Dr DIMITRIOS – JAMES MANOS
1 January 2012

There are many aromatic plant oils that as essential (volatile) oils can be used in a room by putting 3 – 4 drops of them to a special aromatherapy device (e.g. the classical one with a candle or a modern) or by applying and massaging the skin or used in a hot bath (not all the aromatherapy oils can be applied on the skin or diluted in a bath water – ask an expert) (1), (2). The side effects are few with main adverse effect the allergy on a specific aromatherapy oil (including contact dermatitis), photodermatitis and local irritation (e.g. from camphor oil). There isn’t good evidence for their effectiveness. However some people seem to feel better with aromatherapy (however this has not been defined if it is ought to a placebo effect). The aromatherapy oils that are used are very concentrated. People should never drink a volatile oil. There are toxic if ingested. Some aromatherapy oils can be used for massage or in a bath (by diluting some drops in warm water) or as volatile using special device.

The most famous volatile oil is levanter that is said to help insomnia, stress, burns and blisters. Other oils useful for stress are rose wood, rosemary, valerian, ilang – ilang and geranium. The last is also antidepressive.

Tea tree oil is said to help head lice, wound infection and athlete’s foot (fungi).

Eucalyptus oil is famous for common cold and clears the blocked (congested) nose (e.g. Vicks (R)). In the market someone can find sprays for congested nose with eucalyptus. The classic gel Vicks (R) can be used by stirring 1 – 2 teaspoons in a cup containing boiled water and inhaling the vapors (but the patient has to be careful for eye irritation e.g. by closing the eyes and wearing glasses). Also Vicks can be used for chest infections such as bronchitis/ pneumonia by application of the gel on the chest skin (usually at night). In any case the user has to read the written instructions of the product and not be based in the above information. It has to be mentioned that, contrary to natural eucalyptus, patients mustn’t use nasal anticongestants more than 5 – 7 days to avoid the risk of inducing pharmaceutical rhinitis from the drug its self. Some nasal anticongestants combine eucalyptus with an anticongestant medication (so they still need to be used for less than 1 week, contrary to natural 100% eucalyptus products). Very helpful for rhinitis is washing the nose with saline flush or sterile sea water (there are special medications on drug stores (chemists)), but their use should be done without undue pressure as flushing the nose, otherwise they may move the bacteria internally (inner) spreading an infection. 

Thyme oil is antiseptic and used for common cold.

Rosemary was mentioned previously for relaxation. However it is most used as antiseptic and soothing and is said to help especially sinus infections. Sinus infections may become chronic and often resistant to antibiotics.

Peppermint oil is said to be useful for headache and indigestion.

SOME STUDIES

A study evaluated the antimicrobial activity potential of the essential oil of rosemary specifically for its efficacy against the drug-resistant mutants of Mycobacterium smegmatis, Escherichia coli, and Candida albicans. Antibacterial, antifungal, and drug resistance-modifying activity was evaluated both qualitatively and quantitatively following disc diffusion and broth dilution assay procedures. The rosemary essential oil was found to be more active against the gram-positive pathogenic bacteria except E. faecalis and drug-resistant mutants of E. coli, compared to gram-negative bacteria. Similarly, it was found to be more active toward nonfilamentous, filamentous, dermatophytic pathogenic fungi and drug-resistant mutants of Candida albicans. These findings suggest that characterization and isolation of the active compound(s) from the rosemary oil may be useful in counteracting gram-positive bacterial, fungal, and drug-resistant infections (4).

Recently, the importance of non-pharmacological therapies for dementia has come to the fore. A study examined the curative effects of aromatherapy in dementia in 28 elderly people, 17 of whom had Alzheimer’s disease (AD). After a control period of 28 days, aromatherapy was performed over the following 28 days, with a wash out period of another 28 days. Aromatherapy consisted of the use of rosemary and lemon essential oils in the morning, and lavender and orange in the evening. To determine the effects of aromatherapy, patients were evaluated using the Japanese version of the Gottfries, Brane, Steen scale (GBSS-J), Functional Assessment Staging of Alzheimer’s disease (FAST), a revised version of Hasegawa’s Dementia Scale (HDS-R), and the Touch Panel-type Dementia Assessment Scale (TDAS) four times: before the control period, after the control period, after aromatherapy, and after the washout period. All patients showed significant improvement in personal orientation related to cognitive function on both the GBSS-J and TDAS after therapy. In particular, patients with AD showed significant improvement in total TDAS scores. Result of routine laboratory tests showed no significant changes, suggesting that there were no side-effects associated with the use of aromatherapy. Results from Zarit’s score showed no significant changes, suggesting that caregivers had no effect on the improved patient scores seen in the other tests. The study concluded that aromatherapy is an efficacious non-pharmacological therapy for dementia. Aromatherapy may have some potential for improving cognitive function, especially in Alzheimer’s disease (AD) patients (5).

A study assessed the olfactory impact of the essential oils of lavender (Lavandula angustifolia) and rosemary (Rosmarlnus officinalis) on cognitive performance and mood in healthy volunteers. In the study, one hundred and forty-four participants were randomly assigned to one of three independent groups, and subsequently performed the Cognitive Drug Research (CDR) computerized cognitive assessment battery in a cubicle containing either one of the two odors or no odor (control). Visual analogue mood questionnaires were completed prior to exposure to the odor, and subsequently after completion of the test battery. The participants were deceived as to the genuine aim of the study until the completion of testing to prevent expectancy effects from possibly influencing the data. The outcome variables from the nine tasks that constitute the CDR core battery feed into six factors that represent different aspects of cognitive functioning. Analysis of performance revealed that lavender produced a significant decrement in performance of working memory, and impaired reaction times for both memory and attention based tasks compared to controls. In contrast, rosemary produced a significant enhancement of performance for overall quality of memory and secondary memory factors, but also produced an impairment of speed of memory compared to controls. With regard to mood, comparisons of the change in ratings from baseline to post-test revealed that following the completion of the cognitive assessment battery, both the control and lavender groups were significantly less alert than the rosemary condition; however, the control group was significantly less content than both rosemary and lavender conditions. These findings indicate that the olfactory properties of levander and rosemary essential oils can produce objective effects on cognitive performance, as well as subjective effects on mood (6).

A randomized, double-blind, controlled trial of 7 months’ duration, with follow-up at 3 and 7 months, investigated the efficacy of aromatherapy in the treatment of patients with alopecia areata. In the study participated eighty-six patients diagnosed as having alopecia areata. The patients were randomized into 2 groups. The active group massaged essential oils (thyme, rosemary, lavender, and cedarwood) in a mixture of carrier oils (jojoba and grapeseed) into their scalp daily. The control group used only carrier oils for their massage, also daily. Treatment success was evaluated on sequential photographs by 2 dermatologists (I.C.H. and A.D.O.) independently. Similarly, the degree of improvement was measured by 2 methods: a 6-point scale and computerized analysis of traced areas of alopecia. The results showed that nineteen (44%) of 43 patients in the active group showed improvement compared with 6 (15%) of 41 patients in the control group. An alopecia scale was applied by blinded observers on sequential photographs and was shown to be reproducible with good interobserver agreement (kappa = 0.84). The degree of improvement on photographic assessment was significant. Demographic analysis showed that the 2 groups were well matched for prognostic factors. The study concluded that aromatherapy is a safe and effective treatment for alopecia areata. Treatment with these essential oils was significantly more effective than treatment with the carrier oil alone (7).

Behavioral and psychological symptoms in dementia are frequent and are a major management problem, especially for patients with severe cognitive impairment. Preliminary reports have indicated positive effects of aromatherapy using select essential oils, but there are no adequately powered placebo-controlled trials. A placebo-controlled trial was conducted in order to determine the value of aromatherapy with essential oil of Melissa officinalis (lemon balm) for agitation in people with severe dementia. In the study, seventy-two people residing in National Health Service (U.K.) care facilities who had clinically significant agitation in the context of severe dementia were randomly assigned to aromatherapy with Melissa essential oil (N = 36 subjects) or placebo (sunflower oil) (N = 36 subjects). The active treatment or placebo oil was combined with a base lotion and applied to patients’ faces and arms twice a day by caregiving staff. Changes in clinically significant agitation (Cohen-Mansfield Agitation Inventory [CMAI]) and quality of life indices (percentage of time spent socially withdrawn and percentage of time engaged in constructive activities, measured with Dementia Care Mapping) were compared between the 2 groups over a 4-week period of treatment. Seventy-one patients completed the trial. No significant side effects were observed. The results showed that 60% (21/35) of the active treatment group and 14% (5/36) of the placebo-treated group experienced a 30% reduction of CMAI score, with an overall improvement in agitation (mean reduction in CMAI score) of 35% in patients receiving Melissa balm essential oil and 11% in those treated with placebo. Quality of life indices also improved significantly more in people receiving essential balm oil. The finding that aromatherapy with essential balm oil is a safe and effective treatment for clinically significant agitation in people with severe dementia, with additional benefits for key quality of life parameters, indicates the need for further controlled trials (8)

Aromatherapy is becoming increasingly popular; however there are few clear indications for its use. To systematically review the literature on aromatherapy in order to discover whether any clinical indication may be recommended for its use, computerised literature searches were performed to retrieve all randomised controlled trials of aromatherapy. All trials were evaluated independently by both authors and data were extracted in a pre-defined, standardised fashion. Twelve trials were located: six of them had no independent replication; six related to the relaxing effects of aromatherapy combined with massage. These studies suggest that aromatherapy massage has a mild, transient anxiolytic effect. Based on a critical assessment of the six studies relating to relaxation, the effects of aromatherapy are probably not strong enough for it to be considered for the treatment of anxiety. In conclusion, the hypothesis that aromatherapy is effective for any other indication is not supported by the findings of rigorous clinical trials (9)

Parenteral administration of opioids (painkillers such as morphine) and NSAIDs has been the mainstay for postoperative pain control in patients undergoing laparoscopic adjustable gastric banding (LAGB). Both classes of drugs, however, are associated with serious adverse effects. An addition of complimentary analgesic techniques may decrease requirement for traditional analgesics, thus reducing the incidence of side-effects. A prospective randomized placebo controlled study evaluated the effectiveness of lavender aromatherapy in reducing opioid requirements after LAGB. The study was carried out on 54 patients undergoing LAGB. Upon arrival to the post (after) – anesthesia care unit (PACU), patients in the study group were treated with lavender oil, which was applied to the oxygen face mask; the control group patients received non-scented baby oil. Postoperative (after the operation) pain was treated with morphine. Numerical rating scores (0 – 10) were used to measure the level of pain at 5, 30, and 60 min. Sedation was evaluated using the Observer Assessment of Alertness/Sedation scale (0-5). Data analyzed included the amount of opioids, NRS, OAA/S, PACU discharge time, as well as the incidence of side-effects. The two groups were comparable with regard to patient characteristics, intraoperative drug use, and surgical time. The results showed that significantly more patients in the placebo group (PL) required analgesics for postoperative pain (22/27, 82%) than patients in the lavender group (LAV) (12/26, 46%). Furthermore, the LAV patients required significantly less morphine postoperatively than PL patients: 2.38 mg vs 4.26 mg, respectively. There were no differences in the requirements for post-operative antiemetics, antihypertensives, or PACU discharge time. These results suggest that lavender aromatherapy can be used to reduce the demand for opioids (painkillers such as morphine) in the immediate postoperative (after surgery) period. Further studies are required to assess the effect of this therapy on clinically meaningful outcomes, such as the incidence of respiratory complications, delayed gastric emptying, length of hospital stay, or whether this therapy is applicable to other operations (10)

A study evaluated the use of aromatherapy massage and music as an intervention to cope with the occupational stress and anxiety that emergency department staff experience. The study also aimed to compare any differences in results between a summer and winter 12-week massage plan. Emergency nurses are subjected to significant stressors during their work and it is known that workloads and patient demands influence the role stress has on nurses. The perception that winter months are busier for emergency departments has long been held and there is some evidence that people with cardiac and respiratory dysfunction do present more frequently in the winter months. Massage has been found to decrease staff anxiety. The study used a one-group pre-test, post-test quasi-experimental design with random assignment. Staff occupational stress was assessed pre- and post- 12 weeks of aromatherapy massage with music and anxiety was measured pre and post each massage session. Sick leave was also measured. Comparisons of summer and winter data were undertaken. A total of 365 massages were given over two 12-week periods, one during summer and the other during winter. The results demonstrated that aromatherapy massage with music significantly reduced anxiety for both seasonal periods. Pre (before) – massage anxiety was significantly higher in winter than summer. No differences in sick leave and workload were found. There was no difference in the occupational stress levels of nurses following the two 12-week periods of massage. In conclusion, emergency nurses were significantly more anxious in winter than summer but this can’t be attributed to increased sick leave or workloads. Aromatherapy massage with music significantly reduced emergency nurses’ anxiety. High levels of anxiety and stress can be detrimental to the physical and emotional health of emergency nurses and the provision of a support mechanism such as on-site massage as an effective strategy should be considered (11)

Adverse effects of aromatherapy

Several plant-derived essential oils have been known for over a century to have epileptogenic (that induce epilepsy) properties. A report has been published of three healthy patients, two adults and one child, who suffered from an isolated generalized tonic-clonic seizure and a generalized tonic status, respectively, related to the absorption of several of these oils for therapeutic purposes. No other cause of epilepsy was found, and outcome was good in the two adult cases, but the course has been less favorable in the child. A survey of the literature shows essential oils of 11 plants to be powerful convulsants (eucalyptus, fennel, hyssop, pennyroyal, rosemary,sage, savin, tansy, thuja, turpentine, and wormwood) due to their content of highly reactive monoterpene ketones, such as camphor, pinocamphone, thujone, cineole, pulegone, sabinylacetate, and fenchone. The above three cases strongly support the concept of plant-related toxic seizure. Nowadays the wide use of these compounds in certain unconventional medicines makes this severe complication again possible (3)

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 USA FDA. However, ingestion of large amounts of essential oils is not recommended. Moreover, a few cases of contact dermatitis have been reported, mostly in aromatherapists who have had prolonged skin contact with oils from aromatherapy massage. Some essential oils (e.g. camphor oil) can cause local irritation; therefore, care should be taken when applying them. Phototoxicity (chemically induced skin irritation that requires light) 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 after inhaled aromatherapy without massage. Often, aromatherapy uses undefined mixtures of essential oils without specifying the plant sources. Allergic reactions are sometimes reported, especially following topical use. As essential oils age, they 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 tea oils by topical administration was shown in one study to be associated with reversible prepubertal (preadolescence) gynecomastia (abnormal development of large mammary glands in males that results in breast enlargement). The effects appear to have been caused by the purported weak estrogenic and anti-androgenic activities of lavender and tea tree oils. Thus, avoiding these two essential oils is recommended in patients with estrogen – dependant tumors (12).

REFERENCE (LINKS)

(1) http://www.aromatherapycouncil.co.uk

(2) Simon C., Everitt H., Kendrick T., Oxford Handbook of General Practice, Oxford Medical Publications, 2nd edition, 2005.

(3)http://www.springerlink.com/content/ycpbv6cvejrtlplx/

(4)http://www.ncbi.nlm.nih.gov/pubmed/17900043

(5)http://www.ncbi.nlm.nih.gov/pubmed/20377818

(6)http://www.ncbi.nlm.nih.gov/pubmed/12690999

(7)http://www.ncbi.nlm.nih.gov/pubmed/9828867

(8)http://www.ncbi.nlm.nih.gov/pubmed/12143909

(9)http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1313734/

(10)http://www.ncbi.nlm.nih.gov/pubmed/17894152

(11)http://www.ncbi.nlm.nih.gov/pubmed/17727588

(12)http://www.cancer.gov/cancertopics/pdq/cam/aromatherapy/healthprofessional/page6