Essential Oils for Kids: Topical Application

Much of the information regarding the topical application of essential oils revolves around environmental exposures such as those found in personal care products, massage oils, and household tools. In this scenario, the acceptable rate of exposure, in terms of safety, exists in contrast to conventional alternatives. Therefore, it is practical to make recommendations that certain oils be avoided altogether in children and that others be restricted to extremely low doses.

For medicinal applications, however, the alternative is often much more dangerous. A parent of a small child with a skin infection must choose between treating the child with pharmaceutical antibiotic products, essential oil blends, or nothing at all. As the risk of the alternative increases, the tolerance for potential adverse outcomes, skin reactions, and discomfort increases.

This dynamic is not exclusive to aromatherapy; it is found in all topical products. The threshold for irritation from a skin lotion is extremely low. However, the threshold for irritation for a medicinal topical antibiotic is much higher. This threshold is fully dependent upon the alternative. As a result of this variation, it is not possible to produce a definitive dermal maximum concentration for each essential oil. The acceptable concentration of the oil will be dependent upon the oil itself as well as the primary purpose of the preparation. Certain factors are applicable to every application, while others may only be applicable to certain outcomes.

Mechanism of Action

Oils may be applied topically to achieve benefits related to skin conditions or aches and pains near the surface. Topical application is not suited for systemic conditions, such as a respiratory infection or intestinal virus. However, topical application may be used to achieve inhalation benefits. When oils are applied to the skin to maintain exposure to the oil for the purpose of inhalation, the safety guidelines for both inhalation and topical application must be followed.

Another Microbiome

One of the most significant areas of concern with topical application is the disruption of the skin’s microbiome. While a significant amount of attention focuses on the many benefits of a healthy gut microbiome, the skin microbiome is equally important to overall health. The skin microbiome is the second largest population of bacteria in the human body. This microbiome begins development at birth. A child is born coated in vernix, a sticky coating which attracts friendly bacteria from the mother’s skin. The best approach to healthy skin is to delay the baby’s first bath and provide ample skin- to-skin contact with the child’s parents or caregivers.

The first months of a child’s life include critical developmental windows for the skin microbiome, creating bacterial population norms which may last a lifetime. Because all essential oils contain some level of antimicrobial factors, the use of essential oils for any exposure–environmental or medicinal–poses a threat to the health of the microbiome.

As a result, environmental exposures are best avoided during the first months of life. To protect the microbiome, topical substances can be introduced around the time an infant is ready for solid foods. Topical substances can also be introduced in the same way as solid foods–one at a time, with sufficient pause to monitor for allergic reactions or other negative responses. Prior to the completion of the introduction of topical environmental exposures, essential oils should only be used topically for medicinal purposes where the benefits outweigh the risks.

Transdermal Drug Delivery

The purpose of the skin is to act as a barrier, protecting the body from exposures in the environment. Therefore, medicinal applications must penetrate this barrier to achieve the desired outcome. Compared to adults, an infant has about twice the surface area per unit of body weight. This means that environmental exposures for a child are going to be much higher than those of an adult, but does not impact medicinal exposures. For a medicinal exposure, the total application is the key factor, not the total application area. Once the microbiome is developed, children absorb and respond to essential oils in a way that is somewhat similar to an adult with an emphasis on the same precautions. This includes irritation, phototoxicity, and other chemical-related concerns.

Adverse Effects

PHOTOTOXICITY

Phototoxicity occurs when the skin turns red and blisters as though it has been burned after as little as a few minutes to hours of sunlight exposure. NSAIDS are phototoxic, as are many antibiotics. Essential oils, primarily oils from certain citrus plants, may have phototoxic effects.

Phototoxicity does not require complete avoidance or extreme dilutions, however. While environmental exposures must have sufficient dilution to allow for unrestricted use, medicinal exposures of larger doses may be required. When a phototoxic oil is administered to the skin in a medicinal dose, the sunlight must be avoided after application. It is recommended that these products be formulated for application at night to allow several hours before sunlight.

DERMATITIS

There are many forms of dermatitis that may occur as a result of essential oils. Contact dermatitis and allergic dermatitis are the most common forms. Dermatitis is never a beneficial side effect of essential oil use and should be avoided where possible. At times, topical irritation may be a side effect of a formulation used to treat topical infections. This should not be seen as a contraindication. However, that same irritation would pose a contraindication for a lotion to be applied on healthy skin. The acceptability of side effects is always dependent upon the purpose of the preparation.

ALLERGIC EXPOSURES

Allergic dermatitis is a delayed hypersensitivity reaction. Only small quantities of essential oil are required to produce this reaction. Unlike irritant dermatitis which has a dose-response relationship, allergic dermatitis occurs at any dose and at any concentration. Therefore, heavy dilution of an oil does not protect against allergic dermatitis. Allergic dermatitis occurs after someone has been sensitized to a substance. The initial contact does not produce a response but further applications produce the skin reaction.

Sensitization occurs when the individual is genetically prepared to be sensitized, has sufficient initial contact with the substance, and then is exposed to the substance at a later date. Contrary to popular belief, sensitization is not a consequence of using undiluted oils or using the same essential oil for a lengthy period of time. It occurs, just like any other allergic response, as a result of a perfect storm of factors which predispose an individual to developing an allergy. When sensitization occurs, cross-reaction is also a concern. Cross-reaction can occur if the two items share similar functional groups that are required for the hapten-carrier protein interaction. This can make it difficult to identify the actual offending agent because the body will cross react to other agents.

Topical-Oral Drug Delivery

In children, topical applications of essential oils or other products may also become oral applications due to the way in which children explore the world around them. When observed through videotape, young children demonstrated approximately ten hand-mouth contacts per hour. In an average day, this becomes well over 100 hand-mouth contacts. Essential oils applied to a child’s hands for sanitizing purposes, a child’s toys for cleaning purposes, or any other exposure may quickly become oral exposure, producing unintended consequences.

Guidelines for Application

Because total exposure is a construct of dosing, the dilution percentage of the essential oil in its carrier is only a fraction of the information required for safe dosing with children. As such, the common practice of borrowing IFRA’s safety guidelines for mass market personal care products asks these guidelines to achieve something they were never meant to achieve. Medicinal product safety differs from cosmetic safety because the application, purpose, dose, and function differ entirely. Medicinal topical application differs from skin care production in both purpose and dose. For medicinal topical application, the goal is to address a specific health condition or concern and the concentration of essential oils
will be much greater over a shorter period of time.

This application is useful for skin-related conditions such as eczema and psoriasis as well as topical infections such as athlete’s foot. It is also useful for wounds, scars, pain relief, and related conditions.

Topical Applications for Kids: At a Glance
Tools: carrier oils, neat application, or balms/salves
Dose: short term exposure to high concentrations applied frequently
Risk: dermatitis and transient responses such as burning or discomfort – overdose resulting in damage to the skin, damage to the dermal flora, interactions with other topical medications