PLANT TALK
Contact Dermatitis to
Botanical Extracts
David A. Kiken and David E. Cohen
A review of the literature of reported cases of contact derma-
titis to a variety of natural herbal extracts is presented. Natural
extracts are commonly used ingredients in many cosmetic
preparations and homeopathic remedies. Although the term
natural botanical extracts inherently purports to have beneficial
and benign properties, these extracts can cause adverse reac-
tions in individuals. As such, dermatologists should be cogni-
zant of these agents as possible sources of allergenicity in
patients presenting with contact dermatitis.
Copyright 2002, Elsevier Science (USA). All rights reserved.
N ATURAL BOTANICAL EXTRACTS have become
increasingly utilized in the cosmetic industry. Little,
however, is written regarding the immunogenicity associ-
ated with their use. With the increasing popularity of these
items, further investigation regarding their allergenicity
may be necessary.
Approximately 40 years ago, the concept of “hypoaller-
genic” products was introduced to fill the needs of cos-
metic-intolerant patients. In the United States, cosmetic
companies are required to list the ingredients of their
products to aid individuals in avoiding any particular
substances that may be harmful.1 The new emphasis on
“herbal and plant” products has attracted even the most
skeptical consumer because these terms seem to have the
connotation of having beneficial effects without the risk of
adverse side effects. Despite this great attraction to and
belief in natural ingredients, cosmetics must be regarded
as a potential source of allergens.
The incidence of the use of topical medications contain-
ing plant extracts is rising dramatically for the treatment
of common illnesses.1 There also are an increasing number
of individuals who are ingesting and applying plant sub-
stances to their skin. Much of this increase in use can be
attributed to popular (nutritional) literature or by word of
mouth.2 Patients often neglect to include natural remedies
or cosmetics containing natural extracts during histories
taken for contact dermatitis evaluations. Therefore, it is
From the Department of Dermatology, New York University School of Medicine, New
York, NY.
Address reprint requests to David A. Kiken, 415 East 37th Street #11D, New York,
NY 10016.
Copyright 2002, Elsevier Science (USA). All rights reserved.
1046-199X/02/1303-0010$35.00/0
doi:10.1053/ajcd.2002.34564
148 American Journal of Contact Dermatitis, Vol 13, No 3 (September), 2002: pp 148-152
SECTION EDITOR:
THOMAS W. MCGOVERN, M.D.
Ft. Wayne Dermatology, P.C.
S750 Falls Dr
Ft. Wayne, IN 46804
Some people talk to plants. Fewer people think
plants talk to them. We want to talk about plants, and we
hope that you will not only want to listen, but also,
perhaps, you will even occasionally talk to us about
plants.
Plants can cause an array of reactions in members of
Homo sapiens, and in the course of this quarterly feature,
we will provide reviews and/or commentary on common
reactions to common plants, uncommon reactions to
uncommon plants, and many reactions in-between.
Plants and their derivatives have the potential not only
to harm the skin, but also to ameliorate skin disease,
and we welcome papers that concern either of these
aspects of plants. If an occasional column is not neces-
sarily practical, we hope it will be enjoyable.
important that dermatologists become aware of the poten-
tial adverse effects of these products.
Allergic Contact Dermatitis to Individual
Extracts
Aloe
Aloe includes a variety of chiefly African plants of the
genus Aloe, having rosettes of succulent, often spiny-mar-
gined leaves and long stalks bearing yellow, orange, or red
tubular flowers. Aloe has been used historically for medic-
inal purposes and has become a prevalent ingredient in
many cosmetic preparations because of its reported bene-
ficial dermatologic properties. There is little literature on
contact dermatitis to aloe. Contact dermatitis and contact
urticaria have been described after the topical application
of aloe leaf material. Testing to 5% Aloe vera jelly for
delayed and immediate hypersensitivity has revealed pos-
itive reactions.2,3
Arnica Flowers
Arnica is a genus of flowers including perennial herbs in the
Asteraceae (Compositae) family, having opposite, simple
leaves and mostly radiate heads of yellow flowers. Arnica
montana has been used for hundreds of years for sprains,
 Contact Dermatitis to Botanical Extracts
bruises, painful swellings, wounds, and other injuries, as
well as in cosmetic preparations. Numerous cases of con-
tact dermatitis caused by arnica have been reported.4
Arnica tincture has been reported to cause bullous derma-
titis after treatment of a knee injury and mild skin trauma.
Both cases were confirmed by patch testing with 0.5%
arnica extract in ether.5
Hausen6 tested each of the components of the Composi-
tae mix to ascertain the allergenicity of each. He reported
that 51.8% of the Compositae-positive allergic patients
reacted to 0.5% arnica in white petrolatum. Machet et al7
reported a case of allergic contact dermatitis from sun-
flower with cross sensitivity to arnica.
Centella asiatica
Centella asiatica is a herbaceous plant of the Apiaceae (Um-
belliferae) family that is purported to enhance wound
healing by stimulating fibroblast collagen production. Con-
tact dermatitis to C asiatica extract has been documented
in numerous cases by patch testing. Vesicular dermatitis
involving the legs, thighs, face, and trunk were reported
from the use of a cream containing C asiatica for the
treatment of chronic leg ulcers. Patch testing with the
cream and 1% C asiatica in petrolatum both gave positive
reactions, whereas the cream base and the standard test
series did not. Another patient with a positive patch test
result to C asiatica extract 2% alcohol had dermatitis of the
legs.8-11
Contact dermatitis to C asiatica also has been reported
in patients utilizing a cream version for the treatment of
scars and morphea. Patch testing to 1% C asiatica powder in
petrolatum was diagnostic.11
Cucumber
Cucumber (Cucumis spp.) is a tendril-bearing, climbing or
sprawling annual plant widely cultivated for its edible
cylindrical fruit that has a green rind and crisp white flesh.
A 50-year-old cook was reported to have hand dermatitis
that spread to his face from handling pickles. Open imme-
diate skin tests on normal skin produced positive reactions
to cucumber.12
Ginkgo biloba
Ginkgo biloba is a deciduous, dioecious tree native to China.
It has fan-shaped leaves and fleshy yellowish seeds with a
disagreeable odor. However, despite its cross reactivity to
one of the most potent allergens, no cases of allergic
contact dermatitis to G biloba– containing products have
been published. This is likely because of the fact that
extracts of ginkgo found in cosmetic preparations do not
contain the fruit pulp, which is the only part of the ginkgo
plant known to contain allergen. However, Castelli et al13
showed in a double-blind study that 68.2% of subjects who
had experienced allergic contact dermatitis from “various
substances in the European standard series” experienced a
149
significantly diminished skin reactivity on sites treated
with G biloba 2 days after patch removal. This study sug-
gested that G biloba carboxymethyl-␤-1,3-glucan may di-
minish allergic contact hypersensitivity reactions.
Lavender Oil
Lavender includes a variety of aromatic Old World plants
of the genus Lavandula (Lamiaceae), which have clusters of
small purplish flowers that yield oil used for its fragrance.
Two cases of contact dermatitis attributed to lavender oil
have been reported.14 One was precipitated by the use of
lavender oil–treated pillows resulting from a news report
that touted the hypnotic benefits of lavender scent.15 In the
other, acute facial dermatitis developed in a physiothera-
pist after applying a gel formulated with lavender fra-
grance. Patch testing to lavender absolute 2% pet. (Che-
motechnique, Ontario, Canada) was positive.16 Fragrances
and aromatherapy oils containing lavender have been re-
ported to cause contact dermatitis.17
Peppermint
Peppermint oil is derived from Mentha piperita, a member of
the Lamiaceae (Labiatae or mint) family, which has small
purple or white flowers and downy leaves that yield a
pungent oil. The oil is volatile and distilled with steam
from the flowering plant, rectified by distillation and not
dementholized. Peppermint often is used as a flavoring
agent in toothpaste, candy, gum, and mouth sprays be-
cause of its cooling effect. Peppermint oil contains at least
45% menthol, and contact reactions to it are associated
with a burning mouth, recurrent oral ulceration, or oral
lichenoid reactions. Menthol, a component of peppermint
oil, may be present in toothpaste, aroma therapy, lotions,
mouthwashes, and cigarettes. Allergic contact dermatitis
and stomatitis from menthol have been reported.18,19
Several cases of contact dermatitis to peppermint oil
have been reported. A 34-year-old woman with a 9-year
history of stomatitis reported worsening with mint-flavored
foods and oral products. Patch testing results to 5% men-
thol in petrolatum and 1% peppermint oil in petrolatum
was positive. Her oral discomfort was alleviated after elim-
ination of mint from her diet and personal hygiene use.20
Chronic cheilitis, perioral contact dermatitis, oral ulcer-
ations, and burning mouth have been reported in patients
who patch tested positively to peppermint oil.18,21,22
Sources of exposure included oral antiseptic sprays, local
anesthetics, and candy.21
Orofacial granulomatosis of the lower lip was reported
in an individual allergic to both peppermint oil and men-
thol. His lip swelling was reduced after elimination of
peppermint oil and menthol from his diet.23
Peppermint oil also has been noted to cause contact
dermatitis in fragrances and occupational contact derma-
titis in food handlers.24,25 Patch testing results in the
aforementioned cases typically was performed with 2%
peppermint oil in petrolatum.
150 Kiken and Cohen

Table 1. Botanical Extract and Purported Utility

Reported Cases of
Botanical Extract Genus Name (Family) Purported Utility Contact Dermatitis

Aloe Aloe (Aloeaceae) Aid to digestion. Beneficial for complexion. Yes2,3

Angelica root Angelica (Apiaceae or Expectorant, diaphoretic, menstruation promoter, aromatic, and No
Umbelliferae) antiflatulent. Aids skin in elimination of toxins, promotes
perspiration. Digestive and circulatory tonic.
Arnica flowers Arnica (Asteraceae or Historically used for injuries and wounds and in cosmetic Yes4-7,39
Compositae) preparations. A restorative, cardiovascular tonic.
Bladderwrack Fucus (member of Antirheumatic, thyroid regulator, aid in weight reduction and obesity. No
Kingdom Protista)
Catnip Nepeta (Lamiaceae or Antiflatulent, antispasmodic, astringent, diaphoretic. No
Labiatae)
Centella asiatica Hydrocotyle (Apiaceae Enhances skin growth by stimulating fibroblasts to produce collagen Yes8-11
or Umbelliferae) fibers. Used to diminish scarring and in patients with slow-healing
wounds.
Chamomile Chamaemelum nobile Stomachic, antiseptic, antispasmodic and tonic. Expels worms. Yes29-32
(Asteraceae or Phytotherapy.
Compositae)
Comfrey leaf Symphytum Bone, blood, and tissue repair. No
(Boraginaceae)
Coriander Coriandrum (Apiaceae Improved digestion, relief of colic, relief of arthritic pain, and No
or Umbelliferae) prevention of infection.
Cucumber Cucumis Beautification. Yes37
(Cucurbitaceae)
Echinacea Echinacea (Asteraceae Immune stimulant, antiseptic, vasodilator. No
or Compositae)
Ginkgo biloba Ginkgo (Ginkgoaceae) Stimulates mental alertness. Stimulates circulation to extremities, Yes13
heart, brain, and blood. Antioxidant. Treatment of tinnitus,
vertigo, stress, senility, and asthma.
Goldenseal Hydrastis Tonic, anticatarrhal, stomachic, astringent. Used topically for insect No
(Ranunculaceae) bites, eczema, and ringworm.
Green tea Camellia (Theaceae) Anticarcinogenic with immune enhancing properties. No
Hops Humulus Sedative, nervine, analgesic, anodyne, and antiflatulent. Treatment of No
(Cannabaceae) insomnia, headaches, and anxiety.
Kelp Laminaria (member of Source of iodine. Lower rate of breast cancer, obesity, heart disease, No
Kingdom Protista) rheumatism, arthritis, high blood pressure, thyroid disease,
constipation and gastrointestinal ailments, and infectious disease.
Used for Crohn’s, colitis, ulcers, goiter, obesity and hair loss.
Lavender Lavandula (Labiatae) Antiflatulent, mild sedative, antispasmodic, antidepressant, and Yes14-17
fragrant. Treatment for headaches.
Licorice Root Glycyrrhiza (Fabaceae Gastric ulcers, hormones, hypoglycemia, adrenal support, expectorant, No
or Leguminosae) and antispasmodic.
Marigold Calendula (Asteraceae Astringent, diaphoretic, and antiinflammatory agent. Treatment of No
or Compositae) gastric ulcers.
Peppermint Mentha (Lamiaceae or Aromatic, antiflatulent, antianxiety agent, antispasmodic, antiseptic, Yes18-25
Labiatae) aids digestion, and used in treatment of migraines.
Rose hips Rosa (Rosaceae) Tonic, astringent, diuretic. Source of Vitamin C and bio-flavonoids, No
Rosemary Rosmarinus (Lamiaceae Cosmetic agent with antioxidant and antiinflammatory properties. Yes26
or Labiatae) Stomachic, aromatic, antidepressant/stimulant, antispasmodic, and
an antiseptic agent. Treatment of migraine headaches.
Sage Salvia (Lamiaceae or Gargle used to treat sore throat and laryngitis. Antiseptic, astringent, Yes27
Labiatae) expectorant, antiinflammatory, tonic, aromatic. Antihemorrhagic,
and antiflatulent. Used both internally and externally.
Saint John’s Hypericum (Clusiaceae Antidepressant and antianxiety agent. Treatment of lung diseases and Yes28
Wort or Guttiferae) urinary passage infections. Antiviral, antiinflammatory, and
astringent properties used as an aid in healing wounds.
Stinging nettles Urtica (Urticaceae) Diuretic and astringent. Source of minerals, iron, vitamins, and Yes29-32
chlorophyll used in phytotherapy.
Tea tree oil Melaleuca (Myrtaceae) Topical treatment with astringent and antiinflammatory properties Yes33-36
used for a variety of skin disorders
Witch Hazel Hamamelis Cosmetic preparations and as an astringent. Yes1,37-38
(Hamamelidaceae)

Rosemary of the Lamiaceae family were positive only to rosemary

Rosemary is an aromatic evergreen Mediterranean shrub
(Rosmarinus officinalis) that has light blue or pink flowers
and grayish-green leaves. Belonging to the Lamiaceae fam-
ily, it is used commonly in cosmetics and herbal remedies
for its antioxidant properties. Contact dermatitis was re-
ported in a 56-year-old man who used rosemary leaf plas-
ters to alleviate knee pain. Patch tests to various members
leaf. Tests to rosemary leaf were negative in all 10 control
subjects.26
Sage
Sage includes a variety of plants of the genus Salvia,
especially Salvia officinalis, having aromatic grayish-green,
opposite leaves, and it is used as a cooking herb. Fifty-five
 Contact Dermatitis to Botanical Extracts
subjects with suspected contact dermatitis were patch
tested with a variety of common household spices. One had
a positive reaction at both 25% and 10% sage in white
petrolatum, and 2 more were positive to the 25% concen-
tration of sage in white petrolatum.27
St John’s Wort
St John’s wort includes numerous plants of the genus
Hypericum having yellow flowers and dotted leaves. It is
traditionally gathered on St John’s eve to ward off evil. A
61-year-old woman chronically ingesting St John’s Wort for
depression developed erythematous itching plaques in ar-
eas exposed to natural sunlight. Photopatch testing re-
vealed a decrease of the MED-UVB, which was reversible
after withdrawal of the medication.28
Teas: Stinging Nettles and Chamomile
Both stinging nettles and chamomile are used commonly
in phytotherapy. Nettles include plants of the genus Urtica
(Family Urticaceae), having toothed leaves, unisexual
apetalous flowers, and stinging hairs that cause skin irri-
tation on contact. Chamomile is an aromatic perennial
herb (Chamaemelum nobile) in the Asteraceae family, native
to Europe and the Mediterranean region, having feathery
foliage and flower heads with white rays and yellow centers.
Chamomile tea compresses have been reported to cause
contact dermatitis or aggravate existing eczematous der-
matitis. Patch testing to C nobile extract has been reported
to produce positive reactions. Gingivostomatitis was re-
ported from the ingestion of a tea made from stinging
nettles. Patch testing to the leaf of common nettles (Urtica
dioica) as is produced positive reactions.29 Nettle hairs
contain histamine and acetylcholine at a concentration
high enough to trigger a cutaneous reaction.29-31 Photoal-
lergic and airborne contact dermatitis have been reported
to chamomile and have been confirmed with patch and
photopatch testing.32
Tea Tree Oil
Tea tree oil is obtained from the leaves of a tea tree known
as Melaleuca alternifolia. The oil has been used topically to
treat a variety of diseases including infections and psoria-
sis. Numerous cases of contact allergy to tea tree oil have
been reported, including exacerbations of atopic dermatitis
and vesicular dermatitis from topically applied oil.33,34
Knight and Hausen35 evaluated 7 tea tree oil allergic
subjects to ascertain which of the 11 constituent com-
pounds of tea tree oil were allergenic. Of the 7 patients
who reacted to 1% melaleuca oil in anhydrous ethyl alco-
hol, 6 reacted to 1% limonene, 5 to 1% ␣-terpinene, 5 to 1%
aromadendrene, 2 to 1% terpin-4-ol, one to 1% p-cynene,
and one to 1% ␣-phellandrene, all in anhydrous ethanol.
None were reactive to d-carvone, an antioxidative deriva-
tive of limonene.
Rubel et al36 reported 3 of 28 normal volunteers testing
151
positively to 25% tea tree oil in soft, white paraffin, whereas
none reacted to d-limonene. One of 3 cases (33%) was
allergic to ␣-terpinene versus 71% in Knight’s study. Nev-
ertheless, sesquiterpene hydrocarbons appear to be potent
allergens in both studies.
Witch Hazel
Witch hazel is a deciduous shrub or small tree of the genus
Hamamelis, especially Hamamelis virginiana, of eastern North
America, having yellow flowers that bloom in late autumn
or winter. One hundred forty-seven of 19,000 cosmetic
foundations filed with the Food and Drug Administration
in 1978 contained witch hazel.37 Periorbital dermatitis was
reported after the use of a witch hazel– containing eye gel.
Patch test results to Hamamelis distillate (as is and 50% in
ethanol) and cucumber extract were positive.38 Four of
1,032 randomly selected normal subjects reacted to 25%
Hamamelis extract in petrolatum.1
No Reported Cases of Contact Dermatitis
Angelica root, bladderwrack, catnip, comfrey leaf, corian-
der, echinacea, golden seal, green tea, hops, kelp, licorice
root, marigold, and rose hips all are commonly used bo-
tanicals used in cosmetics. A comprehensive literature
search (Table 1) did not find any reported cases of contact
dermatitis to these extracts. However, the paucity of re-
ports may be the result of difficulty testing to these sub-
stances and lack of uniform or standardized allergens.
Further investigation with patch testing would be useful to
verify their lack of allergenicity.
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