Dr. James Manos (MD)
February 17, 2016
February 17, 2016
Aromatherapy with essential oils (volatile oils)
Some aromatherapy essential oils
Many aromatic plant oils are essential (volatile) oils that someone can use as room odor or apply on the skin for massage or in a hot bathtub. Not all aromatherapy oils can be applied on the skin or diluted in bathwater, so users should ask an expert (1), (2). Someone can purchase special lamps with candles for aromatherapy with essential oils. They have a small receptacle filled with water in which a few drops of essential oil are instilled. People with epilepsy should not do aromatherapy.
The side effects of aromatherapy are few. The primary adverse effect is allergy to a specific aromatherapy oil (including contact dermatitis), photodermatitis, and local irritation (e.g., from camphor oil). There isn’t good evidence for their effectiveness. However, some people seem to feel better with aromatherapy, but it is unclear if this is only from a placebo effect. The aromatherapy oils that are used are very concentrated. People should never drink volatile oil as it is toxic if ingested. Some aromatherapy oils can be used for massage or in a bath (by diluting some drops in warm water) or as volatile using a particular aromatherapy lamp (1), (2).
The most famous volatile oil is levanter, which is said to help insomnia, stress, burns, and blisters. Other anti-stress oils are rosewood, rosemary, valerian, ylang-ylang, and geranium. The last is also anti-depressive. Tea tree oil is said to help head lice, wound infections, and athlete’s foot (fungi). Eucalyptus oil is famous for the common cold and clears the blocked (congested) nose (2).
Someone can find sprays for the congested nose with eucalyptus in the market. The classic gel Vicks (R) can be used by stirring 1 – 2 teaspoons in a cup containing boiled water and inhaling the vapors (but you must be careful with eye irritation, avoiding it by closing your eyes and wearing glasses). Also, Vicks can be used for chest infections such as bronchitis/ pneumonia by application of the gel on the chest skin (usually at night). In any case, read the instructions label of the product. It must be mentioned that contrary to natural eucalyptus, patients mustn’t use nasal decongestants for more than 5 – 7 days to avoid the risk of inducing pharmaceutical rhinitis from the drug itself. Some nasal decongestants combine eucalyptus with a decongestant medication. So, in that case, they still need to be used for less than 1 week, contrary to natural herbal products. Helpful for rhinitis is washing the nose with a saline flush or sterile seawater (you can find sterile formulas at a drug store), but their use should be done without undue pressure as flushing the nose. Otherwise, they may move the bacteria internally (inside the sinuses), spreading an infection.
Thyme oil is an antiseptic and is used for common cold. Rosemary was mentioned previously for relaxation. However, it is mostly used as an antiseptic and soothing and is said to help, especially with sinus infections. Sinus infections may become chronic and often resistant to antibiotics. Peppermint oil is said to be useful for headaches and indigestion (2).
Several plant-derived essential oils have been known for over a century to have epileptogenic (that induce epilepsy) properties. A report has been published of three healthy patients, two adults, and one child, who suffered from an isolated generalized tonic-clonic seizure and a general tonic status, respectively, related to the absorption of several of these oils for therapeutic purposes. No other cause of epilepsy was found, and the outcome was good in the two adult cases, but the course has been less favorable to the child. A survey of the literature shows essential oils of 11 plants to be powerful convulsant (that may cause seizures) (eucalyptus, fennel, hyssop, pennyroyal, rosemary, sage, savin, tansy, thuja, turpentine, and wormwood) due to their content of highly reactive monoterpene ketones, such as camphor, pinocamphone, thujone, cineole, pulegone, sabinylacetate, and fenchone. The above three cases strongly support the concept of plant-related toxic seizures. Nowadays, the extensive use of these compounds in certain unconventional medicines makes this severe complication again possible (3).
Several plant-derived essential oils have been known for over a century to have epileptogenic (that induce epilepsy) properties. A report has been published of three healthy patients, two adults, and one child, who suffered from an isolated generalized tonic-clonic seizure and a general tonic status, respectively, related to the absorption of several of these oils for therapeutic purposes. No other cause of epilepsy was found, and the outcome was good in the two adult cases, but the course has been less favorable to the child. A survey of the literature shows essential oils of 11 plants to be powerful convulsant (that may cause seizures) (eucalyptus, fennel, hyssop, pennyroyal, rosemary, sage, savin, tansy, thuja, turpentine, and wormwood) due to their content of highly reactive monoterpene ketones, such as camphor, pinocamphone, thujone, cineole, pulegone, sabinylacetate, and fenchone. The above three cases strongly support the concept of plant-related toxic seizures. Nowadays, the extensive use of these compounds in certain unconventional medicines makes this severe complication again possible (3).
Published studies
A study evaluated the antimicrobial activity potential of the essential oil of rosemary specifically for its efficacy against the drug-resistant mutants of Mycobacterium smegmatis, Escherichia coli, and Candida albicans. The rosemary essential oil was found to be more active against the gram-positive pathogenic bacteria except for Enterococcus faecalis and drug-resistant mutants of E. coli, compared to gram-negative bacteria. Similarly, it was found to be more active toward non-filamentous, filamentous, dermatophytes pathogenic fungi and drug-resistant mutants of Candida albicans. These findings suggest that characterization and isolation of the active compound(s) from the rosemary oil may be useful in counteracting gram-positive bacterial, fungal, and drug-resistant infections (4).
Recently, the importance of non-pharmacological therapies for dementia has come to the fore. A study examined the curative effects of aromatherapy in dementia in twenty-eight elderly people, 17 of whom had Alzheimer’s disease (AD). Aromatherapy consisted of rosemary and lemon essential oils in the morning and lavender and orange in the evening. The study concluded that aromatherapy is an efficacious non-pharmacological therapy for dementia. Aromatherapy may potentially improve cognitive function, especially in Alzheimer’s disease (AD) patients (5).
Another study assessed the olfactory impact of the essential oils of lavender (Lavandula angustifolia) and rosemary (Rosmarlnus officinalis) on cognitive performance and mood in healthy volunteers. Analysis of performance revealed that lavender produced a significant decrement in the performance of working memory and impaired reaction times for both memory and attention-based tasks compared to controls. In contrast, rosemary produced a significant performance enhancement for the overall quality of memory and secondary memory factors but also created an impairment of memory speed compared to controls. Regarding mood, both the control and lavender groups were significantly less alert than the rosemary condition; however, the control group was significantly less content than both rosemary and lavender conditions. These findings indicate that the olfactory properties of levanter and rosemary essential oils can produce objective effects on cognitive performance and subjective results on mood (6).
A randomized, double-blind, controlled trial of 7 months investigated aromatherapy's efficacy in treating alopecia areata (hair loss) patients. In the study, eighty-six patients diagnosed with alopecia areata participated. The patients were randomized into 2 groups. The active group massaged essential oils (thyme, rosemary, lavender, and cedarwood) in a mixture of carrier oils (jojoba and grapeseed) into their scalp daily. The control group used only carrier oils for their massage, also daily. The study concluded that aromatherapy is a safe and effective treatment for alopecia areata. Treatment with these essential oils was significantly more effective than the carrier oil alone (7).
A placebo-controlled trial was conducted to determine the value of aromatherapy with the essential oil of Melissa officinalis (lemon balm) for agitation in people with severe dementia. The study concluded that aromatherapy with essential balm oil is a safe and effective treatment for clinically significant anxiety in people with severe dementia, with additional benefits for crucial life parameters (8)
Aromatherapy is becoming increasingly popular; however, there are few clear indications for its use. To systematically review the literature on aromatherapy to discover whether any clinical evidence may be recommended, computerized literature searches were performed to retrieve all randomized controlled trials of aromatherapy. The review concluded that the hypothesis that aromatherapy is useful is not supported by the findings of rigorous clinical trials (9).
A prospective randomized placebo-controlled study evaluated the effectiveness of lavender aromatherapy in reducing opioid requirements after laparoscopic adjustable gastric banding (LAGB). The results of the study suggest that lavender aromatherapy can be used to reduce the demand for opioids (painkillers such as morphine) in the immediate postoperative (after-surgery) period (10).
A study evaluated the use of aromatherapy massage and music as an intervention to cope with the occupational stress and anxiety that emergency department staff experience. The study also aimed to compare any differences in results between a summer and winter 12-week massage plan. The results demonstrated that aromatherapy massage with music significantly reduced emergency nurses’ anxiety. Elevated levels of anxiety and stress can be detrimental to emergency nurses' physical and emotional health, and a support mechanism such as on-site massage should be considered as an effective strategy (11).
Adverse effects of aromatherapy
Safety testing of essential oils has shown minimal adverse effects. Several oils have been approved for food additives and are classified as GRAS (generally recognized as safe) by the US FDA. However, ingestion of substantial amounts of essential oils is not recommended. Moreover, a few cases of contact dermatitis have been reported, mostly in aromatherapists who have had prolonged skin contact with oils from aromatherapy massage. Some essential oils (e.g., camphor oil) can cause local irritation; therefore, care should be taken when applying them. Phototoxicity (chemically induced skin irritation that requires light) occurs when essential oils (particularly citrus oils) are applied directly to the skin before sun exposure. One case report also showed airborne contact dermatitis after inhaling aromatherapy without massage. Often, aromatherapy uses undefined mixtures of essential oils without specifying the plant sources. Allergic reactions are sometimes reported, especially following topical use. As essential oils age, they often oxidize, so the chemical composition changes. Individual psychological associations with odors may result in adverse responses. Repeated exposure to lavender and tea tree tea oils with a topical application was shown in one study to be associated with reversible prepubertal (preadolescence) gynecomastia (abnormal development of large mammary glands in males that results in breast enlargement). The effects appear to have been caused by the weak estrogenic and anti-androgenic activities of lavender and tea tree oils. Thus, avoiding these two essential oils is recommended in patients with estrogen-dependent tumors (12).
Thanks for reading!
Thanks for reading!
Reference:
(2) Simon C., Everitt H., Kendrick T., Oxford Handbook of General Practice, Oxford Medical Publications, 2nd edition, 2005.
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