Skin Sensitization - Authored by Rose Chard in  MASSAGE MAGAZINE

5 Ways to Avoid Skin Sensitization:

 Integrating essential oils into your massage practice can be rewarding and beneficial for both you and your clients. As massage therapists, contact with skin is unavoidable—and since essential oils are often applied to the skin, learning the basics regarding adverse skin reactions will help keep your clients safe and help you with your confidence when using essential oils.

 What is skin sensitization?

 It is possible to get skin sensitization with some essential oils. This involves an allergic reaction to a substance and results in what is called Allergic contact dermatitis. This is different than the more common type of dermal reaction which is often an irritation from the essential oil caused by direct contact with it. With the later, the irritated area rarely spreads to other areas of the body and complete removal of the essential oil usually resolves the problem.  

 Skin sensitization is when an allergic reaction occurs as a result of the essential oil penetrating the epidermis after skin contact. At the point of contact, the skin may appear inflamed, red and blotchy or blistering however it is not limited to it – the rash can appear in other areas of the body. This process means that your body has become sensitized to a particular substance. In the case of essential oils, the substance would be a particular constituent present in the essential oil.  Once you are sensitized to the substance, you will likely be allergic to it for the rest of your life when you come in contact with it again. Skin sensitization is classified as immediate or delayed – the mechanism for how the allergic reaction occurs in each is different.

 Immediate hypersensitivity causes an immediate allergic reaction. It occurs when antigens bind with multiple immunoglobins E (IgE) antibodies at the same time to trigger the release of mast cell granules that contain histamines, causing an inflammatory reaction. It is rare that an essential oil constituent will cause immediate hypersensitivity.

Delayed hypersensitivity is more common. In this allergic reaction, pre-allergens called haptens penetrate the skin and bind to skin proteins rendering it an antigen. It is now large enough to be found by Langerhans cells that attach to the antigen-peptide and travels to local lymph nodes where the T-lymphocytes recognize it.  Here the T cells multiply resulting in a proliferation of antigen specific memory T-cells. The host is now sensitized and circulating T-cells travel back up to the skin. When the same hapten makes contact with the skin again, the stage is set for a cell reaction which stimulates the skin inflammation response.

 Photosensitization

This is another type of adverse skin reaction. It involves a reaction of the skin to ultraviolet light, resulting in red, pigmented or blistered skin.

Photo allergy, less blistering and more hive-like in appearance is the sensitizing type, which is extremely rare with essential oil use.

The more common type of photosensitization pertaining to essential oils is phototoxicity. It is not an allergic response, but rather a skin irritation reaction caused by essential oils that contain molecules called furanocoumarins, bergapten being most notable in essential oils.

Several citrus oils, such as bergamot, lemon, lime, grapefruit and bitter orange, are considered phototoxic. Steam-distilled versions of some citrus oils are not high risk for phototoxicity.

To avoid any adverse skin reaction resulting from ultraviolet light exposure, do not apply any phototoxic essential oils undiluted in any amount on your clients. It is best to avoid phototoxic oils in massage blends altogether, but if you want to add them in, stick with a very low dilution rate: no more than four drops total of any phototoxic oil per one ounce of carrier.

If photosensitizing oils are applied to the skin, be sure to advise your clients to stay out of the sun or tanning booth for at least 12, and up to 18, hours. Ultraviolet light is present even when it is not sunny outdoors.

 Treatment

Treatment of almost all contact dermatitis arising from an allergic response or irritation begins with eliminating and avoiding the source. If the source is an essential oil, remove any residual oil and gently wash the skin with unscented soap and allow it to dry. If you want to apply a gentle soothing product, aloe vera gel is a good choice; fresh aloe from the plant is even better.

Over-the-counter antihistamines are effective, although oral application may be a better choice, as topical antihistamines may induce further allergic contact dermatitis. Mild over-the-counter corticosteroid creams help relieve itching. Allergic reactions are unpleasant and uncomfortable, but often dissipate quickly. If the irritation or inflammation is not going away, you may want to visit your doctor.

 5 ways to avoid sensitization

 The idea of subjecting your clients and yourself to an adverse skin reaction can be scary; however, topical application presents very few risks when you choose appropriate essential oils, understand dilution rates and apply care in not overusing. Sensitization is unpredictable, meaning not everyone will react to a potential allergen in the same manner. Adhering to the following guidelines will help you reduce both your risk and your clients’ risk dramatically.

  1) Do not apply undiluted essential oils on skin. Perhaps one drop of a low-risk essential oil applied on your hand occasionally is not problematic; however, the risk of adverse skin reactions increase when essential oils are used undiluted on the skin.

Essential oils are meant to be applied with a carrier when used topically. When preparing a massage oil for healthy adults, a good guide is about 10 to 12 drops total of essential oils per one ounce of carrier oil. This is about a 3-percent dilution rate.

 2) Avoid topical application of essential oils that are known sensitizers. Some known sensitizers may be fine to use topically so long as you stick with its recommended dilution rate, which would normally be around or under 1 percent. (The international fragrance association (ifraorg.org) publishes a list of usage guidelines and standards for aromatic material.)

 Known sensitizers are essential oils that contain eugenol such as clove bud, basil, oregano and cinnamon leaf. Others are cinnamon bark and cassia which contain cinnamaldehyde and lemon myrtle and lemongrass contain citral. I would be recommend not using any of these essential oils for body massage.

I recommend that when you introduce a new oil to your practice, do your research on its particular therapeutic actions, constituents and safety information.

Online information can be misleading and often confusing. It is important that you reach out to reputable sources and be mindful of the choices you make for your practice. Thorough research leads you to more confident choices.

 3) Degradation of essential oils increases the risk of dermal sensitization. Store your essential oils in a cool, dark place away from moisture and sunlight to maximize its shelf life. Some common essential oils prone to sensitizing after degradation are most citrus fruit oils, fir and pine oils, all types of frankincense, the tea trees and black pepper.

 4) Remember, it is important for you, the practitioner to take care of yourself. Hand dermatitis is a common condition among massage therapists. Use gloves when preparing blends to avoid even the slight potential of skin contact such as via accidental spillage. If you are around these aromatic oils on a regular basis at work, minimize your exposure to them elsewhere so that your body does not get overloaded. Protect your body first. Your client would expect nothing less. A healthy therapist is good marketing.

 5) Avoid applying essential oils on open skin. Open skin will absorb a higher quantity of essential oil constituents.

 

Client safety

If you ask, your clients are usually upfront about their sensitive skin issues. In fact, they want to avoid any issues and will often let you know about their skin challenges without you prompting them. People with a family history of any type of skin allergy present a higher risk of adverse skin reactions. Respect for the individual’s comfort level with essential oils is important.

If your regular client would like to experiment with an oil, an option would be to skin patch-test. You can add a drop of essential oil in the crook of the arm and leave it undisturbed for several hours. If your client did not experience any reaction, you may discuss options that will include small dilutions of the particular essential oil at their next session.

Skin-patch testing is not foolproof, but it opens dialogue and participation between therapists and clients that wish to use essential oils and are skittish due their skin issues. Clients appreciate this consideration you have toward their well-being.

 Therapist safety

Often our focus on our clients’ safety means that we may neglect to remember that our own hands might be exposed to sensitizing materials at a higher frequency than most people’s skin is exposed, because we are preparing the blends as well as applying them.

Contact dermatitis is obviously a condition we would like to avoid. Certainly, massage therapists are at a greater risk of getting adverse dermal reactions because we work with our hands and we are constantly using some kind of blended massage oil. It is very important to consider your safety as well as your clients’ when you use or create aromatic blends.

 Create Confidence

Streamlining your approach to essential oil usage in your practice by limiting the essential oils to a select number and by researching each oil’s individual profile including its therapeutic margins will help you create confidence with the blends you offer and dramatically decrease the probability of adverse skin reactions.

Article authored by Your Body Needs...owner Rose Chard published in MASSAGE MAGAZINE, August 2016. This article was written for massage therapists.

 Information presented in this article is not intended to replace advice from a medical professional.

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