124Diabetes Spectrum Volume 14, Number 3, 2001

Aromatherapy has a long history ofuse. Dating back to the time ofHippocrates, skin problems weretreated with aromatic baths.1 Sincethen, essential oils have been usedcontinuously not just for their pleas-ant aromas, but also for their medicalproperties.

The renaissance of aromatherapyoccurred in France in the 1940s withthree individuals in the medical field.Gattefosse, a French chemist, burnedhis hand and arm so badly that gasgangrene set in. At that time, the onlytreatment for gas gangrene was ampu-tation, but Gattefosse used essentialoil of lavender, and his wounds healedrapidly. He was so impressed that hededicated his life to the use of essen-tial oils for skin problems.2 Valnet, aphysician, used essential oils onwounds in the Indo-China war whenantibiotics ran out.3 Maury, a surgicalassistant, carried out research on howessential oils helped skin elasticity andintegrity and assisted wound healing.4

Nurses have also been involved inaromatherapy. During the past 10years, nurses have been using aro-matherapy as an enhancement ofnursing care in Australia, SouthAfrica, Germany, Switzerland, theUK, and, more recently, the UnitedStates. The idea that nursing carecould be enhanced with pleasantsmells and gentle touch is not a newone. Florence Nightingale was famousfor anointing the foreheads of herwounded soldiers with lavender oil.

Hospitals can be frightening formany people, and the smells of hospi-tals can compound their fear. Chronicslow-healing wounds can meanrepeated hospital visits. A judicioususe of essential oils can put some hos-pitality back into our hospitals,reduce the stress of coping for bothstaff and patients, improve woundcare, and also reduce the possibility ofchronic infection.

Defining TermsClinical aromatherapy is the therapeu-tic use of essential oils, the efficacy ofwhich is supported by research data.In aromatherapy, essential oils areinhaled or diluted and applied topical-ly to the skin, depending on the symp-tom.

Essential oils are steam distillatesobtained from aromatic plants. Theyhave been used for thousands of yearsfor a multiplicity of symptoms rang-ing from insomnia and depression topoor skin integrity, slow-healingwounds, and infection. All of theseoils have a fragrance and a chemistrythat can lead to a range of responsesthat affect the healing process.

A fragrance stimulates the olfactorysystem. The effects of smell result inan instant reaction. Sometimes, themere thought of a smell can triggerthat reaction.5

A sense of smell plays an importantrole in our survival as well as ourquality of life. Many of our actions,both conscious and subconscious,depend on smell. Each day we inhaleabout 23,040 times and move around438 cubic feet of air.6 Various odorsmay warn us of a fire, of the need toeat, or of the desire to get closer toanother person. Babies find theirmother’s breast through smell, andsmell is one of the last senses to fadeas we die.6

Physiological ResponsesWhen we inhale a scent, the chemicalcomponents within it travel via thenostrils to the olfactory bulb and thento the limbic part of the brain. This isan inner complex ring of structuresbelow the cerebral cortex that arearranged into 53 regions and 35 asso-ciated tracts, including the amygdalaand the hippocampus.7 The amygdalagoverns our emotional response to anaroma. The memory and recognitionof smell takes place in the hippocam-

pus.7 The hippocampus is also wherechemicals in an aroma trigger ourunique repository of learned memo-ries.

Essential oils are lipotrophic, whichmeans they are fat-soluble. The princi-pal barrier to topical drug therapy isthe keratin-rich cells in the stratumcorneum. However, these cells areembedded in multiple lipid bilayers.Recent research8 has shown thatessential oils increase drug perme-ation, thus indicating that essentialoils are themselves absorbed.

Therapeutic UsePleasant aromatics can raise our spiritsand address specific clinical symptoms.A few drops of lavender can aidinsomnia9 or help improve a person’smood.10 Torii et al.11 and Bardia etal.12 reported on the psychologicallystimulating effect of jasmine. Manley13

found lemon, lemongrass, peppermint,and basil to be psychologically stimu-lating and bergamot, chamomile, andsandalwood to be relaxing. Other aro-mas found to be relaxing were roseand lavender.14 Sweet orange essentialoil was found to be effective in bothinduction of anesthesia and recoverytime in children.15

When essential oils are used topi-cally, they are diluted in a cold-pressed vegetable oil, called carrier oil.Cooking oils are not suitable becausethey will have been heated to hightemperatures, which alters their chem-ical constituents and prevents themfrom being absorbed. Carrier oils,which can be purchased from healthfood stores, should be kept refrigerat-ed and discarded when they becomerancid.

Diluted essential oils have beenused with good effect on slow-healingulcers or chronic skin conditions, assummarized in Table 1. Carrier oilssuitable for wound care are shown inTable 2.

Lifestyle and Behavior

Aromatherapy and DiabetesJane Buckle, PhD, MA, RN

125Diabetes Spectrum Volume 14, Number 3, 2001

The procedure is to dilute 1–5drops of essential oil in 1 teaspoon (5ml) of carrier oil to make a 1–5%dilution. Apply this dilution to sterilegauze and pack the wound lightly.Cover with a dressing. The carrier oilswill ensure that the dressing does notstick to the damaged tissue. If thedressing sticks to the tissue injury,unnecessary debridement could occureach time the dressing is replaced.

Essential oils also have antisepticqualities and will ensure that a woundis sterile. An example is thymol,obtained from essential oil of com-mon thyme (Thymus vulgaris).Thymol, discovered by Lister, was thefirst antiseptic and is still being usedas such today—hence, Listerinemouthwash.

Replace the wound dressing twice aday. In addition to being antiseptic,all essential oils have some antibacter-ial activity, although some are moreantibacterial than others.3 Becausethere is a gradient of bacterial concen-tration in chronic wounds with thelargest amount of bacteria beingfound in the ulcer bed,16 it makessense to lightly pack the wound sothat the diluted essential oil will be indirect contact with the infected area.

The use of essential oils can reduceinflammation, encourage cell regener-ation, and eliminate infection. A greatmany essential oils are effectiveagainst Staphylococcus aureus and B-Hemolytic streptococcus—two of themost common wound infections. Afew essential oils, such as Palma rosa(Cymbopogon martini),17 rosemary

(Rosmarinus occicinalis),18 juniper(Juniperus communis),19 and pepper-mint (Mentha piperita),20 are effectiveagainst Pseduomanas aeruginosa. Ofthese, the safest to use in wound carewould be palma rosa and juniperbecause their chemical composition isgentle. Lavender, juniper, teatree, andpeppermint are also effective againstmethicillin-resistant Staphylococcusaureus and vancomycin-resistantEnterococcus faecium.21

Use for People With DiabetesWhereas there is some evidence thatthe oral intake of herbs such as Asianginseng (Panax quinquefolius), fenu-greek (Trigonella foenum-graecum),and aloe (Aloe vera) may improve glu-cose tolerance,22 aromatherapy doesnot make this claim. Also, there is nosuggestion that essential oils can curediabetes (type 1 or type 2). However,essential oils can be used to reduce theside effects of some complications(i.e., ulcers, loss of skin integrity) andto reduce infections that often takelonger to resolve than in nondiabeticpatients.23

Essential oils can also ameliorate

the stress of coping with a lifelongchronic condition such as diabetes.24

Aromatherapy has a long history ofuse for stress reduction, and aromaticshave been used in many cultures toenhance quality of life. Nurses haveused inhaled essential oils to helpreduce their patients’ stress.25 Essentialoils found to be most effective forstress are shown in Table 3.

For many years, stress has beenlinked to chronic skin problems.Recent research26 has shown thatstress affects epidermal permeabilitybarrier function and is a precipitatorof inflammatory dermatoses. Thismeans that anything that can alleviatestress is likely to also have a beneficialeffect on skin integrity.

To use aromatherapy for stress, put3–5 drops of an undiluted essential oilon a handkerchief or cotton ball andask the patient to hold the handker-chief to his or her nose and breath inslowly for 5 min. This treatment canbe repeated every 4 h or more fre-quently when necessary.

Touch has been described as thefirst and most fundamental means ofcommunication; people who aredenied touch have been said to sufferfrom skin hunger.27 Research indicatesthat many chronically ill people longto be touched and that touch canmake pain more bearable. Perhaps forthese reasons, aromatherapy appearsto be particularly effective when dilut-ed essential oils are used with touch,either in the form of massage or withthe ‘M’ Technique (Table 4).

Aromatherapy using touch hasbeen shown in several nursing studiesto reduce stress.27–29 The essential oilslisted in Table 3 are also suitable fortopical use. Dilute them to 1–5%before applying topically.

SummaryAromatherapy holds at least as muchpotential for use with people who

Lifestyle and Behavior

Common Name Botanical Name ResearchLavender Lavandula angustifolia Throne31

Frankincense Boswellia carteri Duwieja et al.32

Sandalwood Santalum album Dwivedi et al.33

Teatree Melaleuca aternifolia Hitchin34

Eucalyptus Eucalyptus globulus Siang35

Geranium Pelargonium graveolons Walsh36

German chamomile Matricaria recutitia Glowania et al.37

Table 1. Essential Oils for Slow-Healing Skin Conditions

Common Name Botanical NameSweet almond Prunus dulcisTamanu Collophyllum inophyllumEvening primrose Oenothera biennisRosehip Rosa rubiginosaOlive Olea europaea

Table 2. Cold-Pressed Carrier Oils

Common Name Botanical NameRoman chamomile Chamomelum nobileNeroli Citrus aurantiumPetitgrain Citrus amaraLavender Lavandula angustifoliaMandarin Citrus reticulataGeranium Pelargonium graveolensRose Rosa damascenaSweet marjoram Origanum majorana

Table 3. Essential Oils for Stress

126Diabetes Spectrum Volume 14, Number 3, 2001

have diabetes as for use with thosewho do not have diabetes. Health careprofessionals can enhance theirpatients’ lives by either obtainingtraining in clinical aromatherapy(Table 4) or referring patients to peo-ple who have such training.

As discussed above, aromatherapycan be beneficial either when used inconjunction with medical treatment(such as for wound healing) or whenused to encourage general relaxation.The potential for even greater positivebenefits exists, for as our patients’aches, pains, and stresses are relieved,so may their physical health be lesschallenged, with resultant improve-ments in their blood glucose levels.Making our patients more comfort-able, whether through the healing ofan infection, the amelioration of asore muscle, the lessening of neuro-pathic pain, or the reduction of psy-chological stress, can improve theiroverall quality of life.

References1Lawless J: Aromatherapy and the Mind. SanFrancisco, P. Thorsons, 1994

2Ryman D: Aromatherapy. London, Piatkus,1991, p. 327

3Valnet J: The Practice of Aromatherapy.Tisserand R, Ed. Rochester, Vt., Healing Arts,1990

4Maury M: Guide to Aromatherapy. Walden,UK, C.W. Daniels Saffron, 1989

5Betts T: The fragrant breeze: the role of aro-matherapy in treating epilepsy. AromatherapyQuart 51:25–27, 1996

6Ackerman D: Smell. In A Natural History of theSenses. New York, Vintage, 1990, p. 3–63

7LeDoux J: The Emotional Brain. New York,Simon & Schuster, 1996

8Williams A, Barry B: Essential oils are novelhuman skin penetration enhancers. Int J

Pharmaceuticals 57:R7–R9, 1989

9Hudson R: The value of lavender for rest andactivity in the elderly patient. Complement TherMed 4:52–57, 1996

10Guilleman J, Rosseau A, Delaveau P:Neurodepressive effects of the essential oil ofLavandula angustifolia. Ann PharmaceutiqueFrancais 47:337–343, 1989

11Torii S, Fukuda H, Kanemoto H, Miyanchi R,Hamauzu Y, Kawasali M: Contingent negativevariation and the psychological effects of odor.In Perfumery: The Psychology and Biology ofFragrance. Dodds G, Van Toller S, Eds. London,Chapman & Hall, 1988, p. 107–120

12Badia P, Wesensten N, Lammer W, CulpepperJ, Marsh J: Responsiveness to olfactory stimulipresented in sleep. Physiol Behav 48:87–90,1990

13Manley CH: Psychophysiological effects ofodor. Crit Rev Food Science Nutr 33:57–62,1993

14Tonoike M, Atsushi M, Hideto K, Iseo K:Measurement of olfactory event-related fieldsevoked by odorant pulses synchronized with res-piration. Electroenceph Clin Neurophysiol 47(Suppl.):143–150, 1996

15Mehta S, Stone DN, Whitehead HF: Use ofessential oils to promote induction of anaesthesiain children. Anaesthesia 53:720–721, 1998

16Greenwood J, Clark S, Chadwick M, Ellison D:Monitoring wound healing by odour. J WoundCare 6:219–221, 1997

17Pattnaik S, Rath C, Subramanyam V:Characterization of resistance to essential oils ina strain of Pseudomonas aeruginosa. Microbios81:29–31, 1995

18Larrondo J, Agut M, Calvo-Torres M:Antimicrobial activity of essences fromLabiataes. Microbios 82:171–172, 1995

19Janssen A, Chin N: Screening for antimicrobialactivity of some essential oils. Pharm Week8:289–292, 1986

20Pattnaik S, Subramanyam V, Kole C:Antibacterial and antifungal activity of ten essen-tial oils in vitro. Microbios 84:195–199, 1996

21Nelson R: In vitro activities of five plant essen-tial oils against Methicillin-resistantStaphylococcus aureus and Vancomycin-resistant

Enterococcus faecium. J AntimicrobialChemotherapeut 40:305–306, 1997

22Rountree R: Herb, drugs and blood sugar.Herbs for Health. Jan/Feb, 2001, p. 26

23Mowat A, Macsween R, Percy-Hobbs L, FoulisA: Liver, biliary tract and pancreas. In Muir’sTextbook of Pathology. 13th edition. MacSweenR, Whaley K, Eds. London, Arnold, 1993, p.674–741

24Grey M: Coping and diabetes. DiabetesSpectrum 13:167–169, 2000

25Lim P: Essential stress relief: the use of oils totreat tension. Brit J Midwifery 5:336–338, 1997

26Garg A, Chren M, Sands L, Matsui M,Marenus K, Feingold K, Elias P: Psychologicalstress perturbs epidermal permeability barrierhomeostasis. Arch Dermatol 137:53–59, 2001

27Pratt JW, Mason A: The Caring Touch.London, Heyden Publishing, 1981

28Stevensen C: The psychophysiological effects ofaromatherapy massage following cardiacsurgery. Complement Ther Med 2:27–35,1994

29Binning S: Sheer inspiration. Nursery World.April 16, 1992, p. 14–15

30Burns E, Blamey C, Ersser S, Barnetson L,Lloyd A: An investigation into the use of aro-matherapy in intrapartum midwifery practice. JAltern Complement Med 6:141–147, 2000

31Throne D: Healing ulcers using essential oils. JCommun Nurs 10:14–16, 1996

32Duwieja M, Zeitlin I, Waterman P, ChapmanJ, Mhango G, Provan G: Anti-inflammatoryactivity of resins from some species of the plantfamily Burseraceae. Planta Medica 50:12–16,1993

33Dwivedi C, Abu-Ghazaleh A: Chemoprevent-ative effects of sandalwood on skin papillomas inmice. Eur J Cancer Prev 6:399–401, 1997

34Hitchin D: Wound care and the aromathera-pist. J Tissue Viabil 92:56–57, 1993

35Siang S: The use of combined traditionalChinese and Western medicine in the manage-ment of burns. Panminerva Med 25:197–202,1983

36Walsh D: Using aromatherapy in the manage-ment of psoriasis. Nurs Stand 11:53–56, 1996

37Glowania H, Raulin C, Svoboda M: The effectof chamomile on wound healing—a controlledclinical experimental double-blind trial.Zeitschrift fur Hautkrankheiten 63:1265–1271,1986

Jane Buckle, PhD, MA, RN, is anadjunct faculty member at TheCollege of New Rochelle, NY, and atBastyr University in Seattle, Wash.She is director of R J BuckleAssociates, LLC, in Hunter, NY.

Lifestyle and Behavior

‘M’ TechniqueThe ‘M’ Technique is a trademarked method of gentle touch that uses structuredstroking sequences in a set pattern and at a set pressure and rhythm that can easilybe used on hands, feet, and face. It is gentle enough to use on critically ill or veryfragile people and can add dignity to the dying process.

Clinical Aromatherapy TrainingFor information about training in clinical aromatherapy and the ‘M’ Technique, con-tact the American Holistic Nurses Association, P.O. Box 2130, 2733 E. LakimDrive, Suite 2, Flagstaff, AZ 86003-2130. Tel: 1-800-278-AHNA.

Table 4. Information and Resources