Aromatherapy is, in the right hands, a safe and effective therapy. However,  essential oils are potent substances and many can be dangerous if incorrectly  used. We need to take a few simple precautions in order to safely apply this extremely beneficial therapy. This article examines the risks inherent in the use of many  different essential oils, many of which have the potential to cause toxicity, dermal irritation, skin sensitisation or photo toxicity if incorrectly used. Some oils are also best avoided when treating certain groups, such as babies and children, pregnant or menstruating women, those with hypertension, diabetes, epilepsy, kidney disease and various other conditions.

Essential oils can be used in a variety of ways and can be applied through massage, in skin oils and lotions, in bath water, mixed with water in hot or cold compresses, in a diffuser or vaporiser, by stream inhalation, added to rinsing water for hair care, diluted in water and/or alcohol as a flower water or douche. 

There are a number of risks inherent in the use of essential oils and most of these can be reduced or eliminated by good practice, a high level of knowledge and a thorough medical screening process. A sample medical screening form is given in Appendix A.

Essential oils should never be taken internally, as many are highly toxic. Some, such as Eucalyptus can prove fatal if as little as 3.5 ml is ingested. 

There are a number of essential oils that should never be used, even by highly experienced Aromatherapists, as the risks of toxicity are just too great and outweigh any possible therapeutic benefits. These include: Bitter Almond, Sweet Birch, Arnica, Boldo, Broom, Buchu, Calamus, Camphor (Brown Or Yellow), Cassia, Chervil, Cinnamon Bark, Costus, Deertongue, Elecampane, Bitter Fennel, Horseradish, Jaborandi, Melilotus, Mugwort, Mustard, Onion, Oregano, Pennyroyal, Dwarf Pine, Rue, Common Sage, Santolina, Sassafras, Savine, Savory, Tansy, Thuja, Red Thyme, Tonka, Wintergreen, Wormseed and Wormwood. Many of the most toxic of these oils are potent neurotoxins and owe 
this toxicity to their ketone content. These include Thuja, Wormwood, Mugwort, Tansy, Pennyroyal and Common Sage. 

Toxic Effects: A great many other oils, like many other beneficial therapeutic agents, including some very widely used and useful remedies, are capable of some toxic effects if used in excess or for too long. Some oils that are considered potentially toxic in excess are considered safe if used at half normal strength, such as Myrrh. Some oils, including Fennel and Sweet Basil, are considered to be slightly carcinogenic. These and many other potentially toxic oils are considered relatively safe if used for a limited period of time such as 2 weeks. These include: Ajowan, Anise Star, Aniseed, Sweet/Exotic Basil, Bay Laurel, West Indian Bay, Calamintha, White Camphor, Cascarilla Bark, Cassie, Cedarwood (Virginian), Cinnamon Leaf, Clove Bud, Coriander, Eucalyptus, Sweet Fennel, Hops, Hyssop, Juniper, Nutmeg, Parsley, Black Pepper, Spanish Sage, Tagetes, Tarragon, White Thyme, Tuberose, Turmeric, Turpentine and Valerian. 

Essential oils should never be used undiluted on the skin. There are a few exceptions to the rule, including Lavender, Tea tree, Ylang Ylang and Sandalwood, which can sometimes be applied neat, but these can cause sensitisation in many individuals and should only be used with extreme caution and only after doing a 24-hour patch test.

Contact Dermatitis: Many otherwise safe essential oils can cause a form of contact dermatitis in some people, usually those with sensitive skins. Such oils include Ajowan, Allspice, Sweet Basil, Black Pepper, Borneol, Cajeput, Caraway, Virginian Cedarwood, Cinnamon Leaf, Clove Bud, Cornmint, Eucalyptus, Garlic, Ginger, Lemon, Parsley, Peppermint, Pine Needle (Scotch and Longleaf), White Thyme and Turmeric. Although uncomfortable, such reactions are rarely serious and most can be avoided by careful medical screening before treatment and by doing a 24-hour patch test of the diluted pure oil on individuals with sensitive skin. Clients should be warned about the possibility of skin reactions, including sensitisation, during the screening process. A suitable medical questionnaire that includes such a warning is given as Appendix A.

Sensitisation: Somewhat more serious than dermal reactions, sensitisation (an allergic reaction) occurs when the body's immune system reacts against a particular chemical constituent of an essential oil. Symptoms are often not felt when the offending substance is applied for the first time, only after subsequent treatments, and range from a mild itchy dermal reaction to systemic reactions including anaphylactic shock. Although such severe reactions are extremely rare, sensitisation should be treated as a serious side effect and must be avoided at all costs. Severe reactions can be avoided by doing a 24-hour patch-test on individuals with sensitive skins before use of any oil known to cause sensitisation. 

In particularly sensitive individuals, a patch test should be considered before using any new oil. Oils that may cause such sensitisation reactions in some individuals include: French Basil, Bay Laurel, Benzoin, Cade, Cananga, Virginian Cedarwood, Chamomile, Citronella, Garlic, Geranium, Ginger, Hops, Jasmine, Lemon, Lemongrasss, Lemon Balm, Litsea Cuba, Lovage, Mastic, Mint, Orange, Peru balsam, Pine (Scotch and Longleaf), Styrax, Tea Tree, White Thyme, Tolu Balsam, Turmeric, Turpentine, Valerian, Vanilla, Verbena, Violet, Yarrow and Ylang Ylang.

Photosensitivity: Some oils can also cause skin reactions if used on skin that is then exposed to ultraviolet light. These reactions are known as phototoxicity or photosensitivity and can vary in severity from mild brown blotches to severe burns. Reactions depend on ultraviolet light, rather than sunlight itself, and so exposure of the skin to daylight, even on a cloudy day, may well be enough to trigger a reaction. Bergamot is known to be particularly phototoxic, as it contains Bergapten, a furocoumarin, which renders Bergamot highly phototoxic, even after some time has elapsed. Bergapten-free Bergamot (or FCF) is available from some suppliers and, this should be substituted if there is any risk of exposure to UV following treatment. Other phototoxic oils (generally citrus oils) include Angelica Root, Cumin, Ginger, 
Grapefruit, Lemon, Lime, Lovage, Mandarin, Orange, Tagetes and Verbena.

Essential Oils During Pregnancy: Although opinions vary over the real dangers of some essential oils during pregnancy, most people agree that it is best to adopt a cautious approach and avoid those few oils that are considered possible risk factors. Any essential oils that is considered safe for use during pregnancy should always be diluted to half the usual strength, because the growing foetus is much more sensitive than an adult would be and also because women are much more likely to suffer dermal reactions during pregnancy than at other times. Finally, some oils, such as Clary Sage and Juniper, are emmenagogues, 
which stimulate the uterus and carry a small associated risk of miscarriage. Essential oils that should be avoided in pregnancy include Ajowan, Angelica, Anise Star, Aniseed, Basil, Bay Laurel, Calamintha, Cedarwood, Celery Seed, Cinnamon leaf, Citronella, Clary Sage, Clove, Cumin, Eucalyptus, Sweet 
Fennel, Hyssop, Juniper, Labdanum, Lovage, Marjoram, Myrrh, Nutmeg, Parsley, Rosewood, Snakeroot, Spanish Sage, Tarragon and White Thyme. In addition, Lavender, Peppermint, Rose and Rosemary are also best avoided during the first trimester. Parsley should not be used during menstruation.

Newborn babies are also very sensitive and no essential oils should be used on a baby until he or she is at least 2 weeks old, allowing the baby time to acclimatise to life outside the womb. After 2 weeks of age, Chamomile, Mandarin and Lavender can be used, highly diluted in carrier oil, applied either by massage or added to bathwater. Slightly older babies can usually tolerate Rose, Neroli or Mandarin. Dilutions for babies are far greater than those used on adults, perhaps using one drop of essential oil in 10 or 15 mls 
of carrier oil. Extreme care must be taken with a baby's sensitive skin and patch tests are recommended before treatment, even with the mildest oils.

High Blood Pressure:  Some essential oils are generally best avoided with individuals suffering from high blood pressure (hypertension), although the evidence is by no means certain, especially as soothing massage is known to actually lower blood pressure. However, it is recommended that the following essential oils are avoided during treatment of individuals suffering from hypertension: Hyssop, Rosemary, Sage, and Thyme. Equally, individuals with particularly low blood pressure should not be treated with Clary Sage, Lavender, Lemon, Marjoram, Melissa or Ylang Ylang.

Cancer: Clients with cancer should be treated with great caution. Generally, those with active tumours should not be treated at all, unless with the explicit agreement of their doctor. In these situations, the following oils should be avoided: Anise, Basil, Fennel, Laurel, Myrtle, Nutmeg and Star Anise.

Epilepsy: Individuals with epilepsy should not be treated with Balsamite, White Camphor, Cedarwood, Sweet Fennel, Hyssop, Peppermint, Rosemary, all types of Sage, Tea Tree or any strong-smelling oil, as there is some risk that an attack could be triggered by the strong odour.

Asthma suffers should be treated with great care as steam inhalation of essential oils can actually worsen symptoms. Moreover, asthmatics may be allergic to the essential oils themselves. However, certain antispasmodic oils can be used safely if inhaled directly.

Other Conditions: There are various other diseases and conditions where avoidance of a few essential oils is indicated and these are described as follows. Angelica should be avoided when treating clients with diabetes. Fevers should be treated cautiously using essential oils and Balsamite, White Camphor, Garlic, 
Hyssop, Massoia, Oakmoss, Treemoss and Verbena should be avoided. Clients with Glaucoma should not be treated with Lemongrass, Melissa or Styrax as intra-ocular pressure may be increased. Kidney disease can be worsened if nephrotoxic oils such as Indian Dill, Juniper, Parsley Leaf/Seed or Black 
Pepper are used, and Nutmeg can be a heart stimulant and should be avoided with cardiac patients. Clients with liver disease should not be treated with Indian Dill, Parsley Leaf/Seed or oils containing menthol. Clients with prostatic hyperplasia should not be treated with Eucalyptus, Lemongrass, 
Melissa or Styrax. Those clients suffering from acute lung or respiratory problems should avoid Garlic, Onion and Sage.

Clients receiving homeopathic treatments should not be treated with Black Pepper, Camphor, Eucalyptus, Peppermint and Rosemary, as these oils can counteract the affects of homeopathic medicines.

New Essential Oils: Most essential oils in wide use today have been tested for toxicity and safe levels of use, as well as any safety warnings and cautions, are well established. However, new oils appear from time to time and it will take time to build up enough safety data for these oils to be used with confidence. Some oils have not undergone any internationally recognised safety trials and are therefore probably best avoided at present, even though it is likely that many will turn out to be perfectly safe. Such oils include: Amni Visnaga, Catnip, Copaiba Balsam, Eucalyptus (other than Globulus varieties and E Citriodora), Kanuka, Manuka, Melissa, Niaouli, Ravensara, Rosemary (other than the Cineol variety), Spikenard, certain Thyme varieties, Valerian and Yarrow

Blended Oils & Poor Quality Oils: Some oils, even if safe when pure, may become harmful if adulterated or blended with other oils to "improve" their odour or to increase yield. For this reason, a good quality supply of essential oils is essential. Poor quality oils can result in adverse reactions and generally poor therapeutic results.

Dilution of Essential Oils: Essential oils, when applied to the skin, must always be diluted to the correct strength in an appropriate carrier oil and this is a fundamental prerequisite for the safety of all oils. For adults, this typically means around 25 drops of essential oil to 50ml carrier oil. However, treatment using certain oils, or treatment of pregnant women, require half this strength. The correct strengths for typical uses are given below:

Adults: (unless pregnant) up to 3% 
Pregnant women: 1 to 1.5%
Babies: 0.5%
Infants 1-5 years of age: 1%
Children 6-12 years: 1.25%

Conclusion: Therapeutic treatment with essential oils can be very beneficial for sufferers of a wide variety of conditions and complaints. However, it is also abundantly clear that many essential oils have the potential to cause very real harm if used incorrectly and should only be used under the direction of a Qualified Aromatherapist.

Aromatherapy Medical Questionnaire

First Name:

Last Name:

Date of Birth:

Address: 



Occupation:

Do you suffer, or have you ever suffered, from any of the following:
(if so then please give full details)

Diabetes
Kidney problems
Epilepsy
Photosensitivity
Surgery or injury to back or joints
Sensitive skin
Allergic skin rashes
Allergies
Varicose Veins
Deep vein thrombosis
Heart disease
High or low blood pressure
Cancer
Stroke
Asthma
Migraines 

Are you currently taking any prescribed or self-prescribed drugs or remedies?
(if so then please give full details)

In the next 12 hours, will you be:
(if so then please give full details)

Driving or operating heavy machinery 
Drinking alcohol
Using a sunbed or exposing your skin to ultraviolet light

Women only:
Is there any possibility you might be pregnant?
Are you currently menstruating?

I confirm that the information given above is correct and complete, and that I have read and accepted the caution listed below. I will inform my aromatherapist before receiving treatment if any of the information above changes at any time during my treatment.


Signed: 

Date:


Caution - Skin Sensitivity: Great care is taken in the choice of safe and effective essential oils for 
your treatment, but some oils may cause skin sensitisation or irritation in a few individuals, especially those with sensitive skin. It is impossible to avoid this slight risk completely without avoiding many otherwise safe and effective essential oils. Moreover, any symptoms that do occur will usually clear up without the need for further treatment. However, it is important that you inform your aromatherapist of any adverse reactions experienced so that the essential oil responsible, and any with chemically similar formulations, can be avoided in future. If you have sensitive skin, your aromatherapist may recommend a 24-hour patch test before proceeding with treatment with some oils. If you do not have sensitive skin but are particularly concerned about dermal irritation or sensitisation, please inform your aromatherapist, who will offer a patch test and/or restrict use to oils that are generally known not to cause any adverse skin reactions.

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