so.

• Burdock root, in the two UK registered tablet combinations. No trial located.

Standard care that heartsease compresses can sit beside, for mild seborrheic skin: an antifungal shampoo or cream, or a short course of a mild topical anti-inflammatory, as advised by a pharmacist or doctor. Nobody has tested whether adding heartsease changes their effect.

Interactions & What NOT to Take

Recorded interactions

None. The EMA monograph lists "none reported," and its 2021 review found no new reports. No study has examined heartsease and any cytochrome P450 enzyme or drug transporter; the absence of interaction data is an absence of testing.

Additive salicylate exposure

For a salicylate-sensitive person, heartsease adds to every other salicylate source:

• aspirin, at any dose;

• salsalate and other non-acetylated salicylates;

• bismuth subsalicylate (Pepto-Bismol and similar), which releases salicylate in the gut;

• methyl salicylate rubs and liniments (oil of wintergreen products);

• salicylic acid acne and dandruff products, especially over large areas.

At up to 27 mg a day from the maximum tea dose, heartsease is a small contributor, but the EMA's contraindication applies to the person, not the amount.

Anticoagulants and methotrexate

Aspirin interacts with both warfarin and methotrexate, and methyl salicylate rubs have increased the effect of warfarin in published case reports, including one in which a low-dose gel applied to the knees for 8 days raised the INR to 12.2 (Joss and LeBlond, Annals of Pharmacotherapy, 2000). None has been reported with heartsease, whose salicylate dose is far lower. A person on either drug should still treat a daily heartsease tea as a change worth mentioning to the prescriber.

Immunosuppressants

The T-cell results raise a theoretical question for people on cyclosporine, tacrolimus or other transplant drugs. There is no human data in either direction; avoiding an untested immune-active herb is the conservative choice.

Blood pressure medicines

A crude heartsease extract lowered blood pressure in anesthetized rats and relaxed isolated rabbit heart and aorta tissue (Saqib and colleagues, FASEB Journal, 2020). No human data exist; anyone on antihypertensives should mention a daily tea to the prescriber.

What not to combine heartsease with

Do not use it as a substitute for a prescribed treatment for infected, weeping or spreading skin, and do not give it by mouth to a child alongside any other salicylate-containing product.

Quality, Testing & Adulteration

Species and identity

The European Pharmacopoeia accepts two species, V. tricolor and V. arvensis, and the EMA's 2021 addendum notes that a third name in the monograph title, V. vulgaris, is now treated as a synonym of V. tricolor. The two accepted species differ in flavonoid content (2.1% versus 1.3% in the EMA data), so a lot of pure field pansy starts closer to the 1.5% floor. Neither the US Pharmacopeia nor any third-party program has a heartsease standard, as far as could be found for this issue.

The substitution risks that matter are by name rather than by fraud:

• Sweet violet (Viola odorata), sold as "violet leaf" or used in Persian violet syrups, is a different herb. A product labeled only "Viola" or "violet" does not tell you which one it contains.

• Garden pansy (Viola × wittrockiana), a hybrid bred for flowers, differs chemically from heartsease in direct comparisons (Vukics and colleagues, 2008) and is not an accepted substitute.

No documented case of deliberate heartsease adulteration was located in the literature or regulatory files reviewed.

Heavy metals

Heartsease grows on heavy-metal soils, including zinc and lead mine waste heaps (Słomka and colleagues, Journal of Plant Physiology, 2011). Field studies classify the violets of its section as heavy-metal excluders: in highly polluted soils the plants hold less metal than the soil, but in clean soils they can hold more than the soil around them (Bothe and colleagues, Chemosphere, 2013). The Słomka team also found that heartsease leaf hairs were especially rich in heavy metals. A wild-collected lot from old mining country is therefore a real contamination question, and the herb's origin and a metals result are worth asking for.

Third-party testing

None of the heartsease products reviewed for this issue (A.Vogel, Bombastus) displayed a third-party seal from USP, NSF or ConsumerLab, and none of their web pages published a flavonoid assay or contaminant results. In the EU, the registered pharmacy tea is the version made under medicinal manufacturing rules; food supplements and plain herbal teas are not.

What a good certificate of analysis contains

• The full Latin name (V. tricolor or V. arvensis) and the plant part (flowering aerial parts).

• An identity test, such as thin-layer chromatography against rutin and violanthin.

• A total flavonoid result expressed as violanthin, compared against the 1.5% minimum.

• Measured lead, cadmium, arsenic and mercury (mg/kg) with the limit each was judged against, plus the country and region of collection.

• For tinctures, the herb-to-solvent ratio and alcohol percentage.

Checks a buyer can run without a lab

Read the Latin name first; "violet" or "Viola" alone is not enough. Look at the cut herb: genuine material contains fragments of small purple, yellow and white flowers along with leaf and stem, and a bag with almost no flower pieces will be lower in rutin. Check whether a tincture states its ratio; A.Vogel's does not. An EU registered tea following the monograph should carry the salicylate contraindication in its leaflet; a product that omits it is not following the EU monograph. Older German labels can omit it: a Heinrich Klenk pharmacy tea leaflet dated 2019 still followed Commission E, with cradle cap, external use only and contraindications "keine bekannt," none known.

Special Considerations

Infants and cradle cap

Cradle cap is the use most specific to heartsease, and the documents disagree about it. Commission E's 1986 approval named "Milchschorf der Kinder," milk crust in children, as an external indication. Bombastus's leaflet listed it as recently as its January 2015 revision, while also saying there were not enough studies in children under 12 and that the tea should not be used in them without medical advice; its September 2021 revision follows the EMA and no longer mentions cradle cap. The EMA's 2010 monograph dropped the pediatric indication and does not recommend skin use under 12 at all. ESCOP's 2015 monograph still lists cradle cap and diaper rash.

What the pediatric evidence actually contains: the Cochrane review of infantile seborrheic dermatitis (Victoire and colleagues, 2019) found six randomized trials, with 310 children randomized, testing biotin, a non-steroidal cream, a lactamide gel and shampoo, a licochalcone lotion against hydrocortisone, and flumethasone ointment against eosin. None tested heartsease. The reviewers rated all the evidence very low certainty and noted that in most studies the outlook was favorable whatever the intervention.

If a parent uses a heartsease compress on an infant's scalp, the documented practice is external only: a cooled infusion, not a drink, on unbroken skin.

Children and oral products

A.Vogel's tincture directs children aged 2 to 12 to take 1 drop per year of age twice a day, in a 50% alcohol base, under food supplement rules. The EMA monograph does not recommend oral heartsease for anyone under 18, so every child the label doses falls in a group the EU herbal committee advises against treating by mouth, and the label gives no salicylate warning. In the UK, aspirin is not given to children under 16 because of Reye's syndrome; no case linking heartsease to Reye's syndrome was found, and the herb's salicylate dose is small, but the EU's age line exists for lack of data, and the EMA's 2021 review found no new pediatric data.

G6PD deficiency

G6PD deficiency is common in people of African, Mediterranean, Middle Eastern and South and Southeast Asian ancestry, and many carriers do not know they have it. The single infant case is the only hemolysis report on file, but it is the reason the monograph lists hemolysis at all. Families with a known diagnosis should avoid giving heartsease by mouth.

Aspirin-sensitive adults

The contraindication is easy to miss because US supplement labels are not required to mention salicylate content. The EMA herb data imply about 2 to 9 mg of salicylates per 3 g dose; a reader who has been told to avoid aspirin and NSAIDs should treat heartsease as part of that instruction until an allergist says otherwise.

Pregnancy and breastfeeding

No safety data exist, and both the EMA and A.Vogel advise against use.

Heart failure and high blood pressure

The EMA's warning concerns hot baths in people with heart failure, high blood pressure, fever or infection. It is a caution about the bath, not about the herb.

Viola odorata research

Sweet violet has its own separate research literature, much of it from Iranian traditional medicine. None of it is heartsease data, and articles or product pages that mix the two species should be read with care.

Research Status & Evidence Quality

Moderate evidence

Constituent chemistry: flavonoid, salicylate, mucilage and carotenoid figures from multiple analyses summarized by the EMA, HPLC flavonoid work from the Vukics group (2008), and a 164-cyclotide catalog from transcriptome and proteome mining (Hellinger, 2015).

Limited evidence

• One randomized, double-blind, vehicle-controlled trial of a three-herb ointment in 88 adults with atopic dermatitis: null on its primary endpoint at 4 weeks.

• One placebo-controlled trial of a three-herb capsule in 60 men with COPD: within-group improvements at 6 months, reported as a subgroup of a larger trial, with randomization and blinding methods criticized by the EMA's assessor.

• A single case report of hemolysis in a G6PD-deficient infant, and two pharmacovigilance reports from 2010 to 2020.

Preliminary evidence

Cell and animal studies of T-cell suppression, cancer-cell toxicity, HIV inhibition, antimicrobial activity, rat skin inflammation and guinea pig gut contraction.

No evidence

No controlled human trial of oral heartsease alone, of a heartsease-only topical, or of any heartsease product in children was located. No human pharmacokinetic data exist for any constituent. No standard toxicology package (repeated dose, genotoxicity, carcinogenicity, reproduction) has been done, per the EMA.

Research Limitations

• Both controlled trials tested combinations, so neither can attribute an effect to heartsease.

• The COPD trial was run by the research group that developed the product, and the paper reports within-group statistics rather than a between-group test.

• Salicylate content is reported as a range (0.06% to about 0.3%) covering salicylic acid and its derivatives together; no study measured how much reaches a cup of tea or a compress.

• Most cyclotide work uses solvent extracts at concentrations never shown to be reached in human blood or skin.

• Many published articles and product pages use "violet" for both V. tricolor and V. odorata, and the pansy literature includes ornamental hybrids.

Summary & Key Takeaways

Bottom Line

Heartsease is a European compress herb for mild flaky skin, approved in Germany for external use only and accepted by the EU as a traditional oral and topical remedy for adults, with no trial of the herb on its own. Its two controlled trials tested it mixed with other herbs; one was null and the other was methodologically weak. Its realistic value is as a cheap, gentle wet dressing, and its main hazard is for the people its own monograph excludes.

Key Safety Points

• Do not use heartsease if aspirin or other salicylates have ever caused you wheezing, hives or swelling; the EU monograph contraindicates it.

• Do not give heartsease to babies or children by mouth. Cradle cap use in the German tradition is external, and the EMA does not recommend skin use under 12.

• Avoid oral use with known G6PD deficiency, and during pregnancy and breastfeeding.

• Do not apply compresses to open wounds or large areas of broken skin, and see a doctor if a skin problem has not improved in 4 weeks.

• Check the Latin name: Viola tricolor or Viola arvensis, not Viola odorata or a garden pansy.

Special Note

The same herb has been sold as a pharmacy compress that says "not for internal use" and a food-supplement tincture with drops for 2-year-olds. When a European regulator has drawn an age line for lack of data, a supplement label that ignores it has not found new data; it is simply operating under different rules.

Forwarded this, or reading it on the web? to get the next breakdown.

Researched and drafted with AI assistance. Every claim verified against primary sources and human-reviewed before publication. Last reviewed: November 2, 2026. Corrections: reply to any issue.

This issue is for education and is not medical advice. If you take any prescription medicine, have asthma, an aspirin allergy, G6PD deficiency or another diagnosed condition, or are pregnant, breastfeeding or treating a child, talk to a clinician before using heartsease or changing anything.