What essential oil is good for allergies

  1. Anderson C, Lis-Balchin M, Kirk-Smith M. Evaluation of massage with essential oils on childhood atopic eczema. Phytother Res. Sep;14(6)
  2. Schaller M, Korting HC. Allergic airborne contact dermatitis from essential oils used in aromatherapy. Clin Exp Dermatol. Mar;20(2)
  3. Sugiura M, Hayakawa R, Kato Y, Sugiura K, Hashimoto R. Results of patch testing with lavender oil in Japan. Contact Dermatitis. Sep;43(3)
  4. Rademaker M. Allergic contact dermatitis from lavender perfume in Difflam gel. Dermatitis. Jul;31(1)
  5. Schempp CM, Schopf E, Simon JC. [Plant-induced toxic and allergic dermatitis (phytodermatitis)]. Hautarzt. Feb;53(2) German.
  6. Kim HM, Cho SH.

    Lavender oil inhibits immediate-type allergic reaction in mice and rats. J Pharm Pharmacol. Feb;51(2)

  7. Mitchell JC, Rook A, , Botanical Dermatology, Plants and Plant products injurious to the skin, Greengrass, Vancouver.
  8. Coulson IH, Khan AS. Facial ‘pillow’ dermatitis due to lavender oil allergy. Contact Dermatitis. Aug;41(2)
  9. Brandao FM. Occupational allergy to lavender oil. Contact Dermatitis. Oct;15(4)
  10. Lovell CR, Plants and the Skin, Blackwell, Oxford.
  11. Benito M, Jorro G, Morales C, Pelaez A, Fernandez A.

    Labiatae allergy: systemic reactions due to ingestion of oregano and thyme. Ann Allergy Asthma Immunol. May;76(5)

  12. Varma S, Blackford S, Statham BN, Blackwell A. Combined contact allergy to tea tree oil and lavender oil complicating chronic vulvovaginitis. Contact Dermatitis. May;42(5)
  13. Botanical Dermatology Database.

Are they safe?

Little is known about how these oils might affect young, growing bodies, but there is some evidence that they can cause harm.

One trap parents may drop into is thinking that these oils are replacements for evidence-based treatments, according to Dr.

Smith. He told me that the parents of one of his young patients had tried treating their child’s croup (a respiratory infection that causes difficulty breathing and a barking cough) with a variety of oils. Eventually, the illness progressed so much that they needed to take the kid to the emergency room.

“While the essential oils didn’t hurt the child,” Dr. Smith said, “the delay in care allowed the condition to get worse.”

But by far, the greatest harm to children occurs when highly concentrated oils are accidentally swallowed, spilled onto the skin or splashed into the eyes.

In , poison control centers in the United States recorded 17, such incidents in children under 12 — an 85 percent increase over the number of cases reported in (This is according to an analysis that the American Association of Poison Control Centers conducted for The New York Times for this story.)

A teaspoon of camphor oil, a type of oil extracted from the wood of a camphor tree, for instance, can cause seizures in children under 5 if swallowed, according to Nena Bowman, Pharm.D., managing director of the Tennessee Poison Center.

A similar dose of wintergreen oil, a cousin to aspirin, can cause rapid labored breathing, fever and — in severe cases — organ failure and death.

Even as little as half a teaspoon of commonly used essential oils such as eucalyptus, lavender and tea tree oils can cause sedation and difficulty breathing in little ones, Dr. Bowman said.

“The exposures we see are almost every in children and almost every accidental because essential oils aren’t always stored properly,” Dr. Bowman said, “they need to be kept up and out of the reach of children.”

Applying concentrated oils to the skin are common causes of adverse reactions too, said Robert Tisserand, an aromatherapy expert and author of the textbook “Essential Oil Safety.” In nature, oils with antioxidant and antimicrobial properties such as clove, oregano and thyme kill invading bacteria by rupturing their cell membranes, Tisserand said.

“And they do a similar thing to your skin cells and the mucous membranes that line and protect the inside of your body,” he said. “If you put undiluted oregano oil on your skin or in your mouth, you’ll own an irritant reaction — a extremely nasty one. The skin will go red and burn love crazy.”

Children are more likely to own side effects from essential oil exposures than adults are, said Dr. Weber from the N.I.H. “They are still developing, which makes their brains and other systems more sensitive to potential toxicity from essential oils.” Their livers and kidneys, for instance, are likely to be less efficient at processing the compounds.

Young Living provides safety information to consumers and asks its sales distributors to share that information with their customers, according to a company spokeswoman.

“It’s significant that every things are done in moderation — specifically where children are concerned,” she noted, adding that Young Living offers product lines where the essential oil is already diluted in a carrier oil, making it safer for kids.

The new oil boom

Stroll through any department store, vitamin store or farmers market and you’re bound to discover little vials filled with strong-smelling oil. These pungent elixirs are extracted from fragrant botanicals, love lavender, citrus, peppermint and cloves.

“If you ponder about when you squeeze a lemon, the extremely strong citrus smell that you get is the essential oil being released from the skin,” said Wendy Weber, Ph.D., N.D., chief of the clinical research branch at the National Middle for Complementary and Integrative Health at the National Institutes of Health.

Sales revenue from these potent plant extracts in the United States increased by almost 40 percent from to By , they’re projected to reach more than $5 billion in entire sales, according to market research firm Grand View Research.

But they’re not just being sold in shops and online. Sheie said that she’s increasingly had to politely sidestep sales pitches from people in her social circles who are selling the oils for two of the largest essential oil companies, doTerra and Young Living.

These manufacturers use multilevel-marketing strategies, where the people who sell their products profit from their own sales as well as those of others they recruit (think Avon or Herbalife). “I most often run into it at church and on social media, especially in my mom groups,” she said.

How to safely use essential oils around your children

Because there’s no solid evidence on the efficacy and safety of essential oils, major medical organizations such as the American Academy of Pediatrics and the American Academy of Family Physicians own not issued recommendations for using them with children.

If you still desire to use the oils on or around kids, discuss it with your child’s doctor first, advised Dr.

Anna Esparham, M.D., a board-certified pediatrician at Children’s Mercy Hospital in Kansas City, Kan., who has been trained in aromatherapy. And heed the following advice.

  1. You can apply certain oils — such as chamomile, cypress and helichrysum — to the skin of children 3 and up, Dr. Esparham said, but you should dilute them first (using about 3 to 6 drops of oil per 1 ounce of a “carrier oil,” such as jojoba or almond oil). Or, use a product specifically formulated for children.

  2. Always hold oils away from the eyes, nose and mouth. And do not apply essential oils to children with sensitive skin, eczema or other chronic skin conditions, as they can be irritating, Dr. Stukus said.

  3. Don’t diffuse essential oils around infants under 6 months ancient. For older babies and children, it’s reasonably safe to diffuse certain oils such as cedarwood, ginger or sweet orange for up to an hour while monitoring your kid, said Dr. Esparham.

  4. Avoid applying citrus oils — such as those made from grapefruit, lemon or orange — to the skin, as they can react with ultraviolet radiation from the sun to cause burns, rashes or skin discoloration.

  5. In general, diffusing essential oils into the air is safer than using them on the skin.

    (But even then, it can be irritating to some. Never diffuse them in classrooms or in public spaces.)

  6. Never add undiluted essential oils to bath water. Oil and water don’t stir, so undiluted drops could irritate the skin. You can, however, add diluted drops, said Dr. Esparham. Use 2 drops of oil to 1 ounce of liquid Castile soap or a carrier oil.

  7. Avoid using synthetic oils, Dr. Esparham said, because the chemicals are more likely to cause side effects such as nausea or headache, skin irritation or breathing problems than more “pure” oils.

    Nonsynthetic oils are typically more expensive than synthetics — around $12 to $25 per vial. You can spot them by looking for their Latin names on their labels, love “ percent Cedrus atlantica oil” for cedar oil, she said.

  8. Even diluted oils can cause irritation, so always do a patch test: Rub the oil on a little area of skin and wait 24 hours to see if there’s any redness, swelling or rash. (If there is irritation, stop using the oil immediately.)

  9. Don’t flavor food or drink with essential oils, even if they are labeled “food safe.” They can be harmful if swallowed, and could damage the lining of the mouth or digestive tract.

  10. Store essential oils in a cool, dry put away from direct sunlight and out of the reach of children. Dr. Esparham advised keeping oils for no longer than a year as rancid oils are more likely to irritate the skin or trigger allergic reactions.

If your kid develops a rash or skin irritation; headaches; nausea or vomiting; coughing, wheezing or difficulty breathing; or any other symptoms while using oils, stop using them immediately and call your doctor.

Never use oils as a replacement for medical care.

(If you or someone you know may own been exposed to a dangerous substance, contact poison control immediately at or go to for assistance.)

Teresa Carr is an award-winning journalist based in Texas who specializes in science and health. She is a previous Consumer Reports editor and author, a Knight Science Journalism Fellow at the Massachusetts Institute of Technology, and she pens the Matters of Fact column for Undark.

Author: Hon A/ProfMarius Rademaker, Dermatologist, Hamilton, New Zealand,

Lavender — codes and concepts

Common name: Lavender (to wash)
Botanical name: Lavandula officinalis
Family: Lavandula species {Lamiaceae or mint family}
Origin: These perennials were found originally wild in the Mediterranean region.

The original name comes from the Latin, to wash.

Description: Lavender belongs to a genus of 28 species of hardy evergreen shrubs. Two of the more common species are English lavender (Lavendula officinalis) and French lavender (L. stoechas).The diverse varieties of this plant range in height from 20 cm to 1 meter in height, although some may grow taller with age. They own thin leaves and numerous endless spikes of lavender or purple flowers that grow up from the leaf axils.
Uses: The flowers and the foliage of lavender are sweet smelling and may be used dried or unused.

They produce fragrant oil that is extracted for commercial use. Hybrids developed specifically for this purpose own a high lavender-oil content and are known as lavandins. Lavender has been used for hundreds of years in sachets, potpourris and linens and to give a light flavour to fruit dishes, sauces, cordials, and confections. Unused sprigs are included in herbal bunches known as tussie mussies, which own been used for hundreds of years to mask unpleasant odours and ward off illness.

Allergens: The allergens in lavender oil are geraniol, linalool, linalylacetate and are well recognised in causing allergic contact dermatitis.

The usual exposure to lavender is from cosmetics and fragrances containing lavender oil. However, a recent study from Japan demonstrated that 4% of patients (with cosmetic allergy) were sensitive to lavender oil. The rate of allergy increased suddenly in , associated with an increase in the practice of aromatherapy. Allergy to lavender oil has also been reported following contact with a variety of medicate creams such as Difflam® gel and Phenergan® cream which contain lavender oils.

Allergy: Lavender oil (aroma therapy), Difflam gel, Phenergan cream.

There do not appear to be any reports of systemic reactions due to ingestion of lavender although there are such reports following eating of both oregano and thyme, which belong to the same family.

Cross reactions:
Other information:
Patch test: lavender oil 5% in petrolatum; 30% linalool, 10% geraniol, 10% linalyacetate

See smartphone apps to check your skin.
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Related information

But can they improve your health?

Some sellers — along with specific social media posts and websites that expound the oils’ benefits — attest with a helpful of evangelical zeal that certain essential oils can assist treat a range of ailments, from attention deficit disorder and depression to Alzheimer’s disease, cancer, skin abrasions, infections, teething pain and more.

Companies commonly market essential oils to parents for their purported ability to boost kids’ immune systems and to improve focus, mood and sleep.

But the bulk of the research done on essential oils has been performed in petri dishes and on rodents. “There are few human studies, and they are mostly little and of low quality,” Dr. Smith said.

And of the research that has been done on humans, said Dr. Smith, the bulk of the studies on essential oils’ effectiveness and safety has been performed on adults. A few studies in children propose that inhaling lavender oil can own a calming effect; that topical applications of tea tree oil may be useful against acne, lice and warts; and that peppermint oil capsules may assist with irritable bowel syndrome and abdominal pain.

However, there’s no evidence to support essential oils’ more common uses, such as for treating “fever, cough, congestion, allergies, teething symptoms and (the one that makes me the most frustrated) behavior problems,” Dr.

Smith wrote in a column for Cook Children’s Health Care System in

Unlike with prescription and over-the-counter drugs, the makers of essential oils do not own to prove to the Food and Drug istration that their products are safe and effective for certain conditions, or even that they contain what they tell they do on the label. And by law, oil makers are not allowed to advertise that their products can prevent or treat disease.

But that hasn’t stopped some sellers from making druglike claims.

Within the past five years, the F.D.A. has issued more than half a dozen warning letters to companies marketing cosmetic products containing essential oils, or the oils themselves. In , for example, the agency stated that paid consultants for both doTerra and Young Living were claiming, without evidence, that some of their essential oils could be useful against conditions such as autism, cancer, Alzheimer’s disease, viral infections (including Ebola) and more.

In response to the F.D.A.’s letter, a spokeswoman for doTerra told The New York Times that the company has created a “compliance team” of more than 50 people that “crawls the web to ensure wellness advocates are not propagating noncompliant claims,” and that the company takes corrective action if needed.

Young Living also has a strict compliance policy, according to a company spokeswoman. “Consequences for violating said policy are swift and consistent,” she said, “up to and including the revoking of membership and its privileges.”

Other websites:


A wide prevalence of socio-religious and cultural practices in the Asian subcontinent often leads to multitude of skin diseases which may be missed by the dermatologists because of a lack of awareness.

‘Henna’ use causes IgE-mediated hypersensitivity reactions and contact dermatitis. ‘Kumkum’ application can result in pigmented contact dermatitis and lichen planus pigmentosus. Sticker ‘bindis’ and ‘alta’ induce contact leukoderma. Irritant and allergic contact dermatitis occurs after playing with ‘Holi’ colors. Threading and drawstring dermatitis lead to koebnerization of pre-existing dermatoses, infections and even squamous cell carcinoma of skin. Mild irritant reactions and contact sensitization happen secondary to balm and hair oil use. ‘Mudichood’ represents the comedogenic effect of hair oils combined with occlusion and humidity.

Aromatherapy oils can cause contact dermatitis and photosensitive reactions. Heavy metal and steroid toxicity along with severe cutaneous adverse effects love erythroderma can happen as a consequent to the use of alternative medicines. Squamous cell carcinoma due to chronic heat exposure from the heating device «kangri» is seen in Kashmiris. Prayer nodules in Muslims and traction alopecia in Sikhs illustrate how religious practices can negatively affect the skin. With increasing globalization and migration, the practice of indigenous customs and traditions is no longer limited to regional territories, making it imperative for the dermatologists to be acquainted with the cutaneous side effects they can cause.

Keywords:Alta, alternative medicine, bindi, drawstring dermatitis, henna, holi dermatoses, kumkum, mudichood, prayer nodules, traction alopecia

How to cite this article:
Gupta D, Thappa DM.

Dermatoses due to indian cultural practices. Indian J Dermatol ;

What was known?
Most of the evidence regarding dermatoses secondary to Indian cultural practices is scattered in the literature and comes from case reports and case series.


In the Asian subcontinent, the presence of various socio-religious and cultural practices along with widespread use of complementary and alternative medicine frequently result in a host of secondary dermatoses. With increasing migration and sharing of cultures, it is vital for dermatologists to be familiar with these dermatoses.

This review focuses on Indian cultural and religious practices and traditional medicines which can result in skin disorders.


The history and origin of henna is hard to trace with centuries of migration and cultural interaction. The athletic ingredient of henna is lawsone (2-hydroxy-1, 4-naphthoquinone). [1] It is derived from the leaves and flowers of Lawsonia inermis, family Lythraceae, a plant which grows in boiling climates of northern Africa and western and southern Asia.

[2] Hence, it is not surprising that the use of henna has flourished in these regions.

In India, henna is used as Mehndi[Figure 1] and also as a hair dye. In the West, henna has gained popularity in recent years as a temporary tattoo as it does not require any piercing (pseudo-tattooing). [3] Traditionally, several medicinal properties are attributed to henna. It is also believed to act as a preservative for leather and cloth as it repels pests and mildew.

Pure henna rarely causes allergic reactions.

[4] However, cases of palpebral eczema, allergic contact dermatitis and immediate-type hypersensitivity with urticaria, rhinitis, conjunctivitis and bronchial asthma own been recorded, [1],[5],[6] with type-I hypersensitivity being confirmed by both skin prick test [7] and radio allergen sorbent test (RAST). [8] In most cases, allergic reactions are caused by coloring agents love para-phenylenediamine (PPD) («Black henna»), diaminotoluenes and diaminobenzenes which are added to pure henna for quicker drying and deeper color intensity.

[1] In one study, the prevalence of patch test positivity to PPD among beauticians and hairdressers was 35%, whereas it was only 3% to pure henna. [9] In fact, the percentage of PPD may be as high as 64% in products purporting to be henna. [10] Heavy metals love nickel and cobalt, which are often present in henna tattoo mixtures, own also been proposed as inciting agents for sensitization. [4] PPD has been known to cause severe generalized vesicular erythema multiforme-like reaction, [11] and contact angioedema [12] progressing to involve pharynx, larynx and bronchi with hoarseness of voice and stridor.

[13] More seriously it may cause acute renal failure and ultimately death due to renal tubular necrosis. [14] It has been reported to cause pruritus, severe bullous contact dermatitis, [15] post inflammatory hypo or hyperpigmentation, [2],[16] persistent leukoderma, [17] hypertrichosis, [18] lichenoid reactions [19] and keloids. [20],[21] Hyperbilirubinemia was observed in glucosephosphate dehydrogenase (G6PD)-deficient individuals exposed to henna, due to oxidative hemolysis. [22] These patients may own been previously sensitized to PPD through exposure to hair or textile dyes, black rubber products, plastics, oils, adhesive tapes, shoes, petrol, certain cosmetics, and ballpoint pens.

[11],[19] The mechanism of sensitization is based on the conversion (by oxidation) of the pro-hapten (PPD) to the hapten (quinone diamine) that can react directly with a protein, causing irritation of the skin and mucous membranes of the sensitive individuals. [22] There own been demands for legislation that prohibits the use of PPD in black henna tattoos. Therefore, patch tests for PPD and heavy metals should be conducted when henna-related allergic contact dermatitis occurs, along with additional tests as necessary.


‘Kumkum’ (available as powder and liquid) is generally applied to the middle of the forehead, occasionally dusted on the front of the neck or used on the hair parting as «Sindoor» (vermilion) to denote the woman’s marital status.

[23] Although majority of Hindu women use kumkum, dermatitis due to it develops only in a few. This can be explained by either individual susceptibility or constant use for a prolonged period. It is also a common practice for males, especially priests, to use kumkum for religious purposes. [24]

Nath and Thappa [23] found pigmented contact dermatitis [Figure 2] in 76% of the patients and allergic contact dermatitis in 24% of the patients using kumkum.

Forehead was the most common site, followed by the glabellar area, hair parting, abdomen, and neck [Figure 3]. The surrounding skin may be involved if the kumkum trickles below the skin in sweat. [25] Other presentations include only brown or slate gray hyperpigmentation without clinically overt dermatitis [25],[26] and lichen planus pigmentosus. [25] ‘Chandan‘ or sandalwood paste in kumkum can also cause photoallergic reactions, and these patients must also undergo a photo patch test.

What essential oil is excellent for allergies


Figure 3: Allergic contact dermatitis extending up to glabella and hair parting. Note that patient continues to wear the bindi in spite of athletic dermatitis

Click here to view

In India, it is often hard to obtain the exact constituents of kumkum from the manufacturers for patch testing. The present knowledge of the constituents of kumkum comes from a limited number of case reports and case series. The commercially prepared kumkum has been shown to contain Brilliant Lake Red R, Sudan I, aminoazobenzene, canaga oil, fragrances, groundnut oil, tragacanth gum, turmeric powder, [27] thimerosal, gallate stir, PPD, Kathon CG, benzotriazol, tert-butyl hydroquinone, [23] parabens, [23],[27]chandan‘, [24] chalk powder colored with various azo dyes [25] and other dyes (coal tar dyes, toluidine red, erythrosine, and lithol red calcium salt).

[28] The red-colored powder «sindoor» contains mercury and the black paste lead sulfide. [25] It is common to see saffron, ash or camphor being smeared onto the neck or forehead skin in the temples (personal observation).


The terms kumkum and bindi overlap somewhat, but are not synonymous. Kumkum is always applied with paste or powder and can cover the face or other parts of the body. On the other hand, a bindi may be paste or a sticker and is worn only between the eyes. Self-adhesive bindis (sticker bindis) are disposable substitutes for older liquid bindis, and are favorite because of their ease of application.

What essential oil is excellent for allergies


Contact leukoderma is one of the most frequent manifestations of sticker bindis [Figure 4]. [29],[30],[31] In a study of cases of chemical leukoderma, (12%) cases were due to adhesive bindi. [32] It is possible that bindi-induced depigmentation may be more common in patients predisposed to vitiligo, [33] and chemical leukoderma must be excluded with certainty from every case of idiopathic vitiligo. [32] Irritation, pruritus and erythema may be seen prior to the development of depigmentation.

[31] The lag period between use and depigmentation is highly variable, ranging from a few weeks to a few years. Other presentations include allergic contact dermatitis [Figure 5][34] and granuloma formation. [35]

The sticker bindis are made up of circular discs of polyvinylchloride (PVC) [31] and the adhesive material contains para-tertiary butyl phenol (PTBP), [31],[32],[36] the concentration of which may be as high as 80%. [36] These agents cause depigmentation through their melanocytotoxic effect. Other allergens implicated in causation of contact dermatitis due to bindi include epoxy resins, [37] Disperse Blue , Disperse Blue , [38] nickel [34] and thimerosal and gallate stir.


The treatment of bindi leukoderma hinges upon early recognition of the condition and cessation of use of sticker bindis, which can be hard as most married Hindu women are strongly conditioned to wear a bindi at every times. Other modalities include topical steroids and melanocyte transfer surgery. [40]


Alta is a red-colored dye applied by women hailing from West Bengal to the border of their feet during religious and social functions.

Sometimes, the Hindu bride steps into a plate of alta before crossing the threshold of her in-laws home for the first time. Alta can cause dermatitis followed by depigmentation at the site of application. [41] Ghosh and Mukhopadhyay found the frequency of alta-induced depigmentation to be % of every chemical leukoderma cases. [32] Chemical agents in alta include azo dyes and PPD. [41] Bajaj et al. found solvent yellow 3, [42] Crocein Scarlet MOO (CSM) (brilliant crocein) and rhodamine B (tetraethyl rhodamine) in alta by chromatographic and spectroscopic analysis.


Holi dermatoses

Holi is a harvest festival in which people symbolically smear dry powdered colors («Abeer» or «Gulal») and spray water soluble colors on each other. These synthetic colors are sold in an unregulated manner in roadside markets and no checks can be enforced on the product composition leading to an annual spurt in dermatoses each year immediately following Holi. [43]

The Holi colors contain numerous hazardous chemicals [Table 1][44] and heavy metals love asbestos or silica, which can cause respiratory problems, skin diseases and eye problems.

Numerous of the water-soluble colors own an alkaline base. [44] Sometimes, mica or powdered glass is added as sparkling agent to the colors. [43]

In a study of 42 patients with Holi dermatoses, Ghosh et al. [45] found itching to be the most common symptom (60%) followed by burning sensation, pain, and oozing. Eczematous lesions were the most common (57%), followed by erosions, scaling, erythema, urticaria, and acute nail-fold inflammation. Aggravation of pre-existing skin disorders (acne, eczema, and paronychia) and secondary pyoderma occurred in 31% and 7% patients, respectively. Vigorous scrubbing with abrading materials to remove color from the skin led to facial abrasions.

The most common site of involvement was the face and other areas of exposed skin. Hand involvement was seen secondary to preparation of the colored solutions. Photosensitivity, tenderness and acute exfoliation due to sunburn own been reported. [43]


This rare condition, the literal meaning of which is «hair-heat» in Malayalam language, is commonly seen in young women in the southern tropical parts of India, especially in Kerala. Women from this area wash and oil their endless hair daily and then leave it to dry in the sun.

This condition represents a nonspecific follicular reaction to oil aggravated by moist environment and profuse sweating. [46]

Mudichood is characterized by itchy, pigmented lichenoid dermatitis with follicular, flat-topped scaly papules on the pinnae, [47] nape of neck, upper back and even forearm. [48] The papules own a thin keratinous rim, and there is a slight depression in the middle. Manual removal of adherent scales leaves a hyperpigmented base. [49] Koebner’s phenomenon has been noted. [46] Long-standing cases may show confluence of papules.


Histopathology is characterized by focal parakeratosis, acanthosis and occasional suprapapillary thinning. Cells with large vacuolated nuclei are seen in superficial layers of the epidermis. The dermal papillae appear edematous, and the capillaries may be dilated. [46],[49]

Treatment with % salicylic, short hair and regular washing with shampoos helps prevent this condition. [46],[49]


Threading is a cheap and effective, though painful, method of removal of facial vellus hairs, which is commonly come across in beauty salons of South Asia and the Middle East.

Most women are unaware of the possible complications of this procedure which include transient erythema, edema, irritant dermatitis, and pigmentary changes love hyperpigmentation as well as depigmentation. [50] In specific, threading-induced trauma can lead to koebnerization of pre-existing dermatoses, especially vitiligo. [51] Infections love folliculitis, verrucae, pseudofolliculitis, molluscum contagiosum [52] and bullous impetigo [53] can arise. Verma proposed that threading-induced disruption of the dermal-epidermal junction allowed seeding of human papilloma virus (HPV), which could own been present on the threading equipment, on the beautician’s hands, or on other parts of the patient’s body.

Damage to the melanocyte stem cell reservoir in the bulge area of hair follicle was believed to lead to depigmentation. [51] Aseptic techniques should be followed by the beautician to prevent infectious complications. [54]

Ayurveda/alternative medicines

Complementary and alternative medicines (CAMs) are used both for dermatological and non-dermatological indications, with side effects which are often dermatological in nature.

In India, the AYUSH system-Ayurveda, Yoga and naturopathy, Unani, Siddha, Homeopathy-is favorite because of its wide acceptability and accessibility, low cost and a perceived lack of side effects. Globally also, the use of CAMs is on the rise, as borne by one study in which up to 30% of attendees in a city-based hospital in United Kingdom were found to own used CAMs at some point of time or other. [55]

These drugs are often dispensed in little paper or plastic packets, and there is no documentation of what drug has been prescribed. However, on detailed analysis, one in five herbal medicine products was shown to contain potentially harmful levels of heavy metals love lead, mercury, arsenic, chromium and cadmium.

[56] Arsenic can cause punctate palmoplantar keratoderma, leukomelanoderma, arsenical keratosis, Bowen’s disease, squamous cell carcinoma, [57] and non-cirrhotic portal fibrosis. [58] Mercury can cause gingivitis, stomatitis, excessive salivation, acrodynia, [58] tylotic eczema, dryness of the skin, skin ulceration and erythroderma. [59] Chromates, in addition, can cause allergic contact dermatitis in sensitized individuals.

Apart from heavy metals, injudiciously prescribed oral or topical steroids in CAMs not only modify the picture of a disease, but also lead to side effects love weight acquire, hypertrichosis and depigmentation at the site of application.


The authors own seen patients of pemphigus and pyodermas, with skin lesions smeared with dry paste of neem (Azadirachta indica) leaves [Figure 6] or sandalwood/turmeric powder [Figure 7], resulting in disease flare, irritant dermatitis, secondary infection, and even life-threatening sepsis.

Aromatherapy/essential oils

Aromatherapy, or essential oils therapy, is using a plant’s aroma-producing oils (essential oils) taken from its flowers, leaves, bark, or roots to treat disease. Mustard, coconut, linseed, and gingelly oils are used commonly in India for massage or «maalish«.

However, essential oils can cause side-effects love allergic or irritant contact dermatitis, [61],[62],[63] photosensitive reactions [63] and perioral and intraoral dematitis with cheilitis. [64] The favorite aromatherapy oil of bergamot, which contains furocoumarins, primarily bergapten (5-methoxypsoralen), possesses phototoxic properties. Bullous phototoxic skin reactions can develop even without direct contact, simply after exposure to aerosolized aromatherapy oil. [65] In one study, hand dermatitis was found to happen in up to 23% of massage therapists [66] and risk factors for its development included contact with essential oils and history of atopic dermatitis.


Dermatitis can happen secondary to allergens love lavender, [63] peppermint, [64] neomycin, perfume stir, [68] ylang-ylang oil, lemongrass oil, sandalwood oil, clove oil, [69] olive oil, [70] black cumin, [71] curcumin, [72] French marigold, [73] jasmine, rosewood, [74] tea-tree oil [75] and numerous others. Cross-reactivity between distillate and main allergen can happen. [69]

Patch test is significant for investigating individuals with suspected aromatherapy allergy and the battery should always include patient’s own products.

[69] Gas chromatography has been advocated for the diagnosis of multiple allergies to essential oils. [76]

Hair oils

The application of oil to the hair is believed to prevent hair loss and make the hair stronger. Mustard oil, coconut oil, amla oil and almond oil are commonly used by the Indian population in addition to various Ayurvedic or herbal hair oils containing menthol, camphor, sesame, rosemary and thyme. [77] Both beneficial and harmful skin effects own been ascribed to these agents. Coconut oil was shown to decrease colonization of Staphylococcus aureus in atopic skin.

[78] Garg and Muller demonstrated that saturated and unsaturated fatty acids in mustard, coconut and amla oil inhibited the growth of dermatophytes. Amla oil had the maximum toxicity against Microsporum canis, M. gypseum and Trichophyton rubrum, while Trichophyton mentagrophytes was most susceptible to coconut oil. They attributed the low incidence of tinea capitis in India to the widespread use of hair oils. [79] Topical application of a polyherbal formulation containing the favorite herb Eclipta albabhringraj«) on rat skin led to an increase in the number of anagen hair follicles and decrease in time required for finish hair growth.


Conversely, mustard oil has been implicated in causing pityriasis rosea-like eruption which was subsequently confirmed by patch testing. [81] Almond oil application led to percutaneous sensitization and contact dermatitis in an atopic kid. [82] Although contact allergy to pure coconut oil is rare, mild irritant reactions and sensitization to coconut derivatives love cocamidopropyl betaine, [83],[84] cocamidopropyl dimethylamine, [84] coconut diethanolamide, [85] and cocamidopropyl PG dimonium chloride phosphate [86] own been reported.

However, it must be noted that these adverse effects were secondary to topical cutaneous application of the oils and/or occupational exposure, and not because of use over scalp.


Self-medication with topical balms to relieve headache, muscle and joint pain is common in South East Asia. Most balms contain methyl salicylate, menthol and camphor. Tiger balm, a Chinese herbal medicament commonly used in India, which additionally combines peppermint, clove oil, cajuput oil, cassia oil and ammonia solution, [87] can cause contact dermatitis. [88] However, upon patch testing, only a mild irritant reaction was observed and the authors opined that it was safe when applied openly.

[87] Cross reaction to balsam of Peru was noted. [88]

Drawstring dermatitis

Drawstring dermatitis is a type of frictional dermatitis that can result from traditional tightly worn garments love «sari» and «salwaar-kameez«. Sari is worn over a petticoat fastened at the waist with drawstrings. Salwaar is a baggy pant, held up at the waist by drawstrings or an elastic band.

The resulting chronic friction at the waist can lead to lichenified grooves, post inflammatory depigmentation/leukoderma [Figure 8] and koebnerization of pre-existing dermatoses love vitiligo [Figure 9] and lichen planus. [89] Chronic friction combined with sweating and humid environment of the tropics predisposes to candida, dermatophytes and bacterial infections [Figure 10]. [89] Rarely, squamous cell carcinoma has been reported. [89] Prevention of the condition lies in weight reduction and tying the drawstrings loosely, especially in those inclined to develop koebnerizing conditions.


Figure 9: Drawstring dermatitis-lip vitiligo with koebnerization at waist

Click here to view

Prayer nodules in Muslims

These own been described as «religious equivalents of an occupational callus». [90] During prayer, Muslims adopt a squatting position and repeatedly touch their forehead on a prayer rock. Repeated pressure and friction leads to formation of callosities over forehead, [91] knees, ankles and dorsa of feet.

[90] Over the forehead they present as discrete, lichenified areas or soft nodules, cm in size, with or without comedones, over the medial finish of the eyebrows. Age-related changes and actinic damage are believed to contribute to the formation of lesions. [91] Histology shows hyperkeratosis, acanthosis, epidermoid cysts, [91] hypergranulosis, dermal papillary fibrosis, and dermal vascularization. [92] Mucin deposition has been described.

[93] Advice regarding alteration of position while praying and topical use of 40% urea ointment can treat this condition. [90]

Traction alopecia of Sikhs

In the Sikh religion, men are prohibited from cutting the hair on their scalp and face. The scalp hair is tied into a tight knot on the vertex area of scalp over which a turban is worn and the beard hair is twisted into a knot under the chin. [94] Over a period of time, the sustained tug inflicts continuous physical trauma to the hair shafts and results in permanent alopecia.

[94] A sharply circumscribed band-like scarring alopecia develops at the frontal hairline [95] as well as along the sides of the mandible. [96] A biopsy shows loss of hair follicles, fibrous stelae and scant dermal inflammatory infiltrate. [95] Hair should be tied loosely during the day and left open at night. [95] Topical steroids may give some relief in initial stages. [94] Once the alopecia has become irreversible, restorative hair transplantation remains the only effective intervention.


Kangri cancer

This is a squamous cell carcinoma (SCC) that occurs due to keeping lighted coal in a kangri basket (used in remote hilly regions of Kashmir) shut to the skin in winter to hold warm. The kangri basket, which holds burning coal and dried chinar (Platanus orientalis) leaves, is held between the thighs or over the lower abdomen for prolonged periods of hours a day. [97] Early changes include dyspigmentation, erythema ab igne, induration and thickening over medial aspect of upper third of the thighs.

Malignant transformation is heralded by development of exophytic growths [97] and ulcers which often get secondarily infected. [98] Tar from chinar leaves and other combustion products were shown to be co-carcinogens in one study. [99]


Cultural and socio-religious beliefs influence our daily lives and own the potential to introduce health hazards in our body. In this era of globalization, cultural practices cut across geographical boundaries.

Raising awareness among physicians with regards to «cultural dermatology» is thus significant. Modern dermatologists should be sensitive to ethno-cultural aspects of dermatoses and must be encouraged to enquire directed questions about the same. This is especially relevant in migrant populations who are trying to integrate into new societies and thus may be hesitant to volunteer such information unless specifically asked for. Testing for safety of various chemicals being used or added in these cosmetic products love essential oils, balms, henna, bindis, kumkum and holi colors should be regulated.

The constituents of the products need to be put on the cover. Most of the evidence regarding the above-mentioned adverse effects comes from case reports and hence establishing a causal link to the perpetrating agent is hard. A systematic research into this complicated area is called for. The cutaneous manifestations resulting from Indian socio-cultural practices are summarized in [Table 2].


1. Polat M, Dikilita M, Ozta P, Alli N. Allergic contact dermatitis to pure henna. Dermatol Online J ;
2. Kazandjieva J, Grozdev I, Tsankov N.

Temporary henna tattoos. Clin Dermatol ;

3. Le Coz CJ, Lefebvre C, Keller F, Grosshans E. Allergic contact dermatitis caused by skin painting (pseudotattooing) with black henna, a mixture of henna and p-phenylenediamine and its derivatives. Arch Dermatol ;
4. Kang IJ, Lee MH. Quantification of para-phenylenediamine and heavy metals in henna dye. Contact Dermatitis ;
5. Belhadjali H, Ghannouchi N, Amri Ch, Youssef M, Amri M, Zili J.

Contact dermatitis to henna used as a hair dye. Contact Dermatitis ;

6. Majoie IM, Bruynzeel DP. Occupational immediate-type hypersensitivity to henna in a hairdresser. Am J Contact Dermat ;
7. Ventura MT, Di Leo E, Buquicchio R, Foti C, Arsieni A. Is black henna responsible for asthma and cross reactivity with latex? J Eur Acad Dermatol Venereol ;
8. Bolhaar ST, Mulder M, van Ginkel CJ. IgE-mediated allergy to henna.

Allergy ;

9. Khanna N. Hand dermatitis in beauticians in India. Indian J Dermatol Venereol Leprol ;
Almeida PJ, Borrego L, Pulido-Melin E, Gonzlez-Daz O. Quantification of p-phenylenediamine and 2-hydroxy-1, 4-naphthoquinone in henna tattoos. Contact Dermatitis ;
Sidwell RU, Francis ND, Basarab T, Morar N. Vesicular erythema multiforme-like reaction to para-phenylenediamine in a henna tattoo.

Pediatr Dermatol ;

Oztas MO, Onder M, Oztas P, Atahan C. Contact allergy to henna. J Eur Acad Dermatol Venereol ;
Broides A, Sofer S, Lazar I. Contact dermatitis with severe scalp swelling and upper airway compromise due to black henna hair dye. Pediatr Emerg Care ;
Nigam PK, Saxena AK. Allergic contact dermatitis from henna. Contact Dermatitis ;
Jung P, Sesztak-Greinecker G, Wantke F, Gtz M, Jarisch R, Hemmer W.

A painful experience: Black henna tattoo causing severe, bullous contact dermatitis. Contact Dermatitis ;

Jung P, Sesztak-Greinecker G, Wantke F, Gtz M, Jarisch R, Hemmer W. The extent of black henna tattoo’s complications are not restricted to PPD-sensitization. Contact Dermatitis ;
Valsecchi R, Leghissa P, Di Landro A, Bartolozzi F, Riva M, Bancone C. Persistent leukoderma after henna tattoo. Contact Dermatitis ;
del Boz J, Martn T, Samaniego E, Vera A, Morn D, Crespo V. Temporary localized hypertrichosis after henna pseudotattoo.

Pediatr Dermatol ;

Rubegni P, Fimiani M, de Aloe G, Andreassi L. Lichenoid reaction to temporary tattoo. Contact Dermatitis ;
Gunasti S, Aksungur VL. Severe inflammatory and keloidal, allergic reaction due to para-phenylenediamine in temporary tattoos. Indian J Dermatol Venereol Leprol ;
Tan E, Garioch J. Black henna tattoos: Coexisting rubber and para-phenylenediamine allergy? Clin Exp Dermatol ;
Raupp P, Hassan JA, Varughese M, Kristiansson B.

Henna causes life threatening haemolysis in glucosephosphate dehydrogenase deficiency. Arch Dis Kid ;

Nath AK, Thappa DM.

What essential oil is excellent for allergies

Kumkum-induced dermatitis: An analysis of 46 cases. Clin Exp Dermatol ;

Tewary M, Ahmed I. Bindi dermatitis to ‘chandan’ bindi. Contact Dermatitis ;
Kumar AS, Pandhi RK, Bhutani LK. Bindi dermatoses. Int J Dermatol ;
Osmundsen PE. Pigmented contact dermatitis. Br J Dermatol ;
Goh CL, Kozuka T. Pigmented contact dermatitis from ‘kumkum’.

Clin Exp Dermatol ;

Mehta SS, Reddy BS. Cosmetic dermatitis-current perspectives. Int J Dermatol ;
Bajaj AK, Govil DC. Contact depigmentation. Indian J Dermatol Venereol Leprol ;
Bajaj AK, Govil DC, Bajaj S. Bindi depigmentation. Arch Dermatol ;
Mathur AK, Srivastava AK, Singh A, Gupta BN. Contact depigmentation by adhesive material of bindi. Contact Dermatitis ;
Ghosh S, Mukhopadhyay S.

Chemical leucoderma: A clinico-aetiological study of cases in the perspective of a developing country. Br J Dermatol ;

Bose SK. Is bindi-induced depigmentation common in patients predisposed to vitiligo? J Dermatol ;
Baxter KF, Wilkinson SM. Contact dermatitis from a nickel-containing bindi. Contact Dermatitis ;
Ramesh V. Foreign-body granuloma on the forehead: Reaction to bindi. Arch Dermatol ;
Bajaj AK, Gupta SC, Chatterjee AK.

Contact depigmentation from free para-tertiary-butylphenol in bindi adhesive. Contact Dermatitis ;

Calnan CD, Cooke MA. Leukoderma in industry. J Soc Occup Med ;
Dwyer CM, Forsyth A. Allergic contact dermatitis from bindi. Contact Dermatitis ;
Laxmisha C, Nath AK, Thappa DM. Bindi dermatitis due to thimerosal and gallate stir. J Eur Acad Dermatol Venereol ;
Bajaj AK, Saraswat A, Srivastav PK.

Chemical leucoderma: Indian scenario, prognosis, and treatment. Indian J Dermatol ;

Bajaj AK, Pandey RK, Misra K, Chatterji AK, Tiwari A, Basu S. Contact depigmentation caused by an azo dye in alta. Contact Dermatitis ;
Bajaj AK, Misra A, Misra K, Rastogi S. The azo dye solvent yellow 3 produces depigmentation. Contact Dermatitis ;
Ghosh SK, Bandyopadhyay D, Verma SB. Cultural practice and dermatology: The «Holi» dermatoses. Int J Dermatol ;
Society for the Confluence of Festivals in India (SCFI).

Holi. Available from: [Last accessed on Oct 16].

Ghosh SK, Bandyopadhyay D, Chatterjee G, Saha D. The ‘holi’ dermatoses: Annual spate of skin diseases following the spring festival in India. Indian J Dermatol ;
Gharpuray MB, Kulkarni V, Tolat S. Mudi-chood: An unusual tropical dermatosis. Int J Dermatol ;
Sugathan P. Mudi-childhood on the pinnae. Br J Dermatol ;
Sugathan P, Martin AM. Mudi-chood: On the forearm.

Indian J Dermatol ;

Sugathan P. Mudi-chood disease. Dermatol Online J ;
Abdel-Gawad MM, Abdel-Hamid IA, Wagner RF Jr. Khite: A non-western technique for temporary hair removal. Int J Dermatol ;
Verma SB. Vitiligo koebnerized by eyebrow plucking by threading. J Cosmet Dermatol ;
Verma SB. Eyebrow threading: A favorite hair-removal procedure and its seldom-discussed complications.

Clin Exp Dermatol ;

Bloom MW, Carter EL. Bullous impetigo of the face after epilation by threading. Arch Dermatol ;
Lilly E, Kundu RV. Dermatoses secondary to Asian cultural practices. Int J Dermatol ;
Nicolaou N, Johnston GA. The use of complementary medicine by patients referred to a contact dermatitis clinic. Contact Dermatitis ;
Saper RB, Kales SN, Paquin J, Burns MJ, Eisenberg DM, Davis RB, et al. Heavy metal content of ayurvedic herbal medicine products. JAMA ;
Kew J, Morris C, Aihie A, Fysh R, Jones S, Brooks D.

Arsenic and mercury intoxication due to Indian ethnic remedies. BMJ ;

Khandpur S, Malhotra AK, Bhatia V, Gupta S, Sharma VK, Mishra R, et al. Chronic arsenic toxicity from Ayurvedic medicines. Int J Dermatol ;
Ernst E. Adverse effects of herbal drugs in dermatology. Br J Dermatol ;
Verma S. Effect of alternative medicinal systems and general practice.

Int J Dermatol ;46 Suppl

Lakshmi C, Srinivas CR. Allergic contact dermatitis following aromatherapy with valiya narayana thailam—an ayurvedic oil presenting as exfoliative dermatitis. Contact Dermatitis ;
Yang CC, Tu ME, Wu YH. Allergic contact dermatitis from incense. Contact Dermatitis ;
Wu PA, James WD. Lavender. Dermatitis ;
Herro E, Jacob SE. Mentha piperita (peppermint).

What essential oil is excellent for allergies

Dermatitis ;

Kaddu S, Kerl H, Wolf P. Accidental bullous phototoxic reactions to bergamot aromatherapy oil. J Am Acad Dermatol ;
Boonchai W, Iamtharachai P, Sunthonpalin P. Occupational allergic contact dermatitis from essential oils in aromatherapists. Contact Dermatitis ;
Crawford GH, Katz KA, Ellis E, James WD. Use of aromatherapy products and increased risk of hand dermatitis in massage therapists. Arch Dermatol ;
Weiss RR, James WD. Allergic contact dermatitis from aromatherapy. Am J Contact Dermat ;
Uter W, Schmidt E, Geier J, Lessmann H, Schnuch A, Frosch P.

Contact allergy to essential oils: Current patch test results () from the Information Network of Departments of Dermatology (IVDK). Contact Dermatitis ;

Williams JD, Tate BJ. Occupational allergic contact dermatitis from olive oil. Contact Dermatitis ;
Steinmann A, Schtzle M, Agathos M, Breit R. Allergic contact dermatitis from black cumin (Nigella sativa) oil after topical use. Contact Dermatitis ;
Hata M, Sasaki E, Ota M, Fujimoto K, Yajima J, Shichida T, et al. Allergic contact dermatitis from curcumin (turmeric).

Contact Dermatitis ;

Bilsland D, Strong A. Allergic contact dermatitis from the essential oil of French marigold (Tagetes patula) in an aromatherapist. Contact Dermatitis ;
Schaller M, Korting HC. Allergic airborne contact dermatitis from essential oils used in aromatherapy. Clin Exp Dermatol ;
Rubel DM, Freeman S, Southwell IA. Tea tree oil allergy: What is the offending agent?

What essential oil is excellent for allergies

Report of three cases of tea tree oil allergy and review of the literature. Australas J Dermatol ;

Dharmagunawardena B, Takwale A, Sanders KJ, Cannan S, Rodger A, Ilchyshyn A. Gas chromatography: An investigative tool in multiple allergies to essential oils. Contact Dermatitis ;
Ayur Natural Beauty. Navratna Plus Herbal Cool Oil-Product Description. Available from: [Last accessed on Oct 16].
Verallo-Rowell VM, Dillague KM, Syah-Tjundawan BS.

Novel antibacterial and emollient effects of coconut and virgin olive oils in adult atopic dermatitis. Dermatitis ;

Garg AP, Mller J. Inhibition of growth of dermatophytes by Indian hair oils. Mycoses ;
Roy RK, Thakur M, Dixit VK. Development and evaluation of polyherbal formulation for hair growth-promoting activity. J Cosmet Dermatol ;
Zawar V. Pityriasis rosea-like eruptions due to mustard oil application. Indian J Dermatol Venereol Leprol ;
Guillet G, Guillet MH.

Percutaneous sensitization to almond oil in infancy and study of ointments in 27 children with food allergy. Allerg Immunol (Paris) ;

Shaffer KK, Jaimes JP, Hordinsky MK, Zielke GR, Warshaw EM. Allergenicity and cross-reactivity of coconut oil derivatives: A double-blind randomized controlled pilot study. Dermatitis ;
Suuronen K, Pesonen M, Aalto-Korte K. Occupational contact allergy to cocamidopropyl betaine and its impurities. Contact Dermatitis ;
Pinola A, Estlander T, Jolanki R, Tarvainen K, Kanerva L. Occupational allergic contact dermatitis due to coconut diethanolamide (cocamide DEA).

Contact Dermatitis ;

Roberts H, Williams J, Tate B. Allergic contact dermatitis to panthenol and cocamidopropyl PG dimonium chloride phosphate in a facial hydrating lotion. Contact Dermatitis ;
Lee TY, Lam TH. Patch testing of 11 common herbal topical medicaments in Hong Kong. Contact Dermatitis ;
Rietschel RL, Fowler JF. Medications from plants.

In: Rietschel RL, Fowler JF, editors. Fisher’s Contact Dermatitis. 6 th ed. Hamilton: BC Decker Inc; p.

Verma SB.

What essential oil is excellent for allergies

Dermatological signs in South Asian women induced by sari and petticoat drawstrings. Clin Exp Dermatol ;

English JS, Fenton DA, Wilkinson JD. Prayer nodules. Clin Exp Dermatol ;
Vollum DI, Azadeh B. Prayer nodules. Clin Exp Dermatol ;
Abanmi AA, Al Zouman AY, Al Hussaini H, Al-Asmari A. Prayer marks. Int J Dermatol ;
O’Goshi KI, Aoyama H, Tagami H. Mucin deposition in a prayer nodule on the forehead. Dermatology ;
James J, Saladi RN, Fox JL. Traction alopecia in Sikh male patients. J Am Board Fam Med ;
Karimian-Teherani D, El Shabrawi-Caelen L, Tanew A.

Traction alopecia in two adolescent Sikh brothers-an underrecognized problem unmasked by migration. Pediatr Dermatol ;

Kanwar AJ, Kaur S, Basak P, Sharma R. Traction alopecia in Sikh males. Arch Dermatol ;
Wani I. Kangri cancer. Surgery ;
Suryanarayan CR. Kangri cancer in Kashmir valley: Preliminary study. J Surg Oncol ;
Gothoskar SV, Ranadive KJ. Experimental studies on the aetiology of «Kangri cancer».

Br J Cancer ;

What is new?
This is a comprehensive and an inclusive review for ready referral for physicians who are not aware of the various skin disorders that can result from Indian socio-religious and cultural habits.


[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]


[Table 1], [Table 2]