Efficacy, safety and tolerability of Tiger Balm® ointments: a systematic review and a meta-analysis of prevalence

Context: Tiger Balm® (TB®) ointments are multi-purpose branded Chinese topical remedies, often used for pain relief and purchasable in many countries as over-the-counter medications. Aims: To assess the efficacy, safety and tolerability of TB® ointments. Methods: Medline, Scopus, EMBASE, Cochrane Library, Web of Science, Google Scholar, PEDro, and the Chinese Clinical Trial Registry were systematically searched for relevant articles. The quality of included studies on the efficacy of TB® ointments was evaluated with dedicated NIH tools. Retrieved evidence was then summarized and critically appraised. Results: After article screening and selection, 12 studies were finally included in the present review (five on TB® ointments efficacy, whereas seven on their safety and tolerability). Two cases of dermatitis and one of cheilitis likely ascribable to the use of TB® ointments have been reported. Based on available studies, it might be estimated that around 4% [95% CI, 3%-5%] of patients with history of contact skin allergy could be positive if patch tested with TB® ointments, therefore caution is recommended in the use of TB® among these subjects. Conclusions: According to retrieved evidence, TB® ointments might be useful for the management of pain due to tension headache, and they seem capable of increasing leg blood flow if combined with massage. Considering available evidence on topical products with camphor, TB® ointments shouldn't be used in children, as well as in pregnant or lactating women. Chronic use, large amounts of balm, and the application on damaged skin must be avoided too. Further studies are recommended.