Mountain horopito (Pseudowintera colorata) has a long history of use in traditional Māori medicine in New Zealand for various skin conditions, including lesions, rashes, and fungal infections. The leaves were often chewed or applied topically as a poultice to support the healing of sores and lesions, owing to their pungent, peppery compounds. The primary active constituent, polygodial, has demonstrated antifungal and antimicrobial activity in laboratory settings, which provides some mechanistic plausibility for its traditional uses. However, there is limited clinical or scientific validation for its effectiveness specifically in treating lesions in humans. Most of the available evidence is anecdotal or based on ethnobotanical records rather than controlled studies. While in vitro studies indicate that horopito extracts can inhibit certain pathogens that might infect skin lesions, there are no robust clinical trials confirming its efficacy for lesion healing or treatment. Thus, the use of mountain horopito for lesions is primarily justified by tradition, with some preliminary scientific support for its antimicrobial properties but lacking direct, high-quality clinical evidence.