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Essential Oils

John Montgomery7 min read

Essential Oils

Essential oils are concentrated, volatile plant extracts made by steam distillation or solvent extraction. Cold-pressed carrier oils such as Sunflower Seed Oil or Coconut Oil are different products (Vaughn 2018). The ones parents most often meet for eczema are tea tree (Melaleuca alternifolia) and lavender (Lavandula), alongside chamomile, eucalyptus, frankincense and others. They are sold neat, blended into “natural” balms, or added to baby washes and lotions for their scent. Supporters say they are antibacterial, antifungal, anti-inflammatory and calming. Tea tree in particular is put on broken skin to “disinfect” it against Staphylococcus aureus. Each oil contains more than 100 constituents, and its composition changes with plant species, soil, climate and distillation method (DermNet 2020; Braunstein 2023). Supplies are poorly regulated, so it is hard to know what is actually in the bottle (Poison Control). Their traditional use is as aromatherapy, massage and folk remedies. DermNet notes that essential oils are rubbed onto infants’ abdomens for colic in several countries, and that this has caused eczematous reactions.

Essential Oils [part-of] Herbal and Home Remedies for Eczema Essential Oils [relates] Fragrance Allergy Essential Oils [relates] Staphylococcus aureus

Strength of evidence. No randomised trial or systematic review shows that any essential oil improves Atopic Dermatitis, in toddlers or adults. The rounds 0–4 searches found none, and NCCIH reports no efficacy data for AD. The available evidence is about harm. The claim that tea tree “kills staph” comes from laboratory work. It has not been tested as a treatment for eczema, and the guideline treatments for Infected Eczema are prescribed antibiotics or antiseptics. Evidence level: anecdotal.

Essential Oils [contradicts] Emollient Therapy Essential Oils [worsens] skin barrier

Toddler safety 1: contact allergy through broken skin. Essential oils are recognised contact allergens. Most of the allergenicity comes from constituents that oxidise on exposure to air. Linalool, found in about 90% of common essential oils, and limonene form hydroperoxides that the standard fragrance mixes do not detect (Tam & Yu 2022). Lavender oil has no natural protection against this autoxidation (Hagvall, cited in Current Dermatology Reports 2021). Tea tree oil has caused more published allergic reactions than any other essential oil (unverified). In one Melbourne clinic, 41 of 2,320 patch-test patients (1.8%) reacted to oxidised tea tree oil over 4.5 years, and the authors called tea tree allergy under-reported (Rutherford 2007). In the French DAG series of 42 patients allergic to their own oils, mainly lavender, tea tree and ravintsara, 8 needed hospital admission. Only 71% were picked up by fragrance mix I/II, and 40% had not mentioned their oil use until asked (Barbaud 2023). The barrier in AD skin is already damaged (Skin Barrier Dysfunction), so applying oils to it is the textbook route to Allergic Contact Dermatitis and to lifelong Fragrance Allergy. In the childhood eczema massage study, children whose eczema worsened had become allergic to the massage oils, chamomile among them (DermNet, Anderson 2000; see Chamomile). Diffusers can also cause airborne contact dermatitis.

Essential Oils [causes] Allergic Contact Dermatitis Skin Barrier Dysfunction [worsens] Fragrance Allergy Essential Oils [worsens] Atopic Dermatitis

Essential oils and fragrance on broken skin

Do not put tea tree, lavender, chamomile or any other essential oil, neat or “diluted”, on a toddler’s eczema, and avoid scented “natural” baby products. Cracked or weeping eczematous skin absorbs fragrance allergens (oxidised linalool, limonene, tea tree constituents) easily. Once a child is sensitised, the allergy is usually permanent and can spread to many products. Standard patch-test fragrance mixes can miss it, so bring the actual oil or product to Patch Testing. Weeping, crusted or painful skin may be Infected Eczema and needs medical treatment, not a home “disinfectant” oil.

Toddler safety 2: poisoning if swallowed. Small children drink from bottles that are left within reach. Between December 1995 and March 1997, the Ontario Poison Centre took 251 calls about children aged 1–5 who had swallowed eucalyptus oil, camphorated oil, Vicks VapoRub or VapAir. Of these, 76 were sent to hospital and 2 had seizures, one a 14-month-old an hour after drinking camphorated oil (Flaman 2001). The literature it reviewed reports coma and seizures after 3–5 mL of pure eucalyptus oil, and a child’s death after 5 mL of camphorated oil. US Poison Control describes a 22-month-old who had a seizure lasting over an hour after eating a piece of camphor. It also describes an 18-month-old who was drowsy and confused, with an abnormal EEG, after swallowing lavandin home fragrance. It warns that wintergreen, sage, eucalyptus and camphor oils can be dangerous in tiny amounts, and that camphor skin rubs have poisoned children when applied too often. Its advice is to discard essential oils or lock them away in homes with young children. See Essential Oil Poisoning.

Essential Oils [causes] Essential Oil Poisoning

Toddler safety 3: the gynaecomastia debate. Henley et al. (NEJM 2007) described three healthy prepubertal boys who developed breast tissue while using lavender or lavender-plus-tea-tree products (a healing balm, a styling gel and shampoo, a scented soap and lotion). The breast tissue went away after the products were stopped. Both oils showed oestrogenic and antiandrogenic activity in MCF-7 cells, and the authors concluded the oils “probably caused” the Prepubertal Gynaecomastia. By 2023, 12 children had been reported (8 boys with gynaecomastia, 4 girls with premature thelarche), all regressing after exposure stopped (Braunstein 2023). Critics point out that the oils and products were never chemically analysed, that other ingredients were not considered, that dermal penetration is low (only 2–8% of terpinen-4-ol from tea tree oil crosses the skin), and that both conditions often regress on their own.

Conflict: [Henley et al., NEJM, 2007] says repeated topical exposure to lavender and tea tree oils “probably caused” prepubertal gynaecomastia. [Braunstein et al., touchREVIEWS in Endocrinology, 2023] says, using Hill’s criteria, the association is weak and “a cause-and-effect association has not been shown”; [Lawrence, Perfumer & Flavorist (fragrance-industry trade journal), 2008] likewise rejects causation. Unresolved — add to open_questions.

Essential Oils [relates] Prepubertal Gynaecomastia

What parents report (evidence: anecdotal). Parent threads split. In r/eczema, one adult commenter on a toddler thread recommends cleaning broken eczema with tea tree oil “before putting any creams or moisturizers on”, and another credits unnamed essential oils with killing staph “in one night”. A third parent stopped prescribed treatment for an Etsy lemongrass-and-zinc balm. None of these claims has been checked. On r/ScienceBasedParenting, parents describe swapping lavender baby washes for unscented ones. One said their paediatrician advised stopping lavender because “it can be super irritating for eczema prone kids”, and “it reduced her skin irritation significantly”. Another was warned about “early puberty or breast growth”. Adults with eczema on several subs say tea tree “stung really bad” or that their eczema got “MUCH worse” after using it on broken skin. This matches the contact-allergy data. Earlier rounds’ natural-oils threads also describe flares that settled once “all the natural stuff” was stopped.

Essential Oils [relates] Steroid Phobia

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