Contact dermatitis caused by lovage (Levisticum officinalis) essential oil

essential oil; lovage; Levisticum officinalis

Essential oils are used as perfume ingredients, and also as therapeutic substances in aromatherapy. Several essential oils have been identified as sensitizers. Here, we report the first case of contact dermatitis caused by lovage.

A 31‐year‐old female presented with sharply demarcated, erythematous and slightly scaling patches on the flexural side of both underarms and the right shoulder (Fig. [NaN] ). The lesions started 2 weeks after application of two undiluted essential oils: fifth Chakra (mixture of Geranium spp., Boswellia carterii, Jasminum grandiflorum absolute, Pogostemon cablin, and Citrus aurantium ssp. bergamia) and Lavas (Levisticum officinalis) (both obtained from Sjankara, Belgium). The lesions healed after treatment with topical and systemic steroids.

Because the lesions were suggestive of allergic contact dermatitis, patch tests were performed with the Belgian baseline series, cosmetic, fragrance and plant series, and the patient's own products (fifth Chakra and Lavas, both diluted 5% in ethanol). The patch tests were placed on the upper back, and occluded for 2 days with van der Bend® square chambers (Van der Bend, Brielle, The Netherlands) fixed with Hypafix® (BSN Medical, Hamburg, Germany). Readings were performed after D2 and D4, according to International Contact Dermatitis Research Group guidelines.

Patch tests were positive for p‐phenylenediamine (+), Myroxylon pereirae (++), sesquiterpene lactone mix (+), eugenol (+), isoeugenol (++), cananga oil (+), jasmine absolute (+), fifth Chakra (+), and Lavas (+++) (Fig. [NaN] ). A patch test with Lavas 5% in ethanol was negative in 4 healthy controls.

Essential oils are aromatic liquids obtained from leaves, stems, flowers, bark, roots, or other plant elements. The methods used to extract essential oils are distillation, maceration, solvent and carbon dioxide extraction, expression, and enfleurage. Essential oils are used as perfumes, but are also applied in aromatherapy for their alleged therapeutic benefits [1] .

Essential oils are important sensitizers, the most common allergens being ylang‐ylang oils, lemongrass oil, jasmine absolute, sandalwood oil, and clove oil. Even though many patients who are allergic to essential oils are positive for fragrance mix I or II, it is important to patch test the patients' own essential oils, because a considerable proportion of patients only react to a specific essential oil, and not to fragrance mix I or II [2] .

We report the first case of contact dermatitis caused by essential oil of lovage (L. officinalis) (CAS no. 84837‐06‐9), a strongly aromatic plant of the Apiacea family that is used in perfumes, food, beverages, and tobacco. Also, medicinal properties have been attributed to this plant [3] .

According to the product data sheet provided by the manufacturer, the lovage essential oil used by the patient mainly contained β‐phellandrene, terpinyl acetate, cis‐β‐ocimene, ligustilide, and myrcene. This is similar to the findings of Bylaite et al., who showed β‐phellandrene and terpinyl acetate to be the two main constituents. They also showed that the composition of essential oil depends on the part of the plant analysed (leaves, stem, flower and seed versus root), and the growth phase of the plant [4] .

Graph: Acute contact dermatitis caused by Levisticum officinalis essential oil.

Graph: Positive patch test reaction to Levisticum officinalis in 5% ethanol.