With the recent dengue outbreak, the use of papaya leaves as natural cure for dengue has received much interest among the public, and in the lay press [1]. Being easily available and affordable, the use of papaya leaves occurs indiscriminately. The physician however remains unclear of his or her stand on the issue.

The therapeutic effects of aqueous extract of papaya (Carica papaya) leaves are presumed to be due to several active components such as papain, chymopapain, cystatin, L-tocopherol, ascorbic acid, flavonoids, cyanogenic glucosides and glucosinolates. These are antioxidants that reduce lipid peroxidation, exhibit anti-tumor activity and immune modulatory effects [2]. Animal studies suggest that papaya leaf extracts have potential therapeutic effect on disease processes causing destabilization of biological membranes as they inhibit hemolysis in vitro [3] and may cause increased platelet and red blood cell counts [4]. A recent open-labelled trial from Malayasia demonstrated significantly higher platelet count after 40-48 hours of first dose of papaya leaves’ juice [5]. Others have also reported encouraging findings. In spite of these small scale studies, the fact remains that dengue is a mostly a self-limiting disease with spontaneous increase in platelets during recovery.

The role of papaya leaves cannot be scientifically substantiated based on a few positive preliminary reports. The need of the day is to commission high quality trials in humans to provide scientific evidence for or against papaya leaves. Herbal products are assumed to be safe because they are natural, but this assumption cannot be valued more than mere conventional wisdom. As reported, anticoagulant effect of warfarin was found to be potentiated after consuming an extract of Carica papaya [6].

The purpose of this communication is not to raise questions on the use of herbal products for disease management, or to belittle the patients’ efforts to use all available measures, whether approved or not, to alleviate their suffering; but, a call to the research community to generate evidence so that any potential benefits are not discredited. The science must provide evidence to dispel myths and focus efforts on evidence-based management of dengue.

1. Home Cure for Dengue Death Sting. Available from: http://articles.timesofindia. indiatimes.com/2012-09-12/kolkata/33788187_1_platelet-dengue-patients-papaya. Accessed October 22, 2013

2. Otsuki N, Dang N H, Kumagai E, Kondo A, Iwata S, Morimoto C. Aqueous extract of Carica papaya leaves exhibits anti-tumor activity and immunomodulatory effects. J Ethnopharmacology. 2010;127:760-7.

3. Ranasinghe P, Ranasinghe P, Kaushalya M, Abeysekera WP, Sirimal Premakumara GA, Perera YS, et al. In vitro erythrocyte membrane stabilization properties of Carica papaya L. leaf extracts. Phcog Res. 2012;4:196-202.

4. Dharmarathna SL, Wickramasinghe S, Waduge RN, Rajapakse RP, Kularatne SA. Does Carica papaya leaf-extract increase the platelet count? An experimental study in a murine model. Asian Pac J Trop Biomed. 2013;3:720-4.

5. Subenthiran S, Choon TC,　Cheong KC, Thayan R, Teck MB, Muniandy PK, et al. Carica papaya leaves juice significantly accelerates the rate of increase in platelet count among patients with dengue fever and dengue haemorrhagic Fever. Evid Based Complement Alternat Med. 2013;2013:616-737.