Cress seed mucilage (Lepidium sativum L.), which is used in pharmaceuticals, has attained increased significance in the growing trend towards using natural ingredients. The physicochemical, pharmacological, functional and textural properties are here reviewed, along with its potential as a pharmaceutical excipient, herbal drug, and food ingredient. There is evidence that it can exhibit antimicrobial, antihypertensive, antioxidant, antispasmodic, antidiarrheal, antiasthmatic, hypoglycemic and hypolipidemic properties. The rheological properties, gel formation, emulsification, foaming stability and textural attributes are reviewed as a function of pH, sugars, salts and thermal treatments to assess its potential as a natural pharmaceutical and food hydrocolloid.