Aromatic Psychodermatology

Aromatic Psychodermatology: The emotional role of essential oils in skincare
By Jade Shutes

Since I was trained as an aromatherapist over 20 years ago aromatherapy has grown tremendously in the field of esthetics. Research into the therapeutic benefits of applying essential oils to the skin have been able to prove that essential oils offer a wide range of activity for a variety of skin conditions. Essential oils are able to reduce inflammation, enhance wound healing, treat fungal, bacterial, and viral infections, relieve itching, prevent wrinkles and slow the aging process, support the detoxification process, and serve as penetration enhancers for allopathic medicines. With such a vast array of therapeutic benefits, it is no wonder that aromatherapy is growing in popularity within the cosmetics and esthetics industries as well as with individual consumers seeking more natural means of maintaining and supporting the health not only of the skin but of their whole body and mind.

According to Harris (2006), “treating skin diseases and promoting and maintaining skin health is of worldwide relevance and represents a multi-billion dollar market to the pharmaceutical, fragrance, cosmetics and toiletries industries. Aromatherapists have at their disposal remarkable tools that can simply and positively impact a range of commonly encountered skin conditions responsible for significant psychosocial distress. The aromatherapist is able to work at the level of the cutaneous interface not only through the judicious application of essential oils and their related products, but also through touch, olfaction and stress reduction with their subsequent positive impacts on skin health”.

The skin is capable of altering its appearance in response to differing emotional states, our overall health, or even to reveal signs of various disorders or imbalances. Hoffman (1983) writes that it is “through the skin that we have physical contact with our environment, as the whole area of the skin is rich in sensory nerve endings. In fact it is worth noting that in the growing embryo the skin develops from the same source as the nervous tissue. This common origin points to the close relationship between skin and nervous system, a relationship which can be seen as a physical manifestation of the close connection between our inner being and the way it is reflected into the world” (p.76). Juhan (2003) observes that “in spite of the increasing distance that separates them (the nervous system/brain and the skin), properties of the skin continue to play a material role in the development and organization of the central nervous system”.

“The skin is the mirror which reflects the state of the mind” is a proverb which has been used since ancient times. The skin shares a common origin with the nervous system and the two continue an intimate relationship throughout our lives. The skin is connected to the brain via the nervous system as well as by the endocrine and immune systems. Due to these close connections, human skin is acutely sensitive to a variety of psychological/emotional states.

Psychological stress has been shown to: exacerbate acne vulgaris (Kraus, 1970 and Chiu, et al., 2003); disturb epidermal permeability barrier homeostasis which can lead to or exacerbate inflammatory dermatoses such as psoriasis and atopic dermatitis (Garg, et al, 2001); reduce epidermal cell proliferation (Choi, et al. 2005); and slow wound healing (Godbout and Glass, 2006). Psychological stress, therefore, is capable of affecting many aspects of the skins function.

Psychodermatology addresses the interaction between the mind and the skin. This discipline acknowledges the complex interplay between the skin and the neuroendocrine and immune systems and has been described as the neuro-immuno-cutaneous system. (Jafferany, 2007) The nervous system, endocrine system, and cutaneous immune system all cooperate to maintain the homeostasis of the skin.
Aromatic psychodermatology could be defined as the interaction between aroma, the mind, and the skin and would be a discipline that acknowledges the complex interplay between olfaction and psychodermatology.

According to work by Koo and Lee (2003) and written about by Jafferany, there are 3 main categories for psychocutaneous disorders. These include: (1) psychophysiologic disorders, (2) psychiatric disorders with dermatologic symptoms, and (3) dermatologic disorders with psychiatric symptoms. Let us explore these categories a bit further.

(1) Psychophysiologic disorders: In this category are skin conditions where psychiatric (emotional) factors are instrumental in the etiology and course of the skin condition. Although the skin disease is not necessarily caused by stress, stress appears to either preciptate the appearance of the condition or exacerbates it once the skin condition has appeared. Conditions falling under this category include: psoriasis, atopic dermatitis, acne excoriee (habitual act of picking at skin lesions), acne vulgaris, rosacea, alopecia areata, herpes simplex, pruritus, hyperhidrosis, and urticaria.

Stress management and relaxation techniques have been found to be quite useful when treating these skin conditions/diseases. Essential oils also have a great role to play in treating psychophysiologic disorders. Olfactory aromatherapy is capable of reducing the impact of stress due to its connection to the limbic/emotional region of the brain. Research on the impact of ‘aromas’ on stress-induced skin changes have shown that odorants with a sedative effect prevent the delay of skin barrier recovery induced by stress after acute barrier disruption (Denda, et al., 2000) and sedative odorants may be useful as a complementary therapy for atopic dermatitis through psychosomatic stress care (Hariya, et al., 2002) . The inhalation of ‘aromas’ have also been found to affect the adrenal system via the sympathetic nervous system.
With this in mind, essential oils considered to be relaxing, anxiety-relieving, soothing, and sedative could potentially be used to reduce the appearance or longevity of psychophysiologic disorders. The following essential oils could be used:

Bergamot                                Citrus bergamia
Cedarwood                             Cedrus atlantica
Roman chamomile               Chamaemelum nobile
German chamomile             Matricaria recutita
Lavender                                Lavandula angustifolia
Marjoram, Sweet                 Origanum marjorana
Melissa                                 Melissa officinalis
Neroli                                    Citrus aurantium var. amara flos.
Sweet orange                        Citrus sinensis
Petitgrain                           Citrus aurantium var amara
Rose                                      Rosa damascena
Tangerine (red)                  Citrus reticulata
Ylang ylang                         Cananga odorata
Vetiver                                  Vetiveria zizanioides

(2) Psychiatric disorders with dermatologic symptoms: In this category are disorders that occur in the context of somatoform disorders, anxiety disorder, factitious disorder, impulse-control disorder, or eating disorder (Jafferany, 2007). This is a complex category and one which will not be explored further in this article.

(3) Dermatologic disorders with psychiatric symptoms: This category includes patients who have emotional problems as a result of having a skin condition/disease. Skin conditions such as psoriasis, chronic eczema, various ichthyosiform syndromes, neurofibromas, severe acne, and disfigurement or disfiguring lesions can all have grave effects on psychosocial interactions, self-esteem, and body image. Individuals may suffer with depression, anxiety, work-related problems, low self image, social isolation, and lack of self confidence.
Essential oils and aromatherapy have a role to play in this category of psychocutaneous disorders as well. According to Harris (2004), “in terms of essential oil choices for anxiety and depression, essentially, this is dependent on the person’s like and dislikes. Generally, floral and citrus essential oils are the most frequently used for anxiety and depression, but in fact, any fragrance to which the person has a positive odor association can be used.”

Consideration should be given to antidepressant and anxiolytic essential oils although individualized care is of the utmost importance.

Anxiolytic Essential Oils

Roman chamomile                  Chamaemelum nobile
German chamomile                 Matricaria recutita
Clary sage                                Salvia sclarea
Frankincense                            Boswellia carteri*
Geranium                                  Pelargonium graveolens
Lavender                                   Lavandula angustifolia
Mandarin                                Citrus reticulata
Neroli                                       Citrus aurantium var. amara
Vetiver                                     Vetiveria zizanioides
Ylang ylang                             Cananga odorata

 

Antidepressant Essential Oils

Clary sage                              Salvia sclarea
Frankincense                     Boswellia carteri*
Grapefruit                            Citrus paradisi
Lemon                             Citrus limon
Mandarin                          Citrus reticulata
Sweet orange                      Citrus sinensis
Patchouli                             Pogostemon cablin
Petitgrain                            Citrus aurantium var. amara
Ylang ylang                         Cananga odorata

*Most species of Frankincense are currently at risk and threatened. Use discernment when choosing to work with this oil.

I am reminded of a client years ago who I was blessed to work with. This female client had been in an automobile accident and as a result she had a large raised scar on the left side of her face. This scar was constantly inflamed and it bothered her a great deal. She suffered with low self esteem and depression because of it. She came to me in hopes that aromatherapy could alter the appearance of the scar tissue as well as reduce the inflammation. After an in-depth consultation, I arrived at the idea of treating the emotional aspects of the scar first while also working on changing the physical appearance of the scar.

The first blend was designed for the emotional aspects of the scar. This blend was a mix of: Rosa damascena, Boswellia carterii and Citrus reticulata. This was placed in a shea butter/jojoba base at a 4% dilution. My intent and goal was to support her in developing a different relationship with and perception of the scar. She applied the blend to her skin twice daily. We worked together for a number of months during which she did indeed arrive at another place with her scar. Over the months of applying the blend she was able to acknowledge the anger she felt over the accident. She reportedcrying quite often and also feeling overwhelmed by the anger which arose. Slowly she was able to release this anger and sadness. With this release she began to develop a different relationship with the scar. She became more accepting, more able to see the positive aspects of her life. This change in relationship with the scar reduced the inflammation. I also noticed that the scar was slowly beginning to fad although it would always be present. I realized then that sometimes it’s not about the physical manifestation but rather our emotional connection to it. It was quite an experience to watch her go through this healing process and it was an honor to help facilitate.

We can begin to see that essential oils have an incredible capacity to alter perceptions and relationships with dermatologic disorders with psychiatric symptoms. At times we can use essential oils to actually ‘treat’ the condition or at least treat the symptoms of the condition (e.g. reduce the inflammation of psoriasis or eczema) and at other times we can utilize essential oils to facilitate different relationships to or perceptions of the disfigurement or skin condition in hopes that this will lead to a better quality of life and a better sense of self.
Aromatherapy is by no means a panacea nor does it work on this level without a degree of willingness and full participation on behalf of the client. However, the potential is great and aromatherapy is at times quite extraordinary in the manner in which it can affect people. My hope is that this opens door and ideas for unique applications of essential oils for the relief and treatment of psychocutaneous disorders.

 

References:
Chiu, A., Chon, S. MD; Kimball, A. MD, MPH, (2003) The Response of Skin Disease to Stress Changes in the Severity of Acne Vulgaris as Affected by Examination Stress. Retrieved October 2, 2005 from: http://archderm.ama-assn.org/cgi/content/full/139/7/897#ACK

Choi, E., Brown, B., Crumrine, D., Chang S., et. al. Mechanisms by Which Psychologic Stress Alters Cutaneous Permeability Barrier Homeostasis and Stratum Corneum Integrity Journal of Investigative Dermatology (2005) 124, 587–595; doi:10.1111/j.0022-202X.2005.23589.x Retrieved October 2, 2005 from: http://www.nature.com/jid/journal/v124/n3/full/5602736a.html

Denda, M., Tsuchiya, T., Shoji, K., and Tanida, M. Odorant inhalation affects skin barrier homeostasis in mice and humans. Br. J Dermatol. 2000 May;142(5):1007-10.

Garg, A., Chren, MM, Sands, L., et al. Psychological Stress Perturbs Epidermal Permeability Barrier Homeostasis. Arch Dermatol. 2001;137:53-59.

Godbout, J. and Glass, R. Stress-Induced Immune Dysregulation: Implications for Wound Healing, Infectious Disease and Cancer. Journal of Neuroimmune Pharmacology. 1.4 / December, 2006, 421-427

Harris, R. (2006).Editorial. International Journal of Clinical Aromatherapy, Vol 3:1, 2.

Harris, R. (2004).Aromatic approaches to end of life care. International Journal of Clinical Aromatherapy, Vol 1:2, 10-20.

Hariya, T., Kobayashi, Y., Aihara M., Ishiwa, M., Shibata, M., Ichikawa, H., and Ikezawa, Z. Effects of sedative odorant inhalation on patients with atopic dermatitis. Arerugi. 2002 Nov;51(11):1113-22.

Hoffman, D. (1983). The New Holistic Herbal. Shaftesbury, Dorset, England: Element Books Ltd.

Jafferany, M. Psychdermatology: A Guide to Understanding Common Psychocutaneous Disorders. Prim Care Companion J Clin Psychiatry 2007;9(3).

Juhan, D. (1987). Job’s Body. New York: Station Hill Press.
Kraus, S. Stress, Acne and Skin Surface Free Fatty Acids. Psychosomatic Medicine, Vol. 32, No. 5, September-October 1970.

Koo JYM, Lee CS. General approach to evaluating psychodermatological disorders. In: Koo JYM, Lee CS, eds. Psychocutaneous Medicine. New York, NY: Marcel Dekker, Inc. 2003. 1.–29. Retrieved on June 8, 2008 from: http://www.psychiatrist.com/pcc/pccpdf/v09n03/v09n0306.pdf