General precautions for topical use of essential oils

Aromatherapy is the holistic application of authentic essential oils extracted from plants for physical, mental and spiritual health.

\"Essential oils can be used safely as aromatic remedies when properly selected and administered,\" says the renowned Peter Holmes. The fact that we have evolved to use plants for both food and as remedies means that the human body recognizes and manages them effectively.

However, essential oils need to be used with more care than the medicinal plants from which they are derived because, unlike herbs, they are a highly concentrated extract of a plant or part of a plant.

Clinical studies assessing the possible adverse effects of certain essential oils in their various forms of application are, of course, needed. But for most constituents both the risks and the safety rules are known.

One of the most popular ways of using essential oils is topical (skin) application. The skin is the largest organ of the body (~1.6-1.8m2 and ~0.5-4mm thick) and its main function is as a barrier (provides antimicrobial and UV protection, prevents water loss, ensures permeability).

Essential oils, absolutes, vegetable oils and any other plant extracts may have adverse effects when applied to the skin. These are closely related to the dose, concentration, frequency of use, toxicity of the oil used, interaction with other substances, but depend primarily on the person using them. There are also environmental factors that influence oil toxicity, namely ultraviolet (UV) radiation.

In this article, I aim to illustrate the most common (possible, not probable) adverse effects of topical application of essential oils, but especially some general rules to allow their safe use. I should mention at the outset that most of the documented adverse effects (in case studies or virtual libraries) following the use of essential oils have occurred when they have been used inappropriately (one or more safety rules not respected).

Adverse effects from topical application

Adverse effects caused by topical application of essential oils are the most difficult to predict, but also the easiest to combat. They all manifest themselves as similar symptoms, with a greater or lesser degree of skin inflammation, and pass by themselves over time (some within minutes, others within weeks), even if no intervention is taken. Skin side effects that may occur with topical use of essential oils are photosensitization, irritation and allergy.

Children under 3 months of age are most susceptible to skin adverse effects due to the immaturity of their skin. For them, the application of essential oils should therefore be avoided. In exceptional cases, they can be applied in very low concentrations (0.1-0.3%), but only on the advice of a doctor or certified aromatherapist.

People with sensitive or fair skin, those suffering from atopic dermatitis, women and those who work with natural or artificial chemicals (cosmetics, spa products, essential oils) are at higher risk of developing adverse reactions, so they should use higher dilutions and test the oils on the inner elbow area before application.

Photosensitivity

Photosensitization is the skin reaction that occurs only in the presence of UV rays when a certain substance is applied topically. It is manifested by pigmentation, irritation, flict (blistering) and can lead to serious burns (depending on the amount of photosensitizing oil and the time of exposure). In the case of essential oils it is generated by the presence of furacoumarins in oils such as Bergamot(lat.Citrus bergamia Risso & Poit.), Cumin (lat. Cuminum cyminum L.), Lime (lat. Citrus x aurantifolia Christm.), Angelica (lat. Angelica archangelica L.) and, to a lesser extent,â in Bitter Orange (lat. Citrus aurantium × L. var. amara), Lemon (lat. Citrus × limon L.), Grapefruit (lat. Citrus × paradisi Macfad.*).

This is one of the most common cutaneous side-effects occurring with topical application of essential oils. It is also the easiest to prevent; we just need to avoid prolonged exposure to the sun or UV rays (12-24 hours) when using photosensitizing oils in therapeutic doses. The degree of photosensitization is different for each of them. At the end of this article you will find a list of essential oils with a high risk of photosensitization, as well as the maximum concentration that can be used topically to avoid adverse skin reactions.

Irritation (irritant contact dermatitis)

It is a skin reaction manifested by reddening of the skin, itching, burning or painful sensation, urticaria, blistering. For most people, the irritant reaction starts within a few minutes (5-10 minutes) of applying an essential oil, but can be instantaneous. The inflammation subsides fairly quickly after the oil is removed from the skin (a few hours), occurs only where the oil has been applied, can be prevented later by appropriate dilution and does not involve the immune system.

Common causes leading to irritation include using undiluted or insufficiently diluted essential oils on the skin or in bath water.

Allergy (allergic contact dermatitis)

Allergy is the most serious skin reaction to essential oils and, like irritation, is manifested by reddening of the skin, pruritus, burning or aching, hives, blistering. Inflammation, however, disappears much more slowly than in the case of irritation (it may last for days, weeks, months), may occur in other sites than the one where the essential oil was applied, may recur later, even at an appropriate dilution, and involves the immune system (it is mediated by lgE - immediate hypersensitivity or by T cells - delayed hypersensitivity).

If irritation occurs, in most cases, in oils with high risk of irritation or allergy (\"hot\") such as Cassia(lat. Cinnamomum cassia Nees ex Blume), Cinnamom(lat. Cinnamomum verum J. Presl), Clove(lat. Syzygium aromaticum L.), especially when undiluted or inadequately diluted, allergy may also occur with oils with low risk of irritation or allergy ('mild'), such as Lavender(lat. Lavandula angustifolia Mill.), Tea Tree(lat. Melaleuca alternifolia Maiden & Betche), Helichrysum(Helichrysum italicum Roth), even when properly diluted. Dilution, however, considerably reduces the risk of an allergy and must take into account the oil used (maximum permissible topical maximum) and personal factors (age, sex, allergic background, skin color, occupation).

Dilution involves mixing the essential oils with vegetable oils (coconut, jojoba, almond, olive...), a gel (Aloe, Aloe Vera Jelly, etc.), a lotion or other neutral odorless base. It is recommended that these ingredients be organic where possible to avoid exposure to insecticides, pesticides or fungicides.

General recommendations for topical application

• Be sure to use genuine and unadulterated essential oils! This topic is described in detail in the article \"Purity and authenticity of essential oils in aromatherapy\".

• Do not use essential oils you do not know! Always inform yourself about each oil you are going to use, both from a therapeutic and safety point of view.

• Always dilute essential oils before applying them to the skin. Check the topical maximum for each oil used, the age and general condition of the user, and the dilution for the problem being addressed! Oils with high irritant potential (rich in cinnamaldehyde, thymol, carvacrol, citral) apply in low concentrations (below 1%).

• Always DILUTE essential oils before applying to the skin of babies, children, pregnant women or people with sensitive skin.

• Check how the skin reacts to an essential oil before applying to a large area of skin or when using an essential oil for the first time. Dilute the oil and apply to the inside of the elbow. Wait 12-24 hours to watch for side effects. Continue application only if they do not occur.

• Never put essential oils in your eyes or ears! Use appropriate dilutions and use with care when applying essential oils around the eyes or ears.

• Never use oxidized oils! They can have negative effects! To prevent oxidation of essential oils, always store essential oils in cool, dark spaces and avoid prolonged exposure to air. For monoterpene-rich oils such as citrus or coniferous, refrigerated storage is recommended.

• Do not add essential oils directly to bath water or salts! They can be safely added to bath water if properly diluted in vegetable oil, or preferably mixed with a dispersing substance (Solubol). The following substances DO NOT disperse essential oils in water: sodium bicarbonate, cornstarch, Epsom salts, table salt, Aloe vera, whole milk, glycerine, witch hazel water, vodka.

• Avoid using the same oil or combinations of oils for long periods of time! A break in administration of 2 days for every 5 days of administration or 1 week for every 3 weeks of administration is recommended. If, for pertinent reasons, this break is not possible, rotating the oils used is recommended. This approach reduces both the risks of adverse skin effects and the development of resistance to essential oils (although this possibility is very low, cases have been reported where after continuous and long-term use, efficacy has decreased).

When, despite all precautions, an adverse skin reaction such as photosensitization, irritation or allergy occurs, there are several steps to follow to relieve immediate discomfort, reduce inflammation and speed healing. For severe cases or those where inflammation persists, always consult your doctor!

• The first action should always be, removing the essential oil by washing the area with soap, preferably without fragrance. Then avoid the oil that has caused the problem throughout the recovery period and introduce it progressively thereafter, at very low dilutions and combined with \"mild\" essential oils (with low risk of irritation or allergy).
• The best method to relieve immediate discomfort is to apply an oatmeal paste (the process is described below).
• Hydrosols (Lavender, Camomile, Rose), Aloe Vera gel (preferably fresh, but commercially available is also useful) and regenerating and soothing plant oils (Calendula, Coconut, Tamanu) can be applied.
• If the essential oils have entered the eyes or ears, try to remove them immediately by washing the area with plenty of water. Always consult a doctor if you still feel discomfort.

Oat paste

• Add a handful of oatmeal, preferably broken into small pieces, but whole oatmeal is acceptable.
• Place in a glass container of water and gently knead to allow the water to soak in.
• Apply to the irritated area as often as needed.

Repeat the soaking process to reactivate the oatmeal, and replace the oatmeal after a few uses or a few hours after the first use.

The key to the safe use of essential oils is to follow certain principles/rules of application/administration and pay attention to dosage according to the person's health and age.

By using the appropriate dilution for each essential oil and paying attention to the frequency of application and where it is applied, essential oils can be used topically safely.

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