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Patch Testing to Essential Oils.

The first patient is a 55-year-old woman who presented with a 1-year history of dermatitis that began on her rightmedial calf after a shave biopsy. She subsequently developed an infection at the biopsy site and began treatment with MelaGel (Melaleuca Inc, Idaho Falls, Ind), an unknown over-the-counter antibiotic cream, and an unknown prescription antibiotic ointment. She developed a periincisional red, indurated, weepy plaque, which subsequently spread to involve her lateral leg (Figs. 1AYC). Additional treatments included lavender oil, Cortisone-10 Ultra Moisturizing Cream (Sanofi, Chattanooga, Tenn), desonide 0.05% cream, and an over-the-counter 1%hydrocortisone cream. The patient reported using other essential oils on her skin as well in an aromatherapy diffuser (Figs. 1DYG). The patient noted previous thin-layer rapid use epicutaneous tests with unknown results. The second patient is a 39-year-old woman who presented with a 1-year history of dermatitis that began on the anterior shins and was treated with a variety of essential oils in coconut and sweet almond carrier oils. Her dermatitis initially improved but then flared again after a vacation during which she used essential oils (Figs. 2AYD). The patient developed bilateral eyelid swelling and pruritus, which spread to involve her right ear and drained clear fluid. Flares had involved the nasal ala, neck, face, and legs, and she had required 2 courses of oral steroids. Additional treatments included triple antibiotic ointment, desonide 0.05% gel, and desoximetasone 0.25% ointment. She used an aromatherapy diffuser at home and applied essential oils to herself and family members. Both patients were tested to the North American Contact Dermatitis Group screening series (70 haptens) as well as other relevant series and personal products including essential oils. The results are summarized in Table 1. These cases illustrate clinically relevant contact dermatitis to a variety of essential oils and fragrances including ylang-ylang and sandalwood oils. Relevant positive reactions may have been missed had we not directly inquired about essential oil use and tested to the patients’ personal products, including essential oils and homemade cosmetics. Essential oils are incorporated in a variety of medicinal, personal care, household, and food products. Distillation of essential oils dates back to the Catalan physician, Arnald de Villanova (1235-1311). Although essential oils have deep historical roots, there has been a modern resurgence of their use and popularity. In our experience, patients report contact with essential oils in diverse settings including home, work, hospitals, and exercise and wellness facilities. There is a growing market for essential oils, and many essential oil retailers also promote complementary consumer goods such as essential oilYcontaining cosmetics and household products, wellness coaching, and club memberships. Many of the personal care products that our patients reacted to were homemade cosmetics with essential oils or products that contained a variety of botanicals and fragrances purchased from essential oils retailers. The North American Contact Dermatitis Group screening series includes 4 essential oils (tea tree oil, lavender oil, peppermint oil, ylang-ylang oil), 1 absolute (jasmine absolute), and several fragrance-related allergens. Although both patients reacted to additional fragrance markers, these chemicals do not consistently detect fragrance allergy.4 Without testing to auxiliary series and personal products, many relevant reactions would have been missed.