Essential Oils & Black SalveDERRICK ADAMS, DO, FAOCD

RED BLUFF, CA

▶ I have no relevant conflicts of interest

Overview

▶ DSHEA – legislative issues

▶ Essential Oils (EO’s)

▶ Escharotic Agents

How Did We Get

Here?

Dietary Supplement Health and

Education Act (DSHEA)

▶ Amendment to Federal Food, Drug, and Cosmetic Act of 1938

▶ Dietary Supplements do not need FDA approval

▶ FDA does not receive info on safety and efficacy

▶ Eliminates regulatory standards for quality and purity

▶ Burden of proof is on consumer and FDA

▶ No premarket approval or premarket testing

1994 DSHEA

Dietary Supplement Safety Act of

2010

▶ Empower FDA to remove dangerous supplements

▶ Remove adulterated products

▶ Set forth civil penalties

▶ Required reporting of “non serious” adverse events

Spotlight Health Conference

▶ “I believe that the amount the Congress heard about this whole

issue was greater than what they received about the Vietnam war.

It was tremendous.” (Jane Henney 1998-2002 FDA)

▶ “It makes [regulating] tobacco look easy.”

What are Essential Oils?

▶ FDA or FTC has no definition

▶ “Essene” vs. “Essential”

▶ Hydrophobic & Volatile

▶Oils we already use—menthol, methyl salicylates, camphor

▶ Aromatherapy/Massage

Essential Oils in My Life

▶Mouthwash

▶ Food Flavoring

▶ Vapor Rub

▶ Analgesic muscle creams

▶ “Medicated” Lip balm

▶ Tea Tree Shampoo

▶ Lavender moisturizer

Father of Aromatherapy

Rene-Maurice Gattefosse

PubMed Listings for EO’s and

Specific Conditions

▶ Psoriasis 30

▶ Seborrhea 12

▶ Tinea 35

▶ Antimicrobial 5,622

▶ Alopecia 16

▶ Rosacea 3

Do essential oils have

antimicrobial properties?

Melaleuca alternifolia (Tea Tree)Reported Benefits

▶ Acne

▶ Antifungal

▶ Seborrhea

▶ Antibiotic

▶ Antiviral

▶ Thrush

▶ Attenuate nickel reactions

▶ Lice

Melaleuca alternifolia (Tea Tree)

Equivalent to Phenol?

▶ Penfold, A. R., and R. Grant. 1925. The germicidal values of some

Australian essential oils and their pure constituents, together with those for some essential oil isolates, and synthetics. Part III. J. R. Soc.

New South Wales 59:346-349.

PubMed - Tea Tree Oil Studies

▶ Bassett IB, Pannowitz DL, Barnetson. A comparative study of tea-tree oil versus benzoylperoxide in the treatment of acne. RSMed J Aust. 1990 Oct 15; 153(8):455-8

▶ Carson, C. F., L. Ashton, L. Dry, D. W. Smith, and T. V. Riley. 2001. Melaleuca alternifolia (tea tree) oil gel (6%) for the treatment of recurrent herpes labialis. J. Antimicrob. Chemother. 48:450-451

▶ Satchell, A. C., A. Saurajen, C. Bell, and R. S. Barnetson. 2002. Treatment of dandruff with 5% tea tree oil shampoo. J. Am. Acad. Dermatol. 47:852-855.

▶ Buck, D. S., D. M. Nidorf, and J. G. Addino. 1994. Comparison of two topical preparations for the treatment of onychomycosis: Melaleuca alternifolia (tea tree) oil and clotrimazole. J. Fam. Pract. 38:601-605.

PubMed - Tea Tree Oil Studies

▶ Bassett IB, Pannowitz DL, Barnetson. A comparative study of tea-tree oil versus benzoylperoxide in the treatment of acne. RSMed J Aust. 1990 Oct 15; 153(8):455-8

▶ Carson, C. F., L. Ashton, L. Dry, D. W. Smith, and T. V. Riley. 2001. Melaleuca alternifolia (tea tree) oil gel (6%) for the treatment of recurrent herpes labialis. J. Antimicrob. Chemother. 48:450-451

▶ Satchell, A. C., A. Saurajen, C. Bell, and R. S. Barnetson. 2002. Treatment of dandruff with 5% tea tree oil shampoo. J. Am. Acad. Dermatol. 47:852-855.

▶ Buck, D. S., D. M. Nidorf, and J. G. Addino. 1994. Comparison of two topical preparations for the treatment of onychomycosis: Melaleuca alternifolia (tea tree) oil and clotrimazole. J. Fam. Pract. 38:601-605.

PubMed - Tea Tree Oil Studies

▶ Bassett IB, Pannowitz DL, Barnetson. A comparative study of tea-tree oil versus benzoylperoxide in the treatment of acne. RSMed J Aust. 1990 Oct 15; 153(8):455-8

▶ Carson, C. F., L. Ashton, L. Dry, D. W. Smith, and T. V. Riley. 2001. Melaleuca alternifolia (tea tree) oil gel (6%) for the treatment of recurrent herpes labialis. J. Antimicrob. Chemother. 48:450-451

▶ Satchell, A. C., A. Saurajen, C. Bell, and R. S. Barnetson. 2002. Treatment of dandruff with 5% tea tree oil shampoo. J. Am. Acad. Dermatol. 47:852-855.

▶ Buck, D. S., D. M. Nidorf, and J. G. Addino. 1994. Comparison of two topical preparations for the treatment of onychomycosis: Melaleuca alternifolia (tea tree) oil and clotrimazole. J. Fam. Pract. 38:601-605.

PubMed - Tea Tree Oil Studies

▶ Bassett IB, Pannowitz DL, Barnetson. A comparative study of tea-tree oil versus benzoylperoxide in the treatment of acne. RSMed J Aust. 1990 Oct 15; 153(8):455-8

▶ Carson, C. F., L. Ashton, L. Dry, D. W. Smith, and T. V. Riley. 2001. Melaleuca alternifolia (tea tree) oil gel (6%) for the treatment of recurrent herpes labialis. J. Antimicrob. Chemother. 48:450-451

▶ Satchell, A. C., A. Saurajen, C. Bell, and R. S. Barnetson. 2002. Treatment of dandruff with 5% tea tree oil shampoo. J. Am. Acad. Dermatol. 47:852-855.

▶ Buck, D. S., D. M. Nidorf, and J. G. Addino. 1994. Comparison of two topical preparations for the treatment of onychomycosis: Melaleuca alternifolia (tea tree) oil and clotrimazole. J. Fam. Pract. 38:601-605.

PubMed - Tea Tree Oil Studies

▶ Bassett IB, Pannowitz DL, Barnetson. A comparative study of tea-tree

oil versus benzoylperoxide in the treatment of acne. RSMed J Aust. 1990 Oct 15; 153(8):455-8

▶ Carson, C. F., L. Ashton, L. Dry, D. W. Smith, and T. V. Riley. 2001.

Melaleuca alternifolia (tea tree) oil gel (6%) for the treatment of

recurrent herpes labialis. J. Antimicrob. Chemother. 48:450-451

▶ Satchell, A. C., A. Saurajen, C. Bell, and R. S. Barnetson. 2002.

Treatment of dandruff with 5% tea tree oil shampoo. J. Am. Acad.

Dermatol. 47:852-855.

▶ Buck, D. S., D. M. Nidorf, and J. G. Addino. 1994. Comparison of two

topical preparations for the treatment of onychomycosis: Melaleuca alternifolia (tea tree) oil and clotrimazole. J. Fam. Pract. 38:601-605.

PubMed – Tea Tree Oil Studies

▶ Caelli, M., J. Porteous, C. F. Carson, R. Heller, and T. V. Riley. 2000.

Tea tree oil as an alternative topical decolonization agent for methicillin-resistant Staphylococcus aureus. J. Hosp. Infect. 46:236-237

▶ Syed, T. A., Z. A. Qureshi, S. M. Ali, S. Ahmad, and S. A. Ahmad. 1999.

Treatment of toenail onychomycosis with 2% butenafine and 5%

Melaleuca alternifolia (tea tree) oil in cream. Trop. Med. Int. Health

4:284-287

▶ Tong, M. M., P. M. Altman, and R. S. Barnetson. 1992. Tea tree oil in the treatment of tinea pedis. Aust. J. Dermatol. 33:145-149

PubMed – Tea Tree Oil Studies

▶ Caelli, M., J. Porteous, C. F. Carson, R. Heller, and T. V. Riley. 2000.

Tea tree oil as an alternative topical decolonization agent for methicillin-resistant Staphylococcus aureus. J. Hosp. Infect. 46:236-

237

▶ Syed, T. A., Z. A. Qureshi, S. M. Ali, S. Ahmad, and S. A. Ahmad. 1999.

Treatment of toenail onychomycosis with 2% butenafine and 5%

Melaleuca alternifolia (tea tree) oil in cream. Trop. Med. Int. Health

4:284-287

▶ Tong, M. M., P. M. Altman, and R. S. Barnetson. 1992. Tea tree oil in the treatment of tinea pedis. Aust. J. Dermatol. 33:145-149

PubMed – Tea Tree Oil Studies

▶ Caelli, M., J. Porteous, C. F. Carson, R. Heller, and T. V. Riley. 2000.

Tea tree oil as an alternative topical decolonization agent for methicillin-resistant Staphylococcus aureus. J. Hosp. Infect. 46:236-

237

▶ Syed, T. A., Z. A. Qureshi, S. M. Ali, S. Ahmad, and S. A. Ahmad. 1999.

Treatment of toenail onychomycosis with 2% butenafine and 5%

Melaleuca alternifolia (tea tree) oil in cream. Trop. Med. Int. Health

4:284-287

▶ Tong, M. M., P. M. Altman, and R. S. Barnetson. 1992. Tea tree oil in the treatment of tinea pedis. Aust. J. Dermatol. 33:145-149

Lavender OilReported Benefits

▶ Acne

▶ Calm anxiety

▶ Alopecia

▶ Improve complexion

▶ Hair growth

▶ Hair removal

▶ Relieve pain

▶ Anti-Aging

▶ The effect of topical application of lavender essential oil on the

intensity of pain caused by the insertion of dialysis needles in hemodialysis patients: A randomized clinical trial. Ghods AA,

Abforosh NH, Ghorbani R, Asgari MR. Complement Ther Med. 2015

Jun;23(3):325-30. doi: 10.1016/j.ctim.2015.03.001.

Lavender

Antioxidant and wound healing activity of Lavandula aspic L. ointment Ben Djemaa FG, Bellassoued K, Zouari S, El Feki A, Ammar E. J Tissue Viability. 2016 Nov;25(4):193-200. doi: 10.1016/j.jtv.2016.10.002. Epub 2016 Oct 5.

Wound healing potential of lavender oil by acceleration of granulation and wound contraction through induction of TGF-β in a rat model. Mori HM, Kawanami H, Kawahata H, Aoki M. BMC Complement Altern Med. 2016 May 26;16:144. doi: 10.1186/s12906-016-1128-7

Hair Growth-Promoting Effects of Lavender Oil in C57BL/6 Mice.Lee BH, Lee JS, Kim YC. Toxicol Res. 2016 Apr;32(2):103-8. doi: 10.5487/TR.2016.32.2.103. Epub 2016 Apr 30.

Lavender

Antioxidant and wound healing activity of Lavandula aspic L. ointment Ben Djemaa FG, Bellassoued K, Zouari S, El Feki A, Ammar E. J Tissue Viability. 2016 Nov;25(4):193-200. doi: 10.1016/j.jtv.2016.10.002. Epub 2016 Oct 5.

Wound healing potential of lavender oil by acceleration of granulation and wound contraction through induction of TGF-β in a rat model. Mori HM, Kawanami H, Kawahata H, Aoki M. BMC Complement Altern Med. 2016 May 26;16:144. doi: 10.1186/s12906-016-1128-7

Hair Growth-Promoting Effects of Lavender Oil in C57BL/6 Mice.Lee BH, Lee JS, Kim YC.Toxicol Res. 2016 Apr;32(2):103-8. doi: 10.5487/TR.2016.32.2.103. Epub 2016 Apr 30.

Side Effects: Gynecomastia

▶ Henley D, Lipson N, Korach K, Bloch C. Prepubertal Gynecomastia

Linked to Lavender and Tea Tree Oils. New England Journal of

Medicine, Feb. 1, 2007.

▶ The Endocrine Society. "Chemicals in lavender and tea tree oil

appear to be hormone disruptors." ScienceDaily. 18 March 2018.

“Lavender oil poses potential environmental health concerns and should be investigated further,” The Endocrine Society

Lemon Oil?

Eucalyptus oil Reported Benefits

▶ Itchy scalp

▶ Insect repellent

▶ Topical pain

▶ Antiseptic

▶ Sun screen

▶ Acne

▶Moisturizer

▶ Enhance drug delivery

Saraf S. In vitro sun protection

factor determination of herbal

oils used in cosmetics.

Pharmacognosy Res. 2010 Jan-

Feb; 2(1): 22–25.

Peppermint OilReported Benefits

▶ Contains menthol & menthone

▶ Natural pesticide

▶ Irritable Bowel Syndrome

▶ Topical usage for nerve pain and muscle aches

▶ No FDA approvals

▶ European Medicines Agency approves topical usage

Camphor

▶OTC Itch Creams

▶OTC Topical Analgesics

▶ Seizures

Khine H, Weiss D, Graber N, Hoffman RS, Esteban-Cruciani N, Avner JR. A cluster of children with seizures caused by camphor poisoning. Pediatrics. 2009; 123:1269-2097.

Oil of WintergreenReported Benefits

▶ Pain relief

▶ Improve digestion

▶ Antiseptic

▶ Counter-irritant to pain

▶OTC muscle liniments

Oil of Wintergreen

▶Methyl salicylate

▶ Ester of salicylic acid and methanol

▶Metabolizes into salicylate

▶ 1 teaspoon = 20 300mg aspirin tablets

Frankincense and Cancer?

Frankincense and Cancer?

Frankincense and Cancer?

Frankincense and Cancer?

Side effects of topical essential oils

▶Wintergreen oil death

▶Gynecomastia

▶ Allergic or Irritant dermatitis

▶ Photodermatitis

▶ Systemic hypersensitivity

▶ Delay of diagnosis and treatment

Center for Poison Control

“If, for some reason, you have bottles

of essential oils at home, consider

discarding them (safely) if you have

young children. Otherwise, they MUST

be locked up, out of sight and reach of

children and pets – all the time.”

Phototoxic & Photosensitive

Reactions

▶ Bergamot

▶Grapefruit

▶ Lemon

▶ Lime

▶ Bitter Orange

▶ Cumin

Random Interesting Studies

EO’s & Dermatology

So Do Topical EO’s Work?

How can we use EO’s in

dermatology?

▶ Alleviate fear of injections?

▶ Post-herpetic neuralgia?

▶ Neuralgia Parathestica?

▶ Pruritic symptoms?

▶ Adjunct to Anti-parasitics?

▶ Adjunct in acne management?

▶ Uncomplicated tinea?

▶ Seborrhea?

▶ Alleviate side effects of other medications?

▶ Enhance penetration of topicals?

Commercial EO Companies

What do these companies do well?

▶ Advocate caution (especially in children)

▶ Recommend dilution

▶ Recommend test spots

▶ Recognize possible irritant and allergic contact dermatitis

▶ Provide lists of photosensitizing agents

▶ Redefine “evidence”

Acceptable Claims for EO’s

▶ “Supports the health of the _______ system ”

▶ “Improve vitality”

▶ “Promote wellbeing”

▶ “Balance the ____ system”

FDA Crackdown!

The Business of Pseudoscience

EO Marketing - Appeal to Antiquity

“The Egyptians were some of the first people to use

aromatic essential oils extensively in medical practice,

beauty treatment, food preparation, and in religious

ceremony.”

“Essential oil extracts were used throughout the dark ages

in Europe for their anti-bacterial and fragrant properties.”

History of the Escharotic Agents

Escharotic Agents

▶ Bloodroot

▶ Zinc Chloride

▶ Indian Mud

▶ Black Salve

▶ Curaderm-BEC5

▶QHS Cream

▶ Yellow Salve

▶ Compound X

▶ Hoxsey’s paste

▶Mohs paste

Recent articles

▶McDaniel S. Consequences of using escharotic agents as primary

treatment for nonmelanoma skin cancer. Arch Dermatol. 2002;138(12):1593-1596.

▶ Robbins A. The dangers of black salve. JAMA Dermatol.

Obversations. 2018;154(5):618-619.

▶ Henley D, Lipson N, Korach K, Bloch C. Prepubertal Gynecomastia

Linked to Lavender and Tea Tree Oils. New England Journal of

Medicine, Feb. 1, 2007.

History of Escharotic Agents

▶ 2,500 years ago – Indian uses of arsenic

▶ Eastern Native American tribes

▶ Ibn Sina of Persia

▶ Hildegard of Germany in the 12th century.

▶ 1815 England first “modern” usage of zinc chloride

▶ Dr. J. Weldon Fell

▶ Harry Hoxsey “Hoxsey’s Paste”

▶ Dr. Mohs – American College of Chemosurgery

▶ Dr. Oz vs. Greg Caton

▶Mohs surgeons & Naturopaths

Mohs Paste

▶ “Chemical Charlatan!”

▶ Cauterize, Kill, Fix

▶ 40.0 gm Stibnite, 10.0 gm Sanguinaria canadensis, 34.5 ml of

saturated zinc chloride solution

Mohs, Frederic Edward (1978). Chemosurgery: microscopically controlled surgery for skin cancer.

Springfield, Ill: Thomas

Bloodroot Conspiracy?

▶ American Society for Mohs Surgery

▶ American College of Mohs Surgery

▶ Dr. Perry Robins Skincancer.org

▶ Nytimes obituary

Guess Who Loves Mohs Paste?

Greg Caton

▶ “I’ve treated over 25,000 patients”

▶ “I know 5 where it didn’t work.”

▶ “Cured mesothelioma”

▶ “…on the FBI’s 10 Most Wanted list”

Taken from online interview with Dr. M. Oz.

https://www.sharecare.com/video/dr-oz/GBO2/dr-oz-talks-to-a-black-salve-

seller