Tagging along with @jtrebach with the DERMATOLOGISTS guide to ESSENTIAL OILS, cutaneous reactions, and why I hate them. #dermtwitter #medtwitter @ACDS_Dermatitis @AADmember #dermatology #Tweetorial https://twitter.com/jtrebach/status/1389613029680197640

Essential oils (EOs) are highly complex oils (up to 400 chemicals) produced via cold processing or steam/dry distillation of parts of fruits and plants (eg lavender). They are used for aromatherapy and in personal care products like creams, moisturizers, shampoos, etc.

Patients often believe that because EOs are "pure" and "natural" they are unlikely to be problematic.

FALSE!!

They smell great but like poison ivy (also natural), EOs can cause ALLERGIC CONTACT DERMATITIS (ACD) which is an itchy rash that appears upon contact.

~80 EOs have been reported to cause ACD.

Most common causes include tea-tree, lavender, peppermint, ylang-ylang, and jasmine and they are all included in our screening series for #patchtesting

de Groot et al. Essential Oils, Part IV: Contact Allergy, Dermatitis: 7/8 2016 - Volume 27 - Issue 4 - p 170-175

In one study, over 1% of people with #contactdermatitis were allergic to ylang-ylang, while 0.92% were allergic to tea-tree oil, 0.66% to jasmine, 0.53% to peppermint, and 0.32% to lavender.

Warshaw et al. Dermatitis: 7/8 2017 - Volume 28 - Issue 4 - p 246-252

Rash may appear at the site of application of the oil (alone or in products) most often on legs, hands, and face.

Airborne EOs from diffusers can lead to facial dermatitis (exposed skin) and eyelid rashes.

EOs in toothpastes can lead to burning mouth and lip rashes.

EOs can also be photosensitizers causing blistering rashes where the sun hits the skin including:
Bergamot
Lemon
Lime
Grapefruit

This is due to photosensitizing chemicals known as psoralens or furocoumarins.

Dermatologists who are members of the @ACDS_Dermatitis can test for over 50 different EOs and #patchtesting is the only way to know if you are allergic to EOs and avoidance is the only cure. https://www.contactderm.org/find/ 

One of the most memorable patients was a woman who came in with an erosive hand rash. She was positive to a myriad of EOs on patch testing. Husband revealed to me that she makes soap out of their garage. She completely cleared with EO avoidance.

Take Home Points
- Just because EOs are "natural" does not make them SAFE
- 80+ EOs have been reported to cause contact dermatitis
- Tea-tree, ylang-ylang, peppermint, jasmine, and lavender are most common
- Avoid if possible!