Citation:Leonard Pearlstine, 2006. Aromatherapy Science. AromaScents Journal 35(Fall):17-24.

Aromatherapy Science

Aromatherapy is a shadowy world of romantic illusion. Its magic easily dispelled by the harsh light of science. Its quaint notions may have a value for patients’ equivalent to a child’s belief in Father Christmas. It would be uncharitable to break the spell too soon.(King 1994 p. 413)

In randomized, double-blinded, controlled clinical trials, Hay et al. ( 1998) found that daily aromatherapy scalp massage with thyme, rosemary, lavender and cedarwood showed significant improvement in patients with hair loss due to alopecia areata compared to a control group using only carrier oils (jojoba and grapeseed). In contrast to conventional treatments, no significant adverse effects were reported from the aromatherapy massages which lasted 7 months with a 3 and 7 month follow-up. Yet, the U.S. National Institutes of Health informational web site for alopecia areata, in listing the pros and cons of treatments, only had this to say about aromatherapy:

Alternative therapies--When drug treatments fail to bring sufficient hair regrowth, some people turn to alternative therapies. Alternatives purported to help alopecia areata include acupuncture, aroma therapy, evening primrose oil, zinc and vitamin supplements, and Chinese herbs. Because many alternative therapies are not backed by clinical trials, they may or may not be effective for regrowing hair. In fact, some may actually make hair loss worse… (National Institute of Arthritis and Musculoskeletal and Skin Diseases 2003)

Therapeutic treatment with essential oils is often regarded with skepticism or simple dismissal by the medical profession, even, as seen above, when carefully controlled clinical trials offer evidence of effectiveness and safety. The above quote also points to one of aromatherapies problems. It is frequently lumped into a broad category of “alternative therapies” which are most often regarded by scientists as being guided by faith and romanticism rather than science (e.g., McCracken 1999).

Plant materials have always been an important component of medicine and pharmaceutical firms continue in the search for plant medicinal properties. Much of the legitimate skepticism of aromatherapy comes not from questioning the efficacy of plant-derived treatments, but from questions of the effectiveness of essential oils applied outside the body to aiding internal disease and discomfort and the anecdotal nature of much of the evidence of its therapeutic successes (e.g., McCracken 1999). When we are sure that something works, we notice when we are getting better while using the something, but we have a remarkable ability to not remember when it fails. Perhaps more importantly, it is easy to overlook all the other circumstances surrounding the event (my daughter-in-law got pregnant after recovering from a cold, but I feel fairly certain that the two events are not related. I am certain, however, that a large volume of anecdotal evidence could be collected of women catching colds and becoming pregnant shortly thereafter). Aromatherapy has a rich history of centuries of anecdotal evidence, however, that has given many scientists and physicians reason to want a closer look.

To illustrate the state-of-the-science, this paper reviews some of the scientific research into aromatherapy, principally for mental discomfort, and evidence for its effectiveness. To increase

readably, just the common names are used in this paper when referring to essential oils. The taxonomic names of referred to essential oils are listed in the appendix.

Aromatherapists have occasionally balked at the idea that you can confirm or reject aromatherapy using scientific approaches because science is reductionist and aromatherapy depends on a holistic approach (Schnaubelt 1998). I completely reject this argument and believe it harms the profession. First, science does not have to be reductionist. The science employed depends on the questions. “Does the constituent limonene have significant motor relaxant effects when applied to the skin?” and “Do patients receiving holistic aromatherapy care respond better to treatment?” and “Is the activity of the natural plant extract greater than the combined activity of individual components in their naturally occurring ratios?” are all legitimate scientific questions that can be approached with controlled experiments.

Secondly, reductionism and holism are not mutually exclusive. Reductionist experiments can inform holistic methods. Knowing, for example, that synergistic interactions between monoterpenoid constituents of sages aids memory, but the terpenoid thujone is toxic in large doses (e.g., Tildesley et al. 2005) may lead the aromatherapist to experiment with Salvia lavandulaefolia rather than Salvia officinalis because of the known composition of those two species, but that knowledge does nothing to stop the aromatherapist from continuing to engage the patient as an individual with preferences and environmental influences that should be brought into the complete therapy.

Well established ideas from historical anecdotes can cause aromatherapists to make misinformed decisions. The myth that 1,8-cineole is a major irritant in tea tree oil (Melaleuca alternifolia) has been passed from author to author, however, repeated research among investigators has dispelled that association (see Carson et al. 2006). Aromatherapists benefit from the knowledge gained in these reductionist studies that essential oils containing 1,8-cineole are safe to the skin and the main cause of skin irritation appears to be oxidation products in aged or improperly stored oils.

Finally, aromatherapist have an ethical responsibly to favor evidence-based, controlled studies over anecdote and, when necessary, their own beliefs, when treating others. Aromatherapy is gaining acceptance in some medical practices, particularly nursing. However, science is, by definition, rationally skeptical. To continue growing as an accepted practice complementing conventional medicine, aromatherapy methods must be vetted against carefully controlled clinical and laboratory trials to demonstrate their efficacy.

Mechanisms of action

It is generally understood that essential oils may improve skin and scalp by external application and they may improve mood simply by offering a pleasant aroma as with a perfume or room spray. Internal therapies may be elicited from direct ingestion of essential oils (practiced in European aromatherapy, but rarely in North America). Inhaled aromatic molecules are another pathway to reach internal tissues. The inhaled molecules react with nerves in the olfactory bulb and relay nerve messages to the limbic system or are absorbed into the blood stream by thin membranes of the nose, bronchioles and lungs. It is also now well accepted that essential oil components can be absorbed through the skin to reach internal organs. In fact, the use of skin patches has become a common mechanism for dispensing pharmaceuticals. These various mechanisms have lead one

author to remark that she prefers the phrase “essential oil therapy” to “aromatherapy” because the oils are not always inhaled and don’t necessarily smell good (Halcon 2002).

More recent literature has supported and expanded our knowledge of the details of these mechanisms. Richard Axel and Linda Buck won the 2004 Nobel Prize in Physiology or Medicine for their research (Axel & Buck 1991) clarifying in molecular detail the gene coding of odorant receptors. An unexpected result was that of all the genes that code for olfactory receptor molecules, each individual olfactory receptor cells expresses only one gene. Different odors are detected by different combinations of receptors. It is the combinatorial power of multiple receptors, each distinguishing a limited piece of the odorant code, that results in our ability to distinguish and form memories of more than 10,000 different odors (Nobelprize.org 2004).

Absorption through the skin was observed by Jager ( 1992). When a 2% solution of lavender was applied to the abdomen, 10% of the lavender was absorbed into the general blood circulation with plasma levels peaking after 20 minutes. Levels of linalool and linalyl acetate, active constituents of lavender oil, dropped to zero after 90 minutes. During this period after application, the lavender oil constituents were circulated to tissue via capillaries. Potentially higher levels of absorption are likely across the highly vascular cribiform plate in the nose with a direct pathway to the brain (Jager 1992).

Many anesthetics, who’s uptake and distribution mechanism is known (Eger 1998), are aliphatic hydrocarbon chains, as are many essential oils. Geiger speculates that the action of anesthetics may conceivably be applied to explain some of the actions of essential oils at the cellular level. Intranuclear protein synthesis from DNA may be involved in the action of constituents of scent at the cellular level (Frondoza et al. 2004).

A growing number of in vitro and in vivo studies document the specific actions of essential oils, particularly anti-inflammatory, antibacterial, and anti-fungal properties. Baylac and Racine ( 2003) suspected that the mechanism for anti-inflammatory properties of some essential oils is inhibition of enzymatic reactions in the epidermis and other tissues. They evaluated 32 essential oils, 10 absolutes and 26 chemical constituents in vitro for their ability to inhibit 5-lipooxygenase, an important enzyme in a complex case of inflammatory events. Many of the oils used in aromatherapy for inflammation (e.g., myrrh, Copaiba balsam, Himalayan cedar, sandalwood, juniper berry and German Chamomile) had strong to good activity. The authors were surprised to find other essential oils, primarily Citrus species, also had strong activity in vitro, but were not reportedly used in aromatherapy for inflammation. Roman chamomile, which is used for inflammation in aromatherapy had poor activity, which suggest that other modes of action are responsible for its anti-inflammatory activity. The authors were also able to compare the activity of individual constituents of the essential oils (Baylac & Racine 2003). Anti-inflammatory effects in vivo due to both lipoxgenase and cyclooxygenase inhibition have been reported earlier for clove essential oils (Saeed & Gilani 1994).

Mood

Aromatherapy is perhaps most well known for its potential to alter mood. Some studies have gathered evidence demonstrating essential oils possess pharmacological effects on brain function.

Gurgel do Vale et al. ( 2002) found that the constituents citral, myrcene and limonene decreased activity in mice and presented sedative as well as motor relaxant effects. Vale et al was studying a

Brazilian herb, cidrcira, however, many essential oils contain one or more of these constituents including clary sage, lavender, geranium, fennel, lemongrass, and palmarosa. Muscle relaxation was observed at the higher doses of citral and myrcene and even at the lowest doses of limonene. Citral and myrcene increased barbiturate sleeping time compared to the control. Citral did not increase onset of sleep, however, it increased duration of sleep. Limonene has similar effect at higher doses. An advantage to studies using mice is that they are free of placebo effects that might affect a trial on a human subject (Mantle 2002). Relaxation of smooth muscle tissue was also observed in laboratory mice by Aqel ( 1992) with rosemary essential oils and Lis-Balchin et al. ( 1998) testing multiple species of geranium essential oils.

The addition of lavender oil to a 10 minute hot foot bath caused delayed, but significant changes in autonomic activity associated with relaxation beyond that observed with a hot foot bath alone (Saeki 2000). This randomized crossover controlled study contrasted with previous studies that have found psychological benefits, but could not find physiological effects with the addition of essential oils. It was in agreement with those same previous studies in finding no significant change in measures such as blood pressure and heart rate, however physiological effects were demonstrated with the more sensitive tests of autonomic function evaluated using spectral analysis of heart rate variability. It is likely, as the author notes, that very little of the essential oil penetrated the skin during the short bath and most of the effect was from inhalation of vapors.

Lewith ( 2005) found inhalation of diffused lavender oil to be effective in improving sleep quality as measured by standard physiological questionnaires in a randomized, single-blinded, crossover design controlled for belief in aromatherapy. A common criticism of “blinded” studies in aromatherapy is that the distinctive odor of essential oils defeats attempts at blinding and the study is thus subject to the placebo effect. That was certainly possible in this study, however before treatment, subjects were less confident that lavender oil would help than they were about the sweet almond oil control. One subject found the smell of lavender unpleasant and yet recorded significantly enhanced sleep quality.

Hudson ( 1996) found a sedative effects of lavender placed on elderly patients pillows. Sleep quality improved in 84% and increased daytime activity levels and alertness in 70% of patients. Another study of sleep quality in young, healthy individuals, presented intermittent stimulus with lavender oil or a distilled water control (Goel et al. 2005). Both polysomnographic and questionnaire data were collected. In addition to a measured increase in deep sleep and higher vigor reported by subjects of both genders in the morning after lavender exposure, this study demonstrated a gender difference between subjects. Women experienced increased light sleep, decreased rapid-eye movement sleep, and decreased amount of time to reach wake after first falling asleep. Men experienced the opposite effects.

The psychological benefits of aromatherapy massage when contrasted with massage alone are often subtle. Kuritama et al. ( 2005) used an extensive set of blood chemistry tests and psychological questionnaire measures to evaluate differences between aromatherapy massage with lavender, cypress and sweet marjoram in sweet almond oil versus a control massage of only sweet almond oil every 2 weeks over a 4 month period. Both groups showed a significant reduction in anxiety and self-ranked depression with no difference between the aromatherapy and control groups. The aromatherapy group, however, exhibited a significant post-treatment increase in peripheral blood

lymphocytes, CD8+ and CD16- lymphociyes. The control group did not show this difference which could be beneficial in immunological disease states that require augmentation of CD8+ lymphocytes (Kuriyama et al. 2005).

A randomized controlled trial comparing aromatherapy massage using neroli oil and massage with plain vegetable oil on post-cardiac surgery patients found equal significant benefit was derived from both the aromatherapy massage and vegetable oil massage groups compared to control groups on day 1 (Stevensen 1994). A follow-up on day 5 post surgery indicated a trend towards greater and more lasting psychological benefit from the massage with neroli oil compared to plain vegetable oil. Kyle ( 2006) evaluated the effectiveness of massage with 1% sandalwood oil when compared to massage with sweet almond oil alone or diffused sandalwood oil in reducing anxiety in palliative care. Two psychological measures gave consistent results in finding that both the aromatherapy massage and diffusion of sandalwood oil showed steady and sustained declines in anxiety over a 4 week period in contrast to the control massage which had little or no decline.

Umezu ( 1999) has shown that lavender and rose essential oils decreased conflict behaviors in mice, suggesting an anti-anxiety effect. The potential to reduce agitated behavior with aromatherapy has received a fair amount of attention. A placebo-controlled, observer-blind rating of agitation in 15 individuals with severe dementia resulted in 60% improvement and 1 patient worsening when treated with 2% lavender massage (Holmes et al. 2002). Melissa was used in another study (Ballard et al. 2002) of 72 patients and resulted in an overall improvement in agitation of 35% of the essential oil patients compared to 11% in the placebo group. In a randomized controlled trial of 21 patients assigned to aromatherapy and massage, conversation and aromatherapy, or massage only, the aromatherapy and massage group showed the greatest decrease in excessive motor behavior (Smallwood et al. 2001). However, when subjects in another study with dementia and behavioral challenges where exposed to aromas of lavender, sweet orange, tea tree, and no aroma, there was no significant difference in resistive behavior resulting from aromatherapy (Gray & Clair 2002). Snow et al. ( 2004) tested whether effects of aromatherapy were the result of skin absorption of the oils or smelling the aromas. This study found no support for use of purely olfactory form of aromatherapy to decrease agitation in severely demented patients and cites previous literature finding that persons with dementia have impaired olfactory abilities.

Uncontrolled, unblinded aromatherapy trials have been reported from hospital birthing and neonatal centers. While the limited design of these studies does not allow firm conclusions to be reached, it does allow the hospital to inexpensively sample a large cohort of patients over an extended period of time. As a result, they are valuable as exploratory trials whose results can focus the questions and experiments of controlled clinical and laboratory studies. One of the most cited studies involved evaluation of 8,058 mothers over 8 years using aromatherapy during childbirth compared to group of 15,799 mothers not using aromatherapy in the same teaching hospital (Burns et al. 2000). Overall, 50% of the mothers found aromatherapy helpful and 14% found it unhelpful. For reduction in anxiety lavender (50%), frankincense (44%) and rose (71%) were rated as helpful. In reducing pain in labor, lavender (54%) and frankincense (64%) were rated as helpful. The study suggested that clary sage augments the strength of contractions in dysfunctional labor, reducing the requirement for oxytocin infusion, but controlled trials are needed. There was a very low number of associated adverse symptoms reported (1%) and aromatherapy was reported to be a very inexpensive care option.

A recent study of postpartum depression treated 36 healthy, first-time mothers to a 30-minute aromatherapy-massage (neroli and lavender at 0.5% concentration) on the second postpartum day. A control group had 20 mothers which stayed with their babies in their hospital room receiving standard care. Psychological questionnaires where completed before and after the massage. Scores significant decreased in the aromatherapy massage group for depression, anxiety and the “Conflict Index of Avoidance/Approach Feeling toward Baby”. The results suggest aromatherapy massage is effective in improving physical and mental status of new mothers and facilitating mother-infant interaction (Imura et al. 2006). This trial did not attempt to differentiate the effects of massage alone versus massage with essential oils.

Alertness & Memory

Peppermint oil is believed to be effective for treating mental fatigue and the constituents of peppermint oil (1,8-cineol, menthone, isomenthone, menthol, (R)-(+)-pulegone, menthyl acetate and caryophyllene) have been found to significantly increased ambulatory activity in mice (Umezu et al. 2001). Spanish sage has been found by several authors to significantly aid memory (Perry et al. 2002,Tildesley et al. 2003,Savelev et al. 2003,Perry et al. 2003,Tildesley et al. 2005). Drugs for treatment of Alzheimer’s Disease inhibit acctylcholinesterase (AChE) resulting in increased levels of the neurotransmitter acctylcholine. Spanish sage has been shown to inhibit AChE in vitro and in vivo (Perry et al. 2002). Savelev et al. ( 2003) monitored synergist and antagonist interactions between components in Spanish sage and found evidence that synergy with individual terpenes measured as the same concentrations as existed in the oil was not as great as the whole oil. They found that high 1,8-cineole and low camphor contents in the oil may increase its anti-AChE activity. With oral administration of Spanish sage, Tildesley observed significant improved immediate word recall in two placebo-controlled, double blind, crossover trials (Tildesley et al. 2003) and consistent improvements in speed of memory and secondary memory in healthy young adults (Tildesley et al. 2005). He also found increases in self-rated alertness, calmness, and contentedness.

Perry et al. ( 2003) found significant reductions in neuropsychiatric symptoms and an improvement in attention in Alzheimer’s patients after 6 weeks of treatment with Spanish sage. The common spice, kitchen sage, has also been shown to provide some protection against declines in cognitive performance in Alzheimer’s patients (Akhondadch et al. 2003).

Conclusions

The psychological benefits of aromatherapy that were the focus of this paper are only one aspect of clinical trials testing therapeutic applications of essential oils. As suggested by the introductory example of scalp treatments, compelling, evidence-based science exist to suggest essential oil therapy efficacies and cautions for many diseases and discomforts. A few, very non-inclusive, examples include studies on pain (e.g., Buckle 1999), skin ulcers (e.g., Warnke et al. 2005), eczema (e.g., Anderson et al. 2000), epilepsy (e.g., Sayyah et al. 2002), herpes virus (e.g., Schuhmacher et al. 2003), weight loss and blood pressure (e.g., Shen et al. 2005), and numerous recent studies of immunological and antiseptic properties (e.g.,Standen & Myers 2004,Caldefie-Chézet et al. 2006).

Most of the clinical trials on humans, however, still suffer from lack of adequate control, small numbers of participants, and lack of repetition by independent researchers. Some standard and important elements of good study design include objective measures of outcome variables,

partitioned effects of confounding variables and follow-up studies (Martin 1996). Investigators also need to be able to follow patients for longer periods of time if effects such as delayed positive or negative responses, sensitization, or acclimation are to be documented. Temporal responses may be critically important knowledge for aromatherapists if observed over a large cohort.

Well crafted scientific study and restudy provides care givers with the evidence necessary to ensure that they are giving patients safe and effective treatments. When all the available evidence is gathered, however, aromatherapy remains a holistic practice, treating not just the ailment, but the whole person. Cawthorn and Carter (2000) set the standard in their institutions. They demand safety in aromatherapy by using evidence-based practice and working within a protocol that defines acceptable practice. But essential oil treatments are just one aspect of their program of HEARTS: holding, empathy, aromatherapy, relaxation, therapeutic relationship, and stroking (modified massage) in cancer and palliative care.

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Health Benefits of Lemongrass Essential Oil – article from about.com http://altmedicine.about.com/od/aromatherapy/a/Lemongrass-Essential-Oil.htm

Lemongrass essential oil is a type of essential oil commonly used in aromatherapy. Sourced from Cymbopogon citratus (a plant native to Southeast Asia), lemongrass essential oil is said to offer a variety of health benefits.

One of the main components of lemongrass essential oil is citral, a compound found to act as an antimicrobial (a substance that destroys or suppresses the growth of microorganisms, including bacteria and fungi). Lemongrass essential oil also contains limonene, a compound shown to reduce inflammation and knock out bacteria in scientific research.

How Does Lemongrass Essential Oil Work?

In aromatherapy, inhaling the aroma of lemongrass essential oil (or absorbing lemongrass essential oil through the skin) is thought to transmit messages to a brain region involved in controlling emotions. Known as the limbic system, this brain region also influences the nervous system. Aromatherapy proponents suggest that essential oils may affect a number of biological factors, including heart rate, stress levels, blood pressure, breathing, and immune function.

Health Benefits of Lemongrass Essential Oil

So far, the health effects of aromatherapeutic use of lemongrass essential oil have been tested in very few scientific studies. Still, some preliminary research indicates that lemongrass essential oil may offer certain health benefits.

In a 2011 study published in the Journal of Ethnopharmacology, for instance, scientists determined that lemongrass essential oil may possess anti-anxiety properties. In tests on mice, the study's authors found that treatment with lemongrass essential oil may help reduce anxiety in part by influencing brain levels of the neurotransmitter gamma-aminobutyric acid.

Several studies (including a 2009 report published in the Journal of Medicinal Food) suggest that lemongrass essential oil may also help inhibit the growth of certain fungi (such asAlternaria alternata, a fungus known to contribute to upper respiratory tract infections). However, there is currently a lack of clinical trials testing the use of lemongrass essential oil in treatment of any type of fungal infection.

Uses for Lemongrass Essential Oil

In aromatherapy, lemongrass essential oil is typically used to treat the following problems:

acne

anxiety

athlete's foot

excessive sweating

headaches

indigestion

muscle aches

In addition, lemongrass essential oil is said to act as a natural insect repellent.

Lemongrass essential oil is also used to alleviate stress and relieve pain.

How to Use Lemongrass Essential Oil

When combined with a carrier oil (such as jojoba, sweet almond, or avocado), lemongrass essential oil can be applied directly to the skin or added to baths.

Lemongrass essential oil can also be inhaled after sprinkling a few drops of the oil onto a cloth or tissue, or by using an aromatherapy diffuser or vaporizer.

Safety

Lemongrass essential oil should not be taken internally without the supervision of a health professional. Internal use of lemongrass essential oil may have toxic effects.

In addition, some individuals may experience irritation when applying lemongrass essential oil to the skin.

Pregnant or nursing women and children should consult with their health care providers before using essential oils.

It's also important to note that self-treating a chronic condition with lemongrass essential oil, and avoiding or delaying standard care, may have serious consequences.

Aromatherapy and Essential OilsArticle from national cancer Institute http://www.cancer.gov/cancertopics/pdq/cam/aromatherapy/healthprofessional/page1/AllPages

Overview

This complementary and alternative medicine (CAM) information summary provides an overview of the use of aromatherapy and essential oils primarily to improve the quality of life of cancer patients. This summary includes a brief history of aromatherapy, a review of laboratory studies and clinical trials, and possible adverse effects associated with aromatherapy use.

This summary contains the following key information:

Aromatherapy is the therapeutic use of essential oils (also known as volatile oils) from plants (flowers, herbs, or trees) for the improvement of physical, emotional, and spiritual well-being.

Aromatherapy is used by patients with cancer primarily as supportive care for general well-being.

Aromatherapy is used with other complementary treatments (e.g., massage and acupuncture) as well as with standard treatment.

Essential oils are volatile liquid substances extracted from aromatic plant material by steam distillation or mechanical expression; oils produced with the aid of chemical solvents are not considered true essential oils.

Essential oils are available in the United States for inhalation and topical treatment. Topical treatments are generally used in diluted forms.

Aromatherapy is not widely administered via ingestion.

The effects of aromatherapy are theorized to result from the binding of chemical components in the essential oil to receptors in the olfactory bulb, impacting the brain’s emotional center, the limbic system. Topical application of aromatic oils may exert antibacterial, anti-inflammatory, andanalgesic effects.

Studies in animals show sedative and stimulant effects of specific essential oils as well as positive effects on behavior and the immune system. Functional imaging studies in humans support the influence of odors on the limbic system and its emotional pathways.

Human clinical trials have investigated aromatherapy primarily in the treatment of stress and anxiety in patients with critical illnesses or in other hospitalized patients. Several clinical trials involving patients with cancer have been published.

Aromatherapy has a relatively low toxicity profile when administered by inhalation or diluted topical application.

Aromatherapy products are not subject to approval by the U.S. Food and Drug Administrationunless there is a claim for treatment of specific diseases.

Many of the medical and scientific terms used in the summary are hypertext linked (at first use in each section) to the NCI Dictionary of Cancer Terms, which is oriented toward nonexperts. When a linked term is clicked, a definition will appear in a separate window.

Reference citations in some PDQ CAM information summaries may include links to external Web sites that are operated by individuals or organizations for the purpose of marketing or advocating the use of specific treatments or products. These reference citations are included for informational purposes only. Their inclusion should not be viewed as an endorsement of the content of the Web sites, or of any treatment or product, by the PDQ Cancer CAM Editorial Board or the National Cancer Institute

General Information

Aromatherapy is a derivative of herbal medicine, which is itself a subset of the biological or nature-based complementary and alternative medicine (CAM) therapies. Aromatherapy has been defined as the therapeutic use of essential oils from plants for the improvement of physical, emotional, andspiritual well-being.

Essential oils are volatile liquid substances extracted from aromatic plant material by steam distillation or mechanical expression. Oils produced with the aid of chemical solvents are not considered true essential oils, because the solvent residues can alter the purity of the oils themselves and lead to adulteration of the fragrance or to skin irritation.

Essential oils are made up of a large array of chemical components that consist of the secondarymetabolites found in various plant materials. The major chemical components of essential oils includeterpenes, esters, aldehydes, ketones, alcohols, phenols, and oxides, which are volatile and may produce characteristic odors. Different types of oils contain varying amounts of each of thesecompounds, which are said to give each oil its particular fragrance and therapeutic characteristics. Different varieties of the same species may have different chemotypes (different chemical composition of the same plant species as a result of different harvesting methods or locations) and thus different types of effects.[1]

Synthetic odors are often made up of many of the same compounds, which are synthesized and combined with other novel odor-producing chemicals. Most aromatherapists believe that synthetic fragrances are inferior to essential oils because they lack natural or vital energy; however, this has been contested by odor psychologists and biochemists.[2]

Aromatherapy is used or claimed to be useful for a vast array of symptoms and conditions. A book on aromatherapy in children suggests aromatherapy remedies for everything from acne to whooping cough.[3] Published studies regarding the uses of aromatherapy have generally focused on itspsychological effects (used as a stress reliever or anxiolytic agent) or its use as a topical treatment for skin-related conditions.

A large body of literature has been published on the effects of odors on the human brain and emotions. Some studies have tested the effects of essential oils on mood, alertness, and mental

stress in healthy subjects. Other studies investigated the effects of various (usually synthetic) odors on task performance, reaction time, and autonomic parameters or evaluated the direct effects of odors on the brain via electroencephalogram patterns and functional imaging studies.[4] Such studies have consistently shown that odors can produce specific effects on human neuropsychological and autonomic function and that odors can influence mood, perceived health, and arousal. These studies suggest that odors may have therapeutic applications in the context of stressful and adverse psychological conditions.

Practitioners of aromatherapy apply essential oils using several different methods, including (1) indirectinhalation via a room diffuser or drops of oil placed near the patient (e.g., on a tissue), (2) direct inhalation used in an individual inhaler (e.g., a few drops of essential oil floated on top of hot water to aid a sinus headache), or (3) aromatherapy massage, which is the application to the body of essential oils diluted in a carrier oil. Other direct and indirect applications include mixing essential oils in bath salts and lotions or applying them to dressings. Different aromatherapy practitioners may have different recipes for treating specific conditions, involving various combinations of oils and methods of application. Differences seem to be practitioner-dependent, with some common uses more accepted throughout the aromatherapy community. Training and certification in aromatherapy for lay practitioners is available at several schools throughout the United States and United Kingdom, but there is no professional standardization in the United States, and no license is required to practice in either country. Thus, there is little consistency in the specific treatments used for specific illnesses among practitioners. This lack of standardization has led to poor consistency in research on the effects of aromatherapy, because anecdotal evidence alone or previous experience has driven the choice of oils, and different researchers often choose different oils when studying the same applications. However, there are now specific courses for licensed health professionals that give nursing or continuing medical education contact hours, including a small research component and information on evaluating/measuring outcomes.

The National Association for Holistic Aromatherapy (NAHA) (www.naha.org/ ) and the Alliance of International Aromatherapists (www.alliance-aromatherapists.org ) are the two governing bodies for national educational standards for aromatherapists. NAHA is taking steps toward standardizing aromatherapy certification in the United States. Many schools offer certificate programs approved by NAHA. A list of these schools can be found on the NAHA Web site (www.naha.org/schools_level_one_two.htm ). National examinations in aromatherapy are held twice per year.

The Canadian Federation of Aromatherapists has established standards for aromatherapy certification in Canada (www.cfacanada.com/ ). They also have standards for safety and professional conduct and a public directory of certified aromatherapists. Other countries may have similar organizations.

Although essential oils are given orally or internally by aromatherapists in France and Germany, use is generally limited to inhalation or topical application in the United Kingdom and United States. Nonmedical use of essential oils is common in the flavoring and fragrance industries. Most essential oils have been classified as GRAS (generally recognized as safe), at specified concentration limits, by theU.S. Food and Drug Administration (FDA). (See the International Federation of Aromatherapists [www.ifaroma.org/ ] for a list of international aromatherapy programs.)

Aromatherapy products do not need approval by the FDA.

References

1. Wildwood C: The Encyclopedia of Aromatherapy. Rochester, Vt: Healing Arts Press, 1996.

2. Dodd GH: The molecular dimension in perfumery. In: Van Toller S, Dodd GH, eds.: Perfumery: The Psychology and Biology of Fragrance. New York, NY: Chapman and Hall, 1988, pp 19-46.

3. Worwood VA: Aromatherapy for the Healthy Child: More Than 300 Natural, Non-Toxic, and Fragrant Essential Oil Blends. Novato, Calif: New World Library, 2000.

4. Buchbauer G, Jirovetz L, Jäger W, et al.: Fragrance compounds and essential oils with sedative effects upon inhalation. J Pharm Sci 82 (6): 660-4, 1993. [PUBMED Abstract]

History

Proponents of aromatherapy report that aromatic or essential oils have been used for thousands of years as stimulants or sedatives of the nervous system and as treatments for a wide range of otherdisorders.[1] They link it historically to the use of infused oils and unguents in the Bible and ancient Egypt,[1] remedies used throughout the Middle Ages and the Renaissance,[2] and the burning of aromatic plants in various religious rites. The current applications of aromatherapy did not come about until the early 20th century when the French chemist and perfumer Rene Gattefosse coined the term “aromatherapy” and published a book of that name in 1937.[2] Gattefosse proposed the use of aromatherapy to treat diseases in virtually every organ system, citing mostly anecdotal and case-based evidence.[2]

Although Gattefosse and his colleagues in France, Italy, and Germany studied the effects of aromatherapy for some 30 years, its use went out of fashion midcentury and was rediscovered by another Frenchman, a physician, Jean Valnet, in the latter part of the century. Valnet published his book The Practice of Aromatherapy in 1982,[3] at which time the practice became more well-known in Britain and the United States. Through the 1980s and 1990s, as patients in Western countries became increasingly interested in complementary and alternative medicine (CAM) treatments, aromatherapy developed a following that continues to this day. In addition to the growing use of essential oils bynurses and aromatherapy practitioners for specific medical issues, the popularity of aromatherapy has also been exploited by cosmetics companies that have created lines of essential oil-based (though often with a synthetic component) cosmetics and toiletries, claiming to improve mood and well-being in their users.

Despite the growing popularity of aromatherapy in the latter part of the 20th century (especially in the United Kingdom), little research on aromatherapy was available in the English-language medical literature until the early or mid-1990s. The research that began to appear in the 1990s was most often conducted by nurses, who tended to be the primary practitioners of aromatherapy in the United States and United Kingdom (although it is dispensed by medical doctors in France and Germany). Aromatherapists now publish their own journal, the International Journal of Essential Oil Therapeutics. Also, many studies regarding the effects of odor on the brain and other systems in

animals and healthy humans have been published in the context of odor psychology and neurobiology (and in the absence of the specific term aromatherapy).

In addition to topical antimicrobial uses,[4] aromatherapy has also been proposed for use in woundcare [5,6] and to treat a variety of localized symptoms and illnesses such as alopecia, eczema, andpruritus.[7-9] Aromatherapy has also been studied via inhalation for airway reactivity.[10]

Studies on aromatherapy have examined a variety of other conditions: sedation and arousal;[11,12] startle reflex and reaction time;[13,14] psychological states such as mood, anxiety, and general sense of well-being;[15-29] psychiatric disorders;[30] neurologic impairment;[23] chronic renal failure;[24]agitation in patients with dementia;[31-35] smoking withdrawal symptoms;[36,37] motion sickness;[38]postoperative nausea;[39,40] nausea and emesis in combination with fatigue, pain, and anxiety in patients in labor;[25,26,41] pain alone;[42-45] and pain in combination with other symptoms.[22,23,25,26]

Published articles have described the use of aromatherapy in specific hospital settings such as cancerwards, hospices, and other areas where patients are critically ill and require palliative care for pain, nausea, lymphedema,[46,47] generalized stress, anxiety,[48] and depression.[49] These observational studies provide examples of the clinical uses of aromatherapy (and other CAM modalities), though they are generally not evidence-based. Subjects have included hospitalized children with HIV,[50] homebound patients with terminal disease,[51] and hospitalized patients with leukemia.[52] Aromatherapy has also been used to reduce malodor of necrotic ulcers in cancer patients.[53]

Studies of aromatherapy use with mental health patients have also been conducted.[54] Most of the resulting articles describe successful incorporation of aromatherapy into the treatment of these patients, though outcomes are clearly subjective.

Theories about the mechanism of action of aromatherapy and essential oils differ, depending on the community studying them. Proponents of aromatherapy often cite the connection between olfaction and the limbic system in the brain as the basis for the effects of aromatherapy on mood and emotions; less is said about proposed mechanisms for its effects on other parts of the body. Most of the aromatherapy literature, however, lacks in-depth neurophysiological studies on the nature of olfaction and its link to the limbic system, and it generally does not cite research that shows these links. Proponents of aromatherapy also believe that the effects of the treatments are based on the special nature of the essential oils used and that essential oils produce effects on the body that are greater than the sum of the individual chemical components of the scents.

These assertions have been contested by the biochemistry and psychology communities, which take a different view of the possible mechanism of action of odors on the human brain (most do not differentiate the odors produced by essential oils from those of synthetic fragrances).[30] This neurobiological view, which focuses mostly on the emotional and psychological effects of fragrances (as opposed to the other symptomatic effects claimed by aromatherapists), takes into account what is known about olfactory transduction and the connection of the olfactory system to other central nervous system functions, including memory; however, it is primarily theoretical because of the lack of significant research addressing this topic.

References

1. Tisserand R: Essential oils as psychotherapeutic agents. In: Van Toller S, Dodd GH, eds.: Perfumery: The Psychology and Biology of Fragrance. New York, NY: Chapman and Hall, 1988, pp 167-80.

2. Gattefosse RM: Gattefosse's Aromatherapy. Essex, England:CW Daniel, 1993.

3. Valnet J: The Practice of Aromatherapy: A Classic Compendium of Plant Medicines & Their Healing Properties. Rochester, NY: Healing Arts Press, 1990.

4. Hartman D, Coetzee JC: Two US practitioners' experience of using essential oils for wound care. J Wound Care 11 (8): 317-20, 2002. [PUBMED Abstract]

5. Asquith S: The use of aromatherapy in wound care. J Wound Care 8 (6): 318-20, 1999. [PUBMED Abstract]

6. Edwards-Jones V, Buck R, Shawcross SG, et al.: The effect of essential oils on methicillin-resistant Staphylococcus aureus using a dressing model. Burns 30 (8): 772-7, 2004. [PUBMED Abstract]

7. Hay IC, Jamieson M, Ormerod AD: Randomized trial of aromatherapy. Successful treatment for alopecia areata. Arch Dermatol 134 (11): 1349-52, 1998. [PUBMED Abstract]

8. Anderson C, Lis-Balchin M, Kirk-Smith M: Evaluation of massage with essential oils on childhood atopic eczema. Phytother Res 14 (6): 452-6, 2000. [PUBMED Abstract]

9. Ro YJ, Ha HC, Kim CG, et al.: The effects of aromatherapy on pruritus in patients undergoing hemodialysis. Dermatol Nurs 14 (4): 231-4, 237-8, 256; quiz 239, 2002. [PUBMED Abstract]

10. Cohen BM, Dressler WE: Acute aromatics inhalation modifies the airways. Effects of the common cold. Respiration 43 (4): 285-93, 1982. [PUBMED Abstract]

11. Diego MA, Jones NA, Field T, et al.: Aromatherapy positively affects mood, EEG patterns of alertness and math computations. Int J Neurosci 96 (3-4): 217-24, 1998. [PUBMED Abstract]

12. Motomura N, Sakurai A, Yotsuya Y: Reduction of mental stress with lavender odorant. Percept Mot Skills 93 (3): 713-8, 2001. [PUBMED Abstract]

13. Miltner W, Matjak M, Braun C, et al.: Emotional qualities of odors and their influence on the startle reflex in humans. Psychophysiology 31 (1): 107-10, 1994. [PUBMED Abstract]

14. Millot JL, Brand G, Morand N: Effects of ambient odors on reaction time in humans. Neurosci Lett 322 (2): 79-82, 2002. [PUBMED Abstract]

15. Stevenson C: Measuring the effects of aromatherapy. Nurs Times 88 (41): 62-3, 1992 Oct 7-13. [PUBMED Abstract]

16. Dunn C, Sleep J, Collett D: Sensing an improvement: an experimental study to evaluate the use of aromatherapy, massage and periods of rest in an intensive care unit. J Adv Nurs 21 (1): 34-40, 1995. [PUBMED Abstract]

17. Buckle J: Aromatherapy. Nurs Times 89 (20): 32-5, 1993 May 19-25. [PUBMED Abstract]

18. Hadfield N: The role of aromatherapy massage in reducing anxiety in patients with malignant brain tumours. Int J Palliat Nurs 7 (6): 279-85, 2001. [PUBMED Abstract]

19. Wilkinson S: Aromatherapy and massage in palliative care. Int J Palliat Nurs 1 (1): 21-30, 1995.

20. Wilkinson S, Aldridge J, Salmon I, et al.: An evaluation of aromatherapy massage in palliative care. Palliat Med 13 (5): 409-17, 1999. [PUBMED Abstract]

21. Corner J, Cawler N, Hildebrand S: An evaluation of the use of massage and essential oils on the wellbeing of cancer patients. Int J Palliat Nurs 1 (2): 67-73, 1995.

22. Louis M, Kowalski SD: Use of aromatherapy with hospice patients to decrease pain, anxiety, and depression and to promote an increased sense of well-being. Am J Hosp Palliat Care 19 (6): 381-6, 2002 Nov-Dec. [PUBMED Abstract]

23. Walsh E, Wilson C: Complementary therapies in long-stay neurology in-patient settings. Nurs Stand 13 (32): 32-5, 1999 Apr 28-May 4. [PUBMED Abstract]

24. Itai T, Amayasu H, Kuribayashi M, et al.: Psychological effects of aromatherapy on chronic hemodialysis patients. Psychiatry Clin Neurosci 54 (4): 393-7, 2000. [PUBMED Abstract]

25. Burns E, Blamey C: Complementary medicine. Using aromatherapy in childbirth. Nurs Times 90 (9): 54-60, 1994 Mar 2-8. [PUBMED Abstract]

26. Burns EE, Blamey C, Ersser SJ, et al.: An investigation into the use of aromatherapy in intrapartum midwifery practice. J Altern Complement Med 6 (2): 141-7, 2000. [PUBMED Abstract]

27. Kite SM, Maher EJ, Anderson K, et al.: Development of an aromatherapy service at a Cancer Centre. Palliat Med 12 (3): 171-80, 1998. [PUBMED Abstract]

28. Komori T, Fujiwara R, Tanida M, et al.: Effects of citrus fragrance on immune function and depressive states. Neuroimmunomodulation 2 (3): 174-80, 1995 May-Jun. [PUBMED Abstract]

29. Wiebe E: A randomized trial of aromatherapy to reduce anxiety before abortion. Eff Clin Pract 3 (4): 166-9, 2000 Jul-Aug. [PUBMED Abstract]

30. Perry N, Perry E: Aromatherapy in the management of psychiatric disorders: clinical and neuropharmacological perspectives. CNS Drugs 20 (4): 257-80, 2006. [PUBMED Abstract]

31. Ballard CG, O'Brien JT, Reichelt K, et al.: Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: the results of a double-blind, placebo-controlled trial with Melissa. J Clin Psychiatry 63 (7): 553-8, 2002. [PUBMED Abstract]

32. Smallwood J, Brown R, Coulter F, et al.: Aromatherapy and behaviour disturbances in dementia: a randomized controlled trial. Int J Geriatr Psychiatry 16 (10): 1010-3, 2001. [PUBMED Abstract]

33. Holmes C, Hopkins V, Hensford C, et al.: Lavender oil as a treatment for agitated behaviour in severe dementia: a placebo controlled study. Int J Geriatr Psychiatry 17 (4): 305-8, 2002. [PUBMED Abstract]

34. Gray SG, Clair AA: Influence of aromatherapy on medication administration to residential-care residents with dementia and behavioral challenges. Am J Alzheimers Dis Other Demen 17 (3): 169-74, 2002 May-Jun. [PUBMED Abstract]

35. Snow LA, Hovanec L, Brandt J: A controlled trial of aromatherapy for agitation in nursing home patients with dementia. J Altern Complement Med 10 (3): 431-7, 2004. [PUBMED Abstract]

36. Rose JE, Behm FM: Inhalation of vapor from black pepper extract reduces smoking withdrawal symptoms. Drug Alcohol Depend 34 (3): 225-9, 1994. [PUBMED Abstract]

37. Sayette MA, Parrott DJ: Effects of olfactory stimuli on urge reduction in smokers. Exp Clin Psychopharmacol 7 (2): 151-9, 1999. [PUBMED Abstract]

38. Post-White N, Nichols W: Randomized trial testing of QueaseEase™ essential oil for motion sickness. International Journal of Essential Oil Therapeutics 1 (4): 158-66, 2007.

39. Tate S: Peppermint oil: a treatment for postoperative nausea. J Adv Nurs 26 (3): 543-9, 1997. [PUBMED Abstract]

40. Hines S, Steels E, Chang A, et al.: Aromatherapy for treatment of postoperative nausea and vomiting. Cochrane Database Syst Rev 4: CD007598, 2012. [PUBMED Abstract]

41. Oyama H, Kaneda M, Katsumata N, et al.: Using the bedside wellness system during chemotherapy decreases fatigue and emesis in cancer patients. J Med Syst 24 (3): 173-82, 2000. [PUBMED Abstract]

42. Dale A, Cornwell S: The role of lavender oil in relieving perineal discomfort following childbirth: a blind randomized clinical trial. J Adv Nurs 19 (1): 89-96, 1994. [PUBMED Abstract]

43. Göbel H, Schmidt G, Soyka D: Effect of peppermint and eucalyptus oil preparations on neurophysiological and experimental algesimetric headache parameters. Cephalalgia 14 (3): 228-34; discussion 182, 1994. [PUBMED Abstract]

44. Marchand S, Arsenault P: Odors modulate pain perception: a gender-specific effect. Physiol Behav 76 (2): 251-6, 2002. [PUBMED Abstract]

45. Kim JT, Wajda M, Cuff G, et al.: Evaluation of aromatherapy in treating postoperative pain: pilot study. Pain Pract 6 (4): 273-7, 2006. [PUBMED Abstract]

46. Barclay J, Vestey J, Lambert A, et al.: Reducing the symptoms of lymphoedema: is there a role for aromatherapy? Eur J Oncol Nurs 10 (2): 140-9, 2006. [PUBMED Abstract]

47. Kohara H, Miyauchi T, Suehiro Y, et al.: Combined modality treatment of aromatherapy, footsoak, and reflexology relieves fatigue in patients with cancer. J Palliat Med 7 (6): 791-6, 2004. [PUBMED Abstract]

48. Buckle J: Clinical Aromatherapy: Essential Oils in Practice. 2nd ed. New York, NY: Churchill Livingston, 2003.

49. Wilkinson SM, Love SB, Westcombe AM, et al.: Effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer: a multicenter randomized controlled trial. J Clin Oncol 25 (5): 532-9, 2007. [PUBMED Abstract]

50. Styles JL: The use of aromatherapy in hospitalized children with HIV disease. Complement Ther Nurs Midwifery 3 (1): 16-20, 1997. [PUBMED Abstract]

51. Rimmer L: The clinical use of aromatherapy in the reduction of stress. Home Healthc Nurse 16 (2): 123-6, 1998. [PUBMED Abstract]

52. Stringer J: Massage and aromatherapy on a leukaemia unit. Complement Ther Nurs Midwifery 6 (2): 72-6, 2000. [PUBMED Abstract]

53. Warnke PH, Sherry E, Russo PA, et al.: Antibacterial essential oils in malodorous cancer patients: clinical observations in 30 patients. Phytomedicine 13 (7): 463-7, 2006. [PUBMED Abstract]

54. Hicks G: Aromatherapy as an adjunct to care in a mental health day hospital. J Psychiatr Ment Health Nurs 5 (4): 317, 1998. [PUBMED Abstract]

Human/Clinical Studies

No studies in the published peer-reviewed literature discuss aromatherapy as a treatment for people with cancer. The studies discussed below, most of which were conducted in patients with cancer, primarily focus on other health-related conditions and on quality of life measures such as stress andanxiety levels.

A major review published in 2000 [1] focused on six studies investigating treatment or prevention of anxiety with aromatherapy massage. Although the studies suggested that aromatherapy massage had a mild transient anxiolytic effect, the authors concluded that the research done at that time was not sufficiently rigorous or consistent to prove the effectiveness of aromatherapy in treating anxiety. This review excluded trials related to other effects of aromatherapy (such as pain control) and did not include any studies looking at the effects of odors that were not specifically labeled as aromatherapy.

Several of the studies included in the Cochrane Database of Systematic Reviews are discussed in more detail. A randomized controlled pilot study examined the effects of adjunctive aromatherapy massage on mood, quality of life, and physical symptoms in patients with cancer.[2] Forty-six patients were randomly assigned to conventional day care alone or day care plus weekly aromatherapy massage using a standardized blend of oils (1% lavender and chamomile in sweet almond carrier oil) for 4 weeks. Patients self-rated their mood, quality of life, and the intensity of the two symptoms that were the most concerning to them at the beginning of the study and at weekly intervals thereafter. Of the 46 patients, only 11 of 23 (48%) in the aromatherapy group and 18 of 23 (78%) in the control group completed all of the 4 weeks. Patient-reported mood, symptoms, and quality of life improved in both groups, and there was no statistically significant difference between the two groups in any of these measures.

Another randomized controlled trial examined the effects of aromatherapy massage and massage alone on 42 patients with advanced cancer over a 4-week period.[3] Patients were randomly assigned to receive weekly massages with or without aromatherapy; the treatment group (aromatherapy group) received massages with lavender essential oil (Lavandula angustifolia Miller [synonyms: Lavandula spicata L.; Lavandula vera DC.]) and an inert carrier oil, and the control group (massage group) received either an inert carrier oil alone or no intervention. The authors reported no significant long-term benefits of aromatherapy or massage in pain control, quality of life, or anxiety, but sleep scores (as measured by the Verran and Snyder-Halpern sleep scale) improved significantly in both groups. The authors also reported statistically significant reductions in depression scores (as measured by the Hospital Anxiety and Depression Scale [HADS]) in the massage-only group.

A placebo-controlled, double-blind, randomized trial conducted in Australia investigated the effects ofinhalation aromatherapy on anxiety during radiation therapy.[4] A total of 313 patients receiving radiation therapy were randomly assigned to one of three groups: carrier oil with fractionated oils, carrier oil only, or pure essential oils of lavender, bergamot (Citrus aurantium L. ssp. bergamia [Risso] Wright & Arn. [Rutaceae]; [synonym: Citrus bergamia Risso]), and cedarwood (Cedrus atlantica [Endl.] Manetti ex Carriere [Pinaceae]). All three groups received the oils by inhalation during their radiation therapy. The authors reported no significant differences in depression (as measured by HADS) or psychological effects (as measured by the Somatic and Psychological Health Report) between the groups. The group that received only the carrier oil showed a statistically significant decrease in anxiety (as measured by HADS) compared with the other two groups.

Another randomized controlled trial investigated the effects of massage or aromatherapy massage in 103 cancer patients who were randomly assigned to receive massage using a carrier oil (massage group) or massage using a carrier oil plus the Roman chamomile essential oil (Chamaemelum nobile[L.] All. [synonym: Anthemis nobilis L.]) (aromatherapy massage group).[5] Two weeks after the massage, the authors found a statistically significant reduction in anxiety in the aromatherapy massage group (as measured by the State-Trait Anxiety Inventory) and an improvement in symptoms (as measured by the Rotterdam Symptom Checklist [RSCL]; the subscales with improved scores were psychological, quality of life, severe physical, and severe psychological). The authors reported that the massage-only group showed improvement on four RSCL subscales; however, these improvements did not reach statistical significance.

In a placebo-controlled, double-blind, randomized trial of bergamot inhalation aromatherapy compared with a pleasant smelling shampoo that did not contain essential oils, administered at the time of stem cell infusion in 37 children and adolescents undergoing stem cell transplant, aromatherapy was not found to be beneficial in reducing nausea, anxiety, or pain.[6] As administered in this study, bergamot inhalation aromatherapy may have contributed to persistent anxiety following the infusion of stem cells. Although no more effective than placebo, parents receiving aromatherapy showed a significant decrease in their transitory anxiety during the period between the completion of their child’s infusion and 1 hour following infusion. Nausea and pain subsided over the course of the intervention for all children, though nausea remained significantly greater in patients receiving aromatherapy. These findings suggest that the diffusion of bergamot essential oil may not provide suitable anxiolytic and antiemetic effects among children and adolescents undergoing stem cell transplantation. The double blinding of the trial may explain the results, as single-blinded or nonblinded trials in general supported the aromatherapy intervention.

A similar study evaluated the efficacy of an aromatherapy intervention for reduction of symptom intensity of nausea, retching, and/or coughing among adult patients receiving stem cells preserved indimethyl sulfoxide. The study found that an intervention of tasting or sniffing sliced oranges was more effective at reducing symptom intensity than an orange essential oil inhalation aromatherapy.[7]

A study whose primary objective was evaluating an aromatherapy service following changes made after an initial pilot at a U.K. cancer center also reported on the experiences of patients referred to the service.[8] Of 89 patients originally referred, 58 completed six aromatherapy sessions. The authors reported significant improvements in anxiety and depression (as measured by HADS) at the completion of the six sessions, as compared with before the six sessions. A small study examined the physical and psychological effects of aromatherapy massage in eight patients with primary malignant brain tumorsattending their first follow-up appointment after radiation therapy.[9] The author reported no psychological benefit in these patients from aromatherapy massage (as measured by HADS) but reported a statistically significant reduction in blood pressure, pulse, and respiratory rate.

Antibiotic -resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) andvancomycin -resistant enterococcus, are an increasing problem worldwide, causing intractable wound infections . Phytochemical mixtures, such as constituents of the volatile oils of lemongrass, eucalyptus, melaleuca, clove, and thyme with butylated hydroxytoluene, triclosan (0.3%), and 95% undenatured ethanol (69.7%), are being investigated against MRSA in vitro . No clinical trials have been performed.[10]

Two topical MRSA eradication regimens were compared in hospital patients. A standard treatment, which included mupirocin 2% nasal ointment, chlorhexidine gluconate 4% soap, and silver sulfadiazine 1% cream was given versus a tea tree oil regimen (melaleuca), which included tea tree 10% cream and tea tree 5% body wash. Both were administered for 5 days. One hundred fourteen patients received the standard treatment, and 56 (49%) were cleared of MRSA carriage. One hundred ten patients received the tea tree oil regimen, and 46 (41%) were cleared of MRSA carriage. In a small group of patients, the tea tree oil regimen was associated with a higher clearance rate of

MRSA carriage in theaxilla, groin, and wound sites, but the difference versus standard treatment was not significant.[11]

Current Clinical Trials

Check NCI’s list of cancer clinical trials for cancer CAM clinical trials on aromatherapy and essential oilsthat are actively enrolling patients.

General information about clinical trials is also available from the NCI Web site.

References

1. Cooke B, Ernst E: Aromatherapy: a systematic review. Br J Gen Pract 50 (455): 493-6, 2000. [PUBMED Abstract]

2. Wilcock A, Manderson C, Weller R, et al.: Does aromatherapy massage benefit patients with cancer attending a specialist palliative care day centre? Palliat Med 18 (4): 287-90, 2004. [PUBMED Abstract]

3. Soden K, Vincent K, Craske S, et al.: A randomized controlled trial of aromatherapy massage in a hospice setting. Palliat Med 18 (2): 87-92, 2004. [PUBMED Abstract]

4. Graham PH, Browne L, Cox H, et al.: Inhalation aromatherapy during radiotherapy: results of a placebo-controlled double-blind randomized trial. J Clin Oncol 21 (12): 2372-6, 2003. [PUBMED Abstract]

5. Wilkinson S, Aldridge J, Salmon I, et al.: An evaluation of aromatherapy massage in palliative care. Palliat Med 13 (5): 409-17, 1999. [PUBMED Abstract]

6. Ndao DH, Ladas EJ, Cheng B, et al.: Inhalation aromatherapy in children and adolescents undergoing stem cell infusion: results of a placebo-controlled double-blind trial. Psychooncology 21 (3): 247-54, 2012. [PUBMED Abstract]

7. Potter P, Eisenberg S, Cain KC, et al.: Orange interventions for symptoms associated with dimethyl sulfoxide during stem cell reinfusions: a feasibility study. Cancer Nurs 34 (5): 361-8, 2011 Sep-Oct. [PUBMED Abstract]

8. Kite SM, Maher EJ, Anderson K, et al.: Development of an aromatherapy service at a Cancer Centre. Palliat Med 12 (3): 171-80, 1998. [PUBMED Abstract]

9. Hadfield N: The role of aromatherapy massage in reducing anxiety in patients with malignant brain tumours. Int J Palliat Nurs 7 (6): 279-85, 2001. [PUBMED Abstract]

10. Sherry E, Boeck H, Warnke PH: Percutaneous treatment of chronic MRSA osteomyelitis with a novel plant-derived antiseptic. BMC Surg 1: 1, 2001. [PUBMED Abstract]

11. Dryden MS, Dailly S, Crouch M: A randomized, controlled trial of tea tree topical preparations versus a standard topical regimen for the clearance of MRSA colonization. J Hosp Infect 56 (4): 283-6, 2004. [PUBMED Abstract]

Adverse Effects

Safety testing on essential oils has shown minimal adverse effects. Several oils have been approved for use as food additives and are classified as GRAS (generally recognized as safe) by the U.S. Food and Drug Administration; however, ingestion of large amounts of essential oils is not recommended. In addition, a few cases of contact dermatitis have been reported, mostly in aromatherapists who have had prolonged skin contact with oils in the context of aromatherapy massage.[1] Some essential oils (e.g., camphor oil) can cause local irritation; therefore, care should be taken when applying them.Phototoxicity has occurred when essential oils (particularly citrus oils) are applied directly to the skin before sun exposure. One case report also showed airborne contact dermatitis in the context of inhaled aromatherapy without massage.[2] Often, aromatherapy uses undefined mixtures of essential oils without specifying the plant sources. Allergic reactions are sometimes reported, especially followingtopical administration. As essential oils age, they are often oxidized so the chemical composition changes. Individual psychological associations with odors may result in adverse responses. Repeated exposure to lavender and tea tree oils by topical administration was shown in one study to be associated with reversible prepubertal gynecomastia.[3] The effects appear to have been caused by the purported weak estrogenic and antiandrogenic activities of lavender and tea tree oils. Therefore, avoiding these two essential oils is recommended in patients with estrogen -dependant tumors. However, this is the first published report of this type of adverse effect when using products containing tea tree or lavender oils.

Summary of the Evidence for Aromatherapy and Essential Oils

To assist readers in evaluating the results of human studies of complementary and alternative medicine (CAM) treatments for people with cancer, the strength of the evidence (i.e., the levels of evidence) associated with each type of treatment is provided whenever possible. To qualify for a level of evidenceanalysis, a study must:

Be published in a peer-reviewed scientific journal.

Report on a therapeutic outcome or outcomes, such as tumor response, improvement in survival, or measured improvement in quality of life.

Describe clinical findings in enough detail that a meaningful evaluation can be made.

Separate levels of evidence scores are assigned to qualifying human studies on the basis of statistical strength of the study design and scientific strength of the treatment outcomes (i.e., endpoints) measured. The resulting two scores are then combined to produce an overall score. A table showing the levels of evidence scores for qualifying human studies cited in this summary is presented below. For an explanation of the scores and additional information about levels of evidence analysis of CAM treatments for people with cancer, refer to Levels of Evidence for Human Studies of Cancer Complementary and Alternative Medicine.

Use of Aromatherapy as a Supportive Care Agent in Cancer and Palliative Care: Table of Clinical Studies

Enlarge

Reference Citations

Type of Study/Essential Oil/Mode ofAdministration

No. of Patients Enrolled; Treated; Control

ConditionInvestigated

Primary Outcome

Secondary Outcome

Level of Evidence Score

[1] Randomized nonblindedtriala/lavender(Lavandula angustifoliaMiller [synonyms:Lavandula spicata L.;Lavandula vera DC.]) andchamomileblend/massage

46; 11; 18

Mood, QOL, physicalsymptoms

No effect on mood, QOL, or physical symptoms

None 1ii

[2] Randomized nonblinded triala/lavender/ massage

42; 29; 13

Pain No effect on pain

Improved sleep in both groups; reduceddepression (in massage group); no effect on QOL

1ii

[3] Randomized nonblinded triala/chamomile/massage

103; 43; 44

Physical andpsychologicalsymptoms, QOL

Reduction inanxiety and in physical and psychological symptoms; improved QOL

None 1ii

[4] Randomized nonblinded triala/chamomile/massage

52; 26; 25

QOL, physical symptoms, anxiety

Improved QOL, fewer physical

None 1ii

Reference Citations

Type of Study/Essential Oil/Mode ofAdministration

No. of Patients Enrolled; Treated; Control

ConditionInvestigated

Primary Outcome

Secondary Outcome

Level of Evidence Score

symptoms, reduced anxiety

[5] Randomized nonblinded triala/aromatherapy blendd/massage

52; 34; 18

Anxiety, mobility

Decreased anxiety, pain; improved mobility

None 1ii

[6] Double-blind randomized control triala/lavender,bergamot (Citrus aurantium L. ssp.bergamia [Risso] Wright & Arn. [Rutaceae]; [synonym: Citrus bergamia Risso]), andcedarwood (Cedrus atlantica [Endl.] Manetti ex Carriere [Pinaceae])/indirect application

313 Anxiety No effect on anxiety

No effect on depression orfatigue

1i

[7] Randomized placebo-controlled double-blind trial/bergamot/ inhalation

37; 17; 20

Anxiety,nausea, pain in children undergoingstem cell transplant

Increased anxiety and nausea in children 1 hour after stem cell infusion

Parental anxiety declined in both groups

1iC

Reference Citations

Type of Study/Essential Oil/Mode ofAdministration

No. of Patients Enrolled; Treated; Control

ConditionInvestigated

Primary Outcome

Secondary Outcome

Level of Evidence Score

in aromatherapy group; no effect on pain

[8] Randomized controlled single-blind trial/sweet orange/inhalation

60; 23; 19; 18 (aromatherapy; orange tasting/sniffing; control)

Symptom intensity (nausea,retching, cough)

Greatest reduction in symptom intensity with orange tasting/sniffing

None 1C

[9] Randomized single-blind trial/choice of 20 essential oils/massage

39; 20; 19

Feasibility; mood

Improvements in mood in both groups (aromatherapy massage and cognitive behavioral therapy)

Preference for aromatherapy over cognitive behavior therapy

1C

[10] Randomized single-blind trial/choice of bitter orange, black pepper, rosemary, majoram,

45; 15; 15; 15 (aromath

Constipation; QOL

Improvement with aromath

Improved QOL

1C

Reference Citations

Type of Study/Essential Oil/Mode ofAdministration

No. of Patients Enrolled; Treated; Control

ConditionInvestigated

Primary Outcome

Secondary Outcome

Level of Evidence Score

andpatchouli/massage erapy massage; plain massage; control)

erapy massage

[11] Nonrandomizedcontrolled clinical trial b/lavender,eucalyptus (Eucalyptus globulus Labill. andEucalyptus radiataSieber ex DC. [Myrtaceae]), and tea tree/topical application

16; 6; 10 Infection No effect onincidence of infection

None 2

[12] Nonrandomized controlled clinical trial b/geranium(Pelargonium species),German chamomile(Matricaria recutita L. [synonyms: Matricaria chamomilla L.,Chamomilla recutita (L.) Rausch.]), patchouli(Pogostemon cablin[Blanco] Benth. [Lamiaceae] [synonyms:Mentha cablin Blanco,Pogostemon patchoulyLetettier]), andturmeric phytol /oral application

48; 24; 24

Gastrointestinalsymptoms

No effect on gastrointestinal symptoms

None 2

[13] Consecutive case series c/lavender or chamomile/massage

18; 8 Anxiety, depression

No reduction in anxiety

Reduction inblood pressure,

3ii

Reference Citations

Type of Study/Essential Oil/Mode ofAdministration

No. of Patients Enrolled; Treated; Control

ConditionInvestigated

Primary Outcome

Secondary Outcome

Level of Evidence Score

or depression

pulse, and respiration

[14] Consecutive casea/various oils/massage

69 General symptoms

General improvement in symptoms reported by patients; no statistical analysis completed

None 3ii

No. = number; QOL = quality of life.

aPatients with cancer.

bPatients with breast cancer undergoing bone marrow transplantation.

cPatients with malignant brain tumors .

dLavender (43%), rosewood (29%), rose (7%), and valerian (4%).

References

1. Wilcock A, Manderson C, Weller R, et al.: Does aromatherapy massage benefit patients with cancer attending a specialist palliative care day centre? Palliat Med 18 (4): 287-90, 2004. [PUBMED Abstract]

2. Soden K, Vincent K, Craske S, et al.: A randomized controlled trial of aromatherapy massage in a hospice setting. Palliat Med 18 (2): 87-92, 2004. [PUBMED Abstract]

3. Wilkinson S, Aldridge J, Salmon I, et al.: An evaluation of aromatherapy massage in palliative care. Palliat Med 13 (5): 409-17, 1999. [PUBMED Abstract]

4. Wilkinson S: Aromatherapy and massage in palliative care. Int J Palliat Nurs 1 (1): 21-30, 1995.

5. Corner J, Cawler N, Hildebrand S: An evaluation of the use of massage and essential oils on the wellbeing of cancer patients. Int J Palliat Nurs 1 (2): 67-73, 1995.

6. Graham PH, Browne L, Cox H, et al.: Inhalation aromatherapy during radiotherapy: results of a placebo-controlled double-blind randomized trial. J Clin Oncol 21 (12): 2372-6, 2003. [PUBMED Abstract]

7. Ndao DH, Ladas EJ, Cheng B, et al.: Inhalation aromatherapy in children and adolescents undergoing stem cell infusion: results of a placebo-controlled double-blind trial. Psychooncology 21 (3): 247-54, 2012. [PUBMED Abstract]

8. Potter P, Eisenberg S, Cain KC, et al.: Orange interventions for symptoms associated with dimethyl sulfoxide during stem cell reinfusions: a feasibility study. Cancer Nurs 34 (5): 361-8, 2011 Sep-Oct. [PUBMED Abstract]

9. Serfaty M, Wilkinson S, Freeman C, et al.: The ToT study: helping with Touch or Talk (ToT): a pilot randomised controlled trial to examine the clinical effectiveness of aromatherapy massage versus cognitive behaviour therapy for emotional distress in patients in cancer/palliative care. Psychooncology 21 (5): 563-9, 2012. [PUBMED Abstract]

10. Lai TK, Cheung MC, Lo CK, et al.: Effectiveness of aroma massage on advanced cancer patients with constipation: a pilot study. Complement Ther Clin Pract 17 (1): 37-43, 2011. [PUBMED Abstract]

11. Gravett P: Aromatherapy treatment for patients with Hickman line infection following high-dose chemotherapy. International Journal of Aromatherapy 11 (1): 18-9, 2001.

12. Gravett P: Treatment of gastrointestinal upset following high-dose chemotherapy. International Journal of Aromatherapy 11 (2): 84-6, 2001.

13. Hadfield N: The role of aromatherapy massage in reducing anxiety in patients with malignant brain tumours. Int J Palliat Nurs 7 (6): 279-85, 2001. [PUBMED Abstract]

14. Evans B: An audit into the effects of aromatherapy massage and the cancer patient in palliative and terminal care. Complement Ther Med 3 (4): 239-41, 1995.

Article from Univeristy of Maryland http://umm.edu/health/medical/altmed/treatment/aromatherapy

Aromatherapy

Overview

What is aromatherapy?

Aromatherapy is the use of essential oils from plants for healing. Although the word “aroma” makes it sound as if the oils are inhaled, they can also be massaged into the skin or -- rarely -- taken by mouth. You should never take essential oils by mouth without specific instruction from a trained and qualified specialist. Whether inhaled or applied on the skin, essential oils are gaining new attention as an alternative treatment for infections, stress, and other health problems. However, in most cases scientific evidence is still lacking.

What are essential oils?

Essential oils are concentrated extracts taken from the roots, leaves, seeds, or blossoms of plants. Each contains its own mix of active ingredients, and this mix determines what the oil is used for. Some oils are used to promote physical healing -- for example, to treat swelling or fungal infections. Others are used for their emotional value -- they may enhance relaxation or make a room smell pleasant. Orange blossom oil, for example, contains a large amount of an active ingredient that is thought to be calming.

What is the history of aromatherapy?

Essential oils have been used for therapeutic purposes for nearly 6,000 years. The ancient Chinese, Indians, Egyptians, Greeks, and Romans used them in cosmetics, perfumes, and drugs. Essential oils were also commonly used for spiritual, therapeutic, hygienic, and ritualistic purposes.

More recently, René-Maurice Gattefossé, a French chemist, discovered the healing properties of lavender oil when he applied it to a burn on his hand caused by an explosion in his laboratory. He then started to analyze the chemical properties of essential oils and how they were used to treat burns, skin infections, gangrene, and wounds in soldiers during World War I. In 1928, Gattefossé founded the science of aromatherapy. By the 1950s massage therapists, beauticians, nurses, physiotherapists, doctors, and other health care providers began using aromatherapy.

Aromatherapy did not become popular in the United States until the 1980s. Today, many lotions, candles, and beauty products are sold as "aromatherapy." However, many of these products contain synthetic fragrances that do not have the same properties as essential oils.

How does aromatherapy work?

Researchers are not entirely clear how aromatherapy may work. Some experts believe our sense of smell may play a role. The "smell" receptors in your nose communicate with parts of your brain (the amygdala and hippocampus) that serve as storehouses for emotions and memories. When you breathe in essential oil molecules, some researchers believe they stimulate these parts of your brain and influence physical, emotional, and mental health. For example, scientists believe lavender

stimulates the activity of brain cells in the amygdala similar to the way some sedative medications work. Other researchers think that molecules from essential oils may interact in the blood with hormones or enzymes.

Aromatherapy massage is a popular way of using essential oils because it works in several ways at the same time. Your skin absorbs essential oils and you also breathe them in. Plus, you experience the physical therapy of the massage itself.

What happens during an aromatherapy session?

Professional aromatherapists, nurses, physical therapists, pharmacists, and massage therapists can provide topical or inhaled aromatherapy treatment. Only specially trained professionals can provide treatment that involves taking essential oils by mouth.

At an aromatherapy session, the practitioner will ask about your medical history and symptoms, as well any scents you may like. You may be directed to breathe in essential oils directly from a piece of cloth or indirectly through steam inhalations, vaporizers, or sprays. The practitioner may also apply diluted essential oils to your skin during a massage. In most cases, the practitioner will tell you how to use aromatherapy at home, by mixing essential oils into your bath, for example.

What is aromatherapy good for?

Aromatherapy is used in a wide range of settings -- from health spas to hospitals -- to treat a variety of conditions. In general, it seems to relieve pain, improve mood, and promote a sense of relaxation. In fact, several essential oils -- including lavender, rose, orange, bergamot, lemon, sandalwood, and others -- have been shown to relieve anxiety, stress, and depression.

Several clinical studies suggest that when essential oils (particularly rose, lavender, and frankincense) were used by qualified midwives, pregnant women felt less anxiety and fear, had a stronger sense of well being, and had less need for pain medications during delivery. Many women also report that peppermint oil relieves nausea and vomiting during labor.

Massage therapy with essential oils (combined with medications or therapy) may benefit people with depression. The scents are thought by some to stimulate positive emotions in the area of the brain responsible for memories and emotions, but the benefits seem to be related to relaxation caused by the scents and the massage. A person’s belief that the treatment will help also influences whether it works.

In one study, Neroli oil helped reduce blood pressure and preprocedure anxiety among people undergoing a colonoscopy.

In test tubes, chemical compounds from some essential oils have shown antibacterial and anti fungal properties. Some evidence also suggests that citrus oils may strengthen the immune system and that peppermint oil may help with digestion. Fennel, aniseed, sage, and clary sage have estrogen like compounds, which may help relieve symptoms of premenstrual syndrome and menopause. However, human studies are lacking.

Other conditions for which aromatherapy may be helpful include:

Alopecia areata (hair loss)

Agitation, possibly including agitation related to dementia

Anxiety

Constipation (with abdominal massage using aromatherapy)

Insomnia

Pain: Studies have found that people with rheumatoid arthritis, cancer (using topical chamomile), and headaches (using topical peppermint) require fewer pain medications when they use aromatherapy

Itching, a common side effect for those receiving dialysis

Psoriasis

Should anyone avoid aromatherapy?

Pregnant women, people with severe asthma, and people with a history of allergies should only use essential oils under the guidance of a trained professional and with full knowledge of your physician.

Pregnant women and people with a history of seizures should avoid hyssop oil.

People with high blood pressure should avoid stimulating essential oils, such as rosemary and spike lavender.

People with estrogen dependent tumors (such as breast or ovarian cancer) should not use oils with estrogen like compounds such as fennel, aniseed, sage, and clary-sage.

People receiving chemotherapy should talk to their doctor before trying aromatherapy.

Is there anything I should watch out for?

Most topical and inhaled essential oils are generally considered safe. You should never take essential oils by mouth unless you are under the supervision of a trained professional. Some oils are toxic, and taking them by mouth could be fatal.

Rarely, aromatherapy can induce side effects, such as rash, asthma, headache, liver and nerve damage, as well as harm to a fetus.

Oils that are high in phenols, such as cinnamon, can irritate the skin. Add water or a base massage oil (such as almond or sesame oil) to the essential oil before applying to your skin. Avoid using near your eyes.

Essential oils are highly volatile and flammable so they should never be used near an open flame.

Animal studies suggest that active ingredients in certain essential oils may interact with some medications. Researchers don’t know if they have the same effect in humans. Eucalyptus, for example, may cause certain medications, including pentobarbital (used for seizures) and amphetamine (used for narcolepsy and attention deficit hyperactivity disorder) to be less effective.

How can I find an aromatherapist?

While there are currently no boards that certify or license aromatherapists in the United States, many professionals are members of professional organizations. To locate a qualified aromatherapist in your area, contact the National Association of Holistic Therapy atwww.naha.org. Many aromatherapists are trained in some other form of therapy or healing system, such as massage or chiropractic, and include aromatherapy in their practice.

What is the future of aromatherapy?

Although essential oils have been used for centuries, few studies have looked the safety and effectiveness of aromatherapy in people. Scientific evidence is lacking, and there are some concerns about the safety and quality of certain essential oils. More research is needed before aromatherapy becomes a widely accepted alternative remedy.

References

Atsumi T, Tonosaki K. Smelling lavender and rosemary increases free radical scavenging activity and decreases cortisol level in saliva. Psychiatry Res. 2007;150(1):89-96.

Bagetta G, Morrone LA, Rombola L, et al. Neuropharmacology of the essential oil of bergamot. Fitoterapia. 2010;81(6):453-61.

Ballard CG, Gauthier S, Cummings JL, Brodaty H, Grossberg GT, Robert P, Lyketsos CG. Management of agitation and aggression associated with Alzheimer disease. Nat Rev Neurol. 2009 May;5(5):245-55. Review.

Bastard J, Tiran D. Aromatherapy and massage for antenatal anxiety: its effect on the fetus.Complement Ther Clin Pract. 2006;12(1):48-54.

Burns E, Zobbi V, Panzeri D, Oskrochi R, Regalia A. Aromatherapy in childbirth: a pilot randomised controlled trial. BJOG. 2007;114(7):838-44.

Dunning T. Applying a quality use of medicines framework to using essential oils in nursing practice. Complement Ther Clin Pract. 2005;11(3):172-81.

Edris AE. Pharmaceutical and therapeutic potentials of essential oils and their individual volatile constituents: a review. Phytother Res. 2007;21(4):308-23.

Fellowes D, Barnes K, Wilkinson S. Aromatherapy and massage for symptom relief in patients with cancer. Cochrane Database Syst Rev. 2004;(2):CD002287.

Fowler NA. Aromatherapy, used as an integrative tool for crisis management by adolescents in a residential treatment center. J Child Adolesc Psychiatr Nurs. 2006;19(2):69-76.

Goel N, Kim H, Lao RP. An olfactory stimulus modifies nighttime sleep in young men and women. Chronobiol Int. 2005;22(5):889-904.

Hadfield N. The role of aromatherapy massage in reducing anxiety in patients with malignant brain tumours. Int J Palliat Nurs. 2001;7(6):279-85.

Anti-Bacterial/Acne Fighting Essential OilsNatural Preservatives for Skin Care

Essential oils can be great allies in the fight against bacteria/acne. Used full strength or diluted with a carrier oil, essential oils can be applied topically to relieve mild to moderate acne. When choosing an essential oil you must consider your skin type, the kind of acne you are dealing with, and whether or not the oil of your choice has to be diluted before use. Some essential oils should not be used full strength and it is important to follow the indications on the bottle. Generally, the more sensitive your skin, the more diluted your oils should be. When using essential oils on the skin it is important to choose carrier oil that will not be sticky or clog pores; Sunflower oil or Calendula infused oil is an excellent choice for the face or body. Essential oils can be problematic during pregnancy, even if they are applied to the skin, and an expert in herbal study or medicine should be consulted before any use. Essential oils can be very strong or very mild depending on strength in the formula. As with any acne treatment, if a rash or irritation develops you should discontinue use immediately; if it persists you should see health practitioner. Regarding essential oils in skin care products they can be added to reduce skin bacteria or fungus.

Choose one from each group:

1) Tea Tree Oil/Palmarosa Oil /Plai (antibacterial - anti-yeast, antifungal)

Tea tree oil with Palmarosa is an excellent antibacterial treatment making it an excellent acne fighter as well as a general purpose wound cleaner. It helps soothe irritations, rashes and burns, control acne and dandruff, and treat warts and other fungal infections. The properties of this oil make it one of the best combination essential oils to have in your medicine cabinet. As an acne treatment, Tea tree/Palmarosa oil is fast acting and acts to clear up the skin while calming the effected area.

2) Bergamot Oil /Lemon Oil/Grapefruit (astringent [drying], and aromatic [smells good])

Bergamot oil has a revitalizing fragrance and it blends well with other oils making it an excellent addition to any acne treatment blend. Bergamot has antibacterial and drying properties making it an ideal spot treatment for existing blemishes. The citrus aroma has a calming effect on the mind and soul. Should not be used full strength except on the advice of a licensed aromatherapy professional -- one who has completed an Aromatherapy Studies Course.

3) Clove Oil/Cinnamon leaf/ Oregano (antibacterial)

Oregano CT carvacrol is a very potent essential oil that has burning and purifying properties. In its pure form, it can be irritating and should be blended with other essential oils that contain essential oil alcohols such as Lavender or Bergamot oil and with a skin friendly carrier oil (like Olive, Calendula or Jojoba oil) before being applied to the skin. Some use these oils full strength as a spot treatment for stubborn acne, but this is not generally advised – always dilute essential oils before use. When diluted, Oregano or Clove oil can be applied to the skin to treat emerging or existing breakouts. It is very strong and acts very quickly. Should not be used full strength except on the advice of a licensed professional.

4) Lavender Oil /Sandalwood from Australia (antibacterial, soothing)

Lavender oil has well known soothing properties and is slightly antibacterial. Its scent is highly regarded and most acceptable. It is excellent as a preventative acne treatment that can stop future breakouts while clearing the redness often associated with acne prone skin. Some Lavender oil can be very strong and as with all essential oils, it should be diluted before application on the skin. Sandalwood from Australia had antibacterial components.

European research confirms that Australian Sandalwood Oil kills bacteria, in vitro, against many gram-positive organisms, including Staphylococcus aureus, (and MRSA or 'Golden Staph') and many species of Streptococcus, in addition to the organisms that are responsible for acne, thrush, tinea, Athletes Foot and ringworm. The concentration of oil required to inhibit the growth of all bacteria (exceptEscherichia coli) is very low, confirming a significant bacteriostatic effect.

5) Rosemary Oil (Rosmarinus officinalis CT verbenone) (astringent and antifungal) with Frankincense

This highly aromatic essential oil is excellent for people with oily skin. When applied topically it helps reduce oil/sebum production thus limiting the breakouts associated with oily skin. Normally Rosemary is not recommended for those with very dry or sensitive skin, although the verbenone chemotype is used. The drying properties of this oil make it an excellent spot treatment that can be applied throughout the day to effected areas.

Cited from article Melaleuca alternifolia (Tea Tree) Oil: a Review of Antimicrobial and Other Medicinal Properties

1. C. F. Carson 1 ,

2. K. A. Hammer 1 and

3. T. V. Riley 1 ,2,*

http://cmr.asm.org/content/19/1/50.full for full article

Antibacterial ActivityThe few reports of the antibacterial activity of TTO appearing in the literature from the 1940s to the 1980s (11, 15, 100, 153) have been reviewed elsewhere previously (35). From the early 1990s onwards, many reports describing the antimicrobial activity of TTO appeared in the scientific literature. Although there was still a degree of discrepancy between the methods used in the different studies, the MICs reported were often relatively similar. A broad range of bacteria have now been tested for their susceptibilities to TTO, and some of the published susceptibility data are summarized in Table 3. While most bacteria are susceptible to TTO at concentrations of 1.0% or less, MICs in excess of 2% have been reported for organisms such as commensal skin staphylococci and micrococci,Enterococcus faecalis, and Pseudomonas aeruginosa (13, 79). TTO is for the most part bactericidal in nature, although it may be bacteriostatic at lower concentrations.

View this table:

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TABLE 3.

Susceptibility data for bacteria tested against M. alternifoliaoil

The activity of TTO against antibiotic-resistant bacteria has attracted considerable interest, with methicillin-resistant Staphylococcus aureus (MRSA) receiving the most attention thus far. Since the potential to use TTO against MRSA was first hypothesized (153), several groups have evaluated the activity of TTO against MRSA, beginning with Carson et al. (31), who examined 64 MRSA isolates from Australia and the United Kingdom, including 33 mupirocin-resistant isolates. The MICs and minimal bactericidal concentrations (MBCs) for the Australian isolates were 0.25% and 0.5%, respectively, while those for the United Kingdom isolates were 0.312% and 0.625%, respectively. Subsequent reports on the susceptibility of MRSA to TTO have similarly not shown great differences compared to antibiotic-sensitive organisms (39, 58, 68, 106, 115).

For the most part, antibacterial activity has been determined using agar or broth dilution methods. However, activity has also been demonstrated using time-kill assays (34, 48, 80, 106), suspension tests (107), and “ex vivo”-excised human skin (108). In addition, vaporized TTO can inhibit bacteria, includingMycobacterium avium ATCC 4676 (105), Escherichia coli, Haemophilus

influenzae, Streptococcus pyogenes, and Streptococcus pneumoniae (85). There are anecdotal reports of aerosolized TTO reducing hospital-acquired infections (L. Bowden, Abstr. Infect. Control Nurses Assoc. Annu. Infect. Control Conf., p. 23, 2001) but no scientific data.

Mechanism of antibacterial action.The mechanism of action of TTO against bacteria has now been partly elucidated. Prior to the availability of data, assumptions about its mechanism of action were made on the basis of its hydrocarbon structure and attendant lipophilicity. Since hydrocarbons partition preferentially into biological membranes and disrupt their vital functions (138), TTO and its components were also presumed to behave in this manner. This premise is further supported by data showing that TTO permeabilizes model liposomal systems (49). In previous work with hydrocarbons not found in TTO (90, 146a) and with terpenes found at low concentrations in TTO (4, 146), lysis and the loss of membrane integrity and function manifested by the leakage of ions and the inhibition of respiration were demonstrated. Treatment of S. aureuswith TTO resulted in the leakage of potassium ions (49, 69) and 260-nm-light-absorbing materials (34) and inhibited respiration (49). Treatment with TTO also sensitized S. aureus cells to sodium chloride (34) and produced morphological changes apparent under electron microscopy (127). However, no significant lysis of whole cells was observed spectrophotometrically (34) or by electron microscopy (127). Furthermore, no cytoplasmic membrane damage could be detected using the lactate dehydrogenase release assay (127), and only modest uptake of propidium iodide was observed (50) after treatment with TTO.

In E. coli, detrimental effects on potassium homeostasis (47), glucose-dependent respiration (47), morphology (67), and ability to exclude propidium iodide (50) have been observed. A modest loss of 280-nm-light-absorbing material has also been reported (50). In contrast to the absence of whole-cell lysis seen in S. aureus treated with TTO, lysis occurs in E. coli treated with TTO (67), and this effect is exacerbated by cotreatment with EDTA (C. Carson, unpublished data). All of these effects confirm that TTO compromises the structural and functional integrity of bacterial membranes.

The loss of viability, inhibition of glucose-dependent respiration, and induction of lysis seen after TTO treatment all occur to a greater degree with organisms in the exponential rather than the stationary phase of growth (67; S. D. Cox, J. L. Markham, C. M. Mann, S. G. Wyllie, J. E. Gustafson, and J. R. Warmington, Abstr. 28th Int. Symp. Essential Oils, p. 201-213, 1997). The increased vulnerability of actively growing cells was also apparent in the greater degree of morphological changes seen in these cells by electron microscopy (S. D. Cox et al. Abstr. 28th Int. Symp. Essential Oils, p. 201-213). The differences in susceptibility of bacteria in different phases of growth suggest that targets other than the cell membrane may be involved.

When the effects of terpinen-4-ol, α-terpineol, and 1,8-cineole on S. aureuswere examined, none was found to induce autolysis but all were found to cause the leakage of 260-nm-light-absorbing material and to render cells susceptible to sodium chloride (34). Interestingly, the greatest effects were seen with 1,8-cineole, a component often considered to have marginal antimicrobial activity. This raises the possibility that while cineole may not be one of the primary antimicrobial components, it may permeabilize bacterial membranes and facilitate the entry of other, more active components. Little work on the effects of TTO components on cell morphology has been reported. Electron microscopy of terpinen-4-ol-treated S. aureus cells (34) revealed lesions similar to those seen after TTO treatment (127), including mesosome-like structures.

Mechanism of action studies analogous to those described above have not been conducted with P. aeruginosa. Instead, research has concentrated on how this organism is able to tolerate higher concentrations of TTO and/or components. These studies have indicated that tolerance is associated with the outer membrane by showing that when P. aeruginosa cells are pretreated with the outer membrane permeabilizer polymyxin B nonapeptide or EDTA, cells become more susceptible to the bactericidal effects of TTO, terpinen-4-ol, or γ-terpinene (99,103).

In summary, the loss of intracellular material, inability to maintain homeostasis, and inhibition of respiration after treatment with TTO and/or components are consistent with a mechanism of action involving the loss of membrane integrity and function.