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Rachel
Introduction
Rachel
is a 36-year-old married woman who approached me wanting treatment for her
eczema. She had been receiving
conventional treatment since early childhood and was interested in finding out
if essential oils could help. Rachel
had learned to put up with her eczema and would rely on E45 cream and
Beclomethasone (a topical corticosteroid) prescribed for her own daughter’s
eczema which she would occasionally apply during flare-ups.
Normally her eczema was dry, but could be irritated by clothing,
particularly on the backs of her knees and around her ankles. She would seek
relief by scratching which would make the irritation worse, particularly when in
bed at night.
Rachel
is a very busy and energetic woman. She
looks after 3 school-age children, works part time and studies in the evenings
for a social work qualification. She
thrives on being busy and regards the eczema as an unfortunate symptom of her
hectic lifestyle. She has little
time for GP appointments for herself but quite liked the idea of someone coming
to her home when it suited her to offer treatment which would not only help her
eczema, but could offer her quality time to relax and recharge.
The Consultation
Rachel
told me she is normally fit and healthy but has suffered periodically from mild
eczema since early childhood. She
is a very active person and enjoys everything she does. She also enjoys a good relationship with her husband and
children and they impressed me as being a very happy family. In addition to treating her eczema, Rachel identified a need
for her to be able to relax and unwind at the end of a busy day and she would
often try to achieve this by having a long bath and read before bedtime.
During the consultation we talked about dietary factors as a possible
cause of eczema, and although not willing to cut out certain foods completely,
she was willing to try cutting down on wheat and dairy products.
She agreed to modify her diet for a week before starting aromatherapy
treatments in order to ascertain the sole effect of diet on her eczema. The initial aims of treatment were to address Rachel’s
eczema through dietary advice, to offer the topical application of essential
oils through massage, and a cream to help relieve the symptoms of itching and
moisturise the skin. Before the
first planned treatment, I arranged to visit Rachel midweek to patch test the
blends I would be preparing as a result of the consultation.
Planning treatments
Eczema
is a skin disorder characterised by inflammation, itching, blistering, cracked
and sometimes weeping and crusting of the skin (Martin 1994, p206).
Rachel’s’ eczema is atopic in origin meaning it is associated with
some sort of allergy. In many cases, the allergens cannot be identified, but the
most common allergens include milk and other dairy products, wheat cereals, some
fruits and peanuts. Stress can also
be an exacerbating factor as well as metabolic imbalance (particularly
deficiency in zinc), both probably upsetting the body’s natural immune
responses.
Conventional
treatment relies on modifying the diet, emollient creams, topical
corticosteroids and oral antihistamines. Emollient
creams have a gentle, non-irritating action and can sooth the skin by cooling
and lubricating the surface. Corticosteroid
creams are more powerful, being absorbed into the lower layers of the skin
inhibiting the release of histamine, the chemical associated with itching and
inflammation. While corticosteroids
can alleviate itching significantly within a few days, prolonged use causes
permanent changes such as thinning of the skin, and can eventually suppress the
body’s immune system (Henry 1995, p174).
Antihistamines suppress the production of histamine that causes the
redness and irritation of an allergic reaction.
Essential
oils reported as being the most useful in treating eczema include Bergamot,
Chamomile (Roman and German), Everlasting (Helichrysum), Lavender, Patchouli and
Rose (Damask and Cabbage) (Lawless 1999, p200); and Chamomile (German and
Moroccan), Geranium, Juniper, and Lavender (Price 1998, p270); and Chamomile
(Roman) (Price et al. 1999, p317, Chamomile (German) p318, Chamomile (Moroccan)
p337, Lavender (Angustifolia) p329 (dry eczema), Peppermint (p333), and for
inflamed skin: Patchouli (p340).
There
is little research to quantify the success of these essential oils with eczema,
the success probably being as a result of the anti-inflammatory properties of
such oils. The most frequently
mentioned oils relating to eczema include the Chamomiles already mentioned, and
Calendula (Lawless 1999, p126, Bartram 1995, p163, Price et al. 1999, p105).
Price
et al. 1999 also mentions peppermint (Mentha piperita) as being particularly
effective with eczema (p333), possibly due to the cooling and anaesthetic effect
of the menthol content. Cooling
lotions are also used conventionally to relieve episodes of mild itching with
topical lotions often containing menthol, camphor or phenol (Henry 1995, p173)
but are not recommended for widespread application. Care must also be taken when using Peppermint essential oil
as it can cause allergic skin reactions and must be used in low concentration
(Price et al. 1999, p334).
There
are few essential oils reported as being anti-histaminic, although Price et al.
1999 cites studies supporting the use of Caraway, Chamomile (German) and
Everlasting (p354-355).
In
Aromatherapy, carrier oils are normally used as a medium in which to hold the
essential oils on the skin until they are able to be absorbed through the dermal
layers into the body. The molecules of carrier oils are too large to be absorbed
deeper than the epidermis and stratum corneum in any significant therapeutic
quantity (Price 1998, p159). However,
in a condition such as eczema, which mostly affects the surface layers of the
skin, carrier oils anti-inflammatory properties can play an important role in
penetrating and relieving areas of surface inflammation and irritation.
Carrier oils can moisturise and protect the surface layers of the skin in
the same way as prescribed emollient creams, offering similar properties and
relief from itching and inflammation. Suitable
carrier oils include Calendula with Hypericum (Price 1998, p162) Jojoba (p166),
Sesame (p169) and Rose hip (p169). Price
et al. 1999 also specifically mentions Rose hip as being useful for eczema
(p104). Other carrier oils listed
include Sweet almond, Apricot Kernel, Avocado, Carrot, Hypericum and Evening
primrose (Price et al. 1999, p105). Bartram
(1995, p163) also suggests Arnica (sold as ‘Weleda’ cream), Evening
primrose, Jojoba oil, Aloe Vera gel and Witch Hazel.
As
wheat products are well-known antagonists of allergic eczema, I thought it wise
to avoid Wheat germ oil and other nut-based carriers due to a link with eczema
and peanut allergy (Alternative Nutrition – no date). There is much evidence to suggest that Evening primrose taken
as a supplement is very effective with eczema (Bartram 1995, p163) and can be
obtained on prescription for that purpose.
Treatments
After
considering the evidence and information available, I decided to treat
Rachel’s eczema using massage, a bath lotion, and a cream for self-application
for local relief from itching and inflammation.
Severe or weeping eczema can be a contraindication for massage but in
Rachel’s case, the eczema was mild enough for massage to be a suitable method
of applying therapeutic oils to the affected area. Providing a prescription for
regular bathing would ensure continuity of treatment. I agreed to treat Rachel once a week for 4 – 6 weeks, then
re-evaluate with her if further treatment was needed.
For
the massage blend, I chose to use a carrier blend of 20% Calendula, 20%
Hypericum (both macerated in Sunflower oil) with 40% Sesame oil (Sesamum indicum)
to address Rachel’s dry skin type, and modify the consistency of the blend
making it more suitable for massage. In
addition to the therapeutic properties of the carrier oils, I added 1.5% German
Chamomile (Chamomilla recutita) for its antihistaminic, anti-inflammatory and
relaxing properties.
For
use in the bath I provided a blend of German Chamomile with Everlasting (Helychrysum
angustifolium - both for their antihistaminic and anti-inflammatory properties.
Everlasting has also been described by Penoel as the “… super arnica
of aromatherapy” (cited in Price et al. 1999, p327).
For
the cream, I made up a blend using 4 drops of Peppermint (Mentha piperita) (0.5%
of the total blend), with 7 drops (1%) of Lavender (Angustifolia) in 15ml Jojoba
oil (Simmondsia chinensis) added to 15ml warmed (melted) beeswax to make the
desired consistency for a cream. The
blend is then stirred until partially solidified in order to disperse the
essential oil evenly throughout. Peppermint
was chosen for its cooling and analgesic action (Price et al. 1999, p333) and
Lavender for its suitability for dry eczema, anti-inflammatory, mild local
analgesic and general healing properties (Price et al. 1999, p329-330).
Lavender promotes cell regeneration (Tisserand 1999, p248), and its
antibacterial properties would help prevent any infection through broken skin
due to excessive scratching. I
chose Jojoba for its anti-inflammatory properties (Price 1998, p166), non-toxic
and non-allergenic properties, and suitability for dry skin conditions (Bartram
1995, p258). The beeswax was used
to partially solidify the blend to make a good consistency for a cream.
Patch tests of the massage blend and cream on a small area of Rachel’s eczema behind her knees showed no adverse skin reaction after 24 hours, therefore I considered it safe to start treatment.
Rachel
had experienced no change in her eczema over the first 7 days before starting
treatment, despite cutting out eggs, and cutting down on wheat and dairy
products. Ideally these products
should be eliminated completely then re-introduced gradually in order to
ascertain if they caused the eczema, but due to Rachel’s hectic lifestyle,
this was not practical. Neither did
she consider her eczema serious enough to warrant the extra effort of a total
elimination diet.
I
had made an evening appointment to offer Rachel a full body massage, after which
she planned to go to bed and read. Before
starting treatment, I gave her the made up prescriptions for her bath and cream
with instructions for use. I also
gave her an aftercare leaflet indicating what steps to take should she
experience any unexpected reaction to the treatments.
Rachel
agreed to help me evaluate treatment by giving her eczema a score each day
depending on its severity. By
starting with a baseline of 5 (out of 10) prior to the first treatment, the
higher the score, the worse the eczema. Using
the score 5 as a starting point, she would also be able to help assess the
effectiveness of the bath and cream preparations. I took some time to explain the scoring method to Rachel, as
I believe that the accurate evaluation of treatment has an important role to
play in maintaining the credibility of aromatherapy as a profession.
Rachel
stated that she found the massage very pleasant and relaxing and was looking
forward to seeing if the oils had any affect on her eczema.
I
continued to use the same oils at successive treatments because I wanted to give
them chance to work together over a set period of time.
Rachel assessed her eczema as becoming slightly worse after 3 days but by
the time of the second treatment, she scored it at 5 again.
Some Aromatherapist may have called this a ‘healing crisis’ but it
was probably due to the body’s reaction to foreign chemical before becoming
desensitised. She had used the
cream on her legs and ankles twice during the week when she estimated that the
eczema was worse. She had found the
cream pleasantly cooling giving some temporary relief.
As
the treatments progressed, Rachel continued to look forward to having the
opportunity for complete relaxation. She
found massage physically relaxing but remarked that it left her feeling
emotionally recharged afterwards, with renewed energy to cope with the demands
of the coming week. She continued
to cut down on wheat and dairy products and had started to alter her way of
shopping by buying alternatives.
While
not immediately apparent to myself, by the third week of treatment, Rachel
thought that her eczema might be lessening.
What was apparent however was that her daughter’s eczema had
significantly improved due to the changed eating habits of the whole family.
Rachel then admitted to me that she had been letting her daughter use the
bath oils and the cream. In most
cases, the oils I had prescribed for Rachel would not have done any harm because
of the low concentrations involved and the use of safe oils.
However, now knowing the circumstances, it would not have been
responsible practice to allow Rachel’s daughter to continue using a
prescription intended for someone else. I
decided that the best way to deal with this situation was to offer Rachel’s
daughter a separate consultation and make up a prescription for her own use.
By
the fourth week Rachel was able to say definitely that her own eczema was
improving and gave it a score of 3. I
was also beginning to notice a difference, the irritation around the backs of
her ankles was less pronounced with less flaking of the skin. Rachel told me that she was now applying the cream routinely
as a moisturiser on the affected areas every morning, which seemed to help with
the dryness and irritation. Due to
the progress made, I was reluctant to change the treatment plan but as a
precaution against sensitisation, I made up Rachel’s next supply of cream with
a lower concentration of essential oils choosing to rely more on the emollient
and therapeutic properties of the Jojoba oil and beeswax rather than risk over
use of the Mentha piperita which can precipitate allergic reactions in some
individuals (Price et al. 1999, p334).
Rachel’s
eczema continued to steadily improve over the next 2 weeks.
She continued to use the weekly massage sessions as an opportunity to
relax and de-stress, and was using the cream daily as a preventative rather than
a reliever of her eczema. She had asked me for her own supply of German
chamomile and Everlasting to use in her bath at night so I offered to purchase
the oils on her behalf from my own supplier to ensure continuity of quality.
By the end of the 7th week, Rachel scored her eczema at 2 and
was pleased with the significant improvement.
After 7 weeks, Rachel was pleased enough with the outcome to stop the
massage treatments but I continue to supply her and her daughter with cream for
their eczema.
Conclusion
Rachel’s
eczema significantly improved over a 7-week period of intensive treatment using
a combination of approaches to address her different needs - making it difficult
to identify any single factor most responsible for success.
The first 7 days showed no improvement by altering diet alone, but due to
the significant changes in her daughter’s condition, I would be reluctant to
rule out the long term contribution of cutting down on dairy and wheat products
on the eczema.
In my opinion, success was due to the combination of all factors constituting a holistic approach - addressing lifestyle through dietary needs; the appropriate selection of anti-inflammatory and antihistaminic essential oils; application of the essential oils through bathing and massage to help relieve stress and improve the body’s ability to heal itself; and the regular topical application of a cream to relieve symptoms and moisturise the skin. I also learned that for skin conditions such as eczema, the therapeutic properties of carrier oils are just as important as the appropriate selection of essential oil - Calendula, Hypericum, Jojoba and Sesame oil being particularly successful in this case.