March 22, 2017



Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

Related Terms

  • Aromatherapy massage, bergamot, Cananga odorata, chamomile, Citrus aurantium, clary sage, essential oils, geranium, grapefruit, inhalation, inunction, lavender, lavender vera, Lavendula officinalis, lemon balm, Melaleuca alternifolia, mandarin, massage therapy, meditation, Melissa officinalis, myrrh, neroli, orange, peppermint, relaxation therapy, Roman chamomile, rose, sandalwood, Santalum album, sweet orange, tea tree, vetivert, ylang ylang oil.


  • Fragrant oils have been used for thousands of years to lubricate the skin, purify air, and repel insects. Ancient Egyptians used fragrant oils for bathing and massage. Essential oils of plants have been used medicinally through application directly to the skin (usually diluted), as a part of massage, added to bathwater, via steam inhalation, or in mouthwashes.

  • Aromatherapy is a technique in which essential oils from plants are used with the intention of preventing or treating illness, reducing stress, or enhancing well-being. Fragrance oils and products containing man-made compounds are not used in the practice of genuine aromatherapy. Although many gift shops sell scented candles, pomanders, and potpourri as "aromatherapy," genuine aromatherapy treatments use higher strength (concentrated) essential oils drawn from various herbs.

  • There is no formal training or licensing procedure for aromatherapists in the United States. This technique is offered by a wide range of practitioners with licenses in other fields, including massage therapists, chiropractors, and other therapists.


  • A variety of mechanisms have been proposed for the reported effects of aromatherapy. It has been suggested that following placement of oil onto the skin, or breathing in fragrant air, the odor-sensing nerves in the nose are stimulated, sending impulses to the limbic system of the brain (a center for processing of emotions). A different theory is that some oils directly interact with hormones or enzymes in the blood, or stimulate the adrenal glands. Scientific research is limited in these areas, and it remains unclear how specific types of aromatherapy may work in the body.

  • There are more than 100 essential oils commonly used for aromatherapy. These oils are extracted from flowers (rose, narcissus), roots (orris), leaves and needles (eucalyptus, pine), resins (turpentine), seeds (caraway), fruits (lemon, lime), berries (cloves), bark (cinnamon) and wood (cedar). Many are obtained from familiar herbs and spices (basil, anise, nutmeg, cumin, oregano), and many are derived from substances related to herbal medicine (ginger, garlic, St. John's wort).

Scientific Evidence


These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.


Agitation in patients with dementia

Aromatherapy using essential oil of lemon balm (Melissa officinalis) may reduce agitation in people with severe dementia, when applied to the face and arms. Other research reports that steam inhalation of lavender aromatherapy may have similar effects. Overall, the evidence does suggest potential benefits.


Alcohol withdrawal

Aromatherapy may be as effective as some types of acupuncture in treating alcohol withdrawal symptoms. More study is needed in this area.


Alopecia areata (hair loss)

Alopecia areata is a disorder in which the body's immune system attacks hair follicles, resulting in unpredictable patches of hair loss. Early evidence suggests a blend of essential oils rubbed into the scalp may show benefit.


Anxiety (lavender aromatherapy)

Lavender aromatherapy may be able to reduce anxiety. However, there have been conflicting results, and more study is needed in this area.


Anxiety (sandalwood aromatherapy in palliative care)

Lavender may contribute to reduced anxiety and improved mood, at least subjectively, but some other aromas, such as sandalwood, may not. More studies are needed to confirm these findings.


Anxiety/stress in intensive care unit patients (lavender aromatherapy)

It is unclear whether lavender aromatherapy reduces anxiety levels in intensive unit care patients.


Arthritis (wellbeing)

There is not enough scientific evidence to recommend for or against the use of aromatherapy in arthritis patients.


Atopic eczema (children)

It is unclear whether aromatherapy might benefit children with atopic eczema.


Cancer (quality of life)

Aromatherapy is often used in people with chronic illnesses (frequently in combination with massage), with the intention to improve quality of life or well- being. There is not enough scientific evidence in this area.



Aromatherapy may be helpful during childbirth to relieve anxiety, pain, nausea, and/or vomiting or to strengthen contractions. It may also reduce pain perceived by first time mothers.


Chronic obstructive pulmonary disease (COPD)

Early evidence suggests that aromatherapy may aid mucus clearance in COPD. More studies are needed before conclusions about this application of aromatherapy can be made.



Early research in Guillian Barré syndrome patients show a possible benefit of aromatherapy massage for constipation, and rosemary, lemon, and peppermint essential oils may be beneficial in the elderly. Additional study is warranted to differentiate the effects of essential oils vs. massage.


Decongestant-expectorant/upper respiratory tract infection (eucalyptus aromatherapy)

Despite widespread use in over-the-counter agents and vapors, there is not enough scientific evidence to recommend use of eucalyptus oil as a decongestant-expectorant (by mouth or inhaled form).



There is not enough scientific evidence to recommend for or against the use of aromatherapy in patients with mild depression.



Abdominal aromatherapy massage with a combination of essential oils may reduce the intensity of menstrual cramps in women with dysmenorrhea. More research is needed in this area to identify the most effective essential oils.


Itching (pruritus) in dialysis patients

Preliminary research reports reduced itching in dialysis patients receiving aromatherapy massage. Further research is necessary before a firm conclusion can be drawn.



Massage and skin care with and without aromatherapy improved relief and wellbeing in breast cancer patients. More study is needed in this area.


Nausea and vomiting (post-operative)

There is not enough scientific evidence to recommend for or against the use of aromatherapy in patients with post-surgery nausea.



It has been suggested that aromatherapy massage may reduce abdominal obesity or appetite. Additional evidence is needed before a clear conclusion can be reached.


Perineal discomfort after childbirth

Early research on the use of essential oils in bath water or soap suggests limited or no benefit for post-partum perineal discomfort. More studies are needed before conclusions can be reached about this application of essential oils.


Postpartum care

Aromatherapy is popularly used to improve mood. A preliminary study found that aromatherapy in first-time mothers had improved moods after aromatherapy. Higher quality research is needed in this area.


Sleep apnea (pediatric)

Early research suggests that pre-mature newborns with sleep apnea may benefit from aromatherapy. However, more data are needed before definitive recommendations can be made.


Sleep quality (adults)

Early research suggests that lavender may have general benefits for sleep quality and specific benefits for insomnia.


Stroke recovery

There is not enough scientific evidence to recommend for or against the use of aromatherapy in recovering stroke patients.


Wound care

Early research suggests that aromatherapy may contribute to reduced pain intensity during dressing changes in wound care. More study is needed in this area.


*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).


The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

  • Acne, addiction, allergies, Alzheimer's disease, antibacterial, anticonvulsant, antifungal, antiviral, asthma, autonomic dysfunction, back pain, bereavement/grief, bladder infections, boils, bronchitis, burns, chronic bronchitis (prevention and treatment), chronic pain, circulation, cognitive performance enhancement, common cold, confidence boosting, coping skills, digestion disorders, exercise recovery, exhaustion, fever, gas, Guillian-Barre syndrome (symptom relief), headache, high blood pressure, hormonal disorders, immune system stimulant, impatience, impotence, improving circulation, indigestion, infections (intravenous/Hickman line), inflammation, insect bites, irregular heartbeat, irritability, joint pain, labor pain, laryngitis, liver disorders, loss of appetite, maternal comfort during labor, memory enhancement, menstrual cramps, motion sickness, mucositis, muscle pain, nausea, nerve pain, pain, palliative care, panic attacks, pimples, prevention of respiratory tract infections, psoriasis, psychosomatic illness, reducing swelling after injuries, relieving menstrual symptoms, restlessness, rheumatic disorders, seizure disorder, sexually transmitted diseases, skin infections, skin rash in bone marrow transplant patients (engraftment syndrome rash), smoking withdrawal symptoms, spasms, sprains and strains, stimulation of digestion, stomach complaints, sunburn, study performance (math tasks), swelling, tendonitis, vaginitis, yeast infections.


Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

  • Skin rash (dermatitis) from direct contact with various essential oils has been reported in humans, and skin irritation can develop with regular use. Peppermint and eucalyptus oils may burn the skin if applied at full strength. With the possible exception of lavender, essential oils should be diluted with a base oil before use to avoid skin irritation. Severe phototoxicity/photosensitivity (skin sensitivity to light) may occur, particularly with oil of bergamot. Vapors from aromatherapy may irritate the eyes, and patients are advised to keep their eyes closed while inhaling aromatic vapors.

  • Allergy may occur with use of essential oils, and may be due to contamination, or to constituents of the herb(s) from which the oil is derived. In cases of suspected skin allergy, some aromatherapists will place a single drop of oil on the skin to see if a reaction occurs over 24 hours. Individuals who have difficulty breathing with the use of aromatherapy should seek medical attention before attempting aromatherapy again.

  • Oils applied to the skin or inhaled through the nose and mouth can be absorbed into the body and can have systemic effects. There are reports of agitation, drowsiness, nausea, and headache with the use of aromatherapy. Some oils are thought to have toxic effects on the brain, liver and kidney, or to increase the risk of cancer with long-term use. Aromatherapies that may increase sedation or drowsiness, such as lavender or chamomile, may add to the effects of drugs, herbs, or supplements that also cause fatigue or sedation. Caution is advised in people who are driving or operating heavy machinery.

  • Essential oils may be toxic if taken by mouth, and should not be swallowed. Fragrances may contain unknown and potentially toxic contaminants. There are reports that lead emission may occur from the burning wick of aromatherapy candles, although long-term health effects are not clear.

  • Based on human use, sage, rosemary, and juniper oils may cause the uterus to contract when taken in large amounts. Due to these reports, and lack of reliable safety data, the use of these oils is discouraged during pregnancy.

  • Infants and young children may be especially sensitive to the effects and side effects of essential oils. Peppermint oil is not recommended in children under the age of 30 months. It is suggested to consult a qualified healthcare professional before using aromatherapy in children.

Author Information

  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).


Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

  1. Anderson C, Lis-Balchin M, Kirk-Smith M. Evaluation of massage with essential oils on childhood atopic eczema. Phytother Res 2000 Sep;14(6):452-6. View Abstract

  2. Ballard CG, O'Brien JT, Reichelt K, et al. Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: the results of a double-blind, placebo- controlled trial with Melissa. J Clin Psychiatry 2002;63(7):553-558. View Abstract

  3. Barclay J, Vestey J, Lambert A, et al. Reducing the symptoms of lymphoedema: is there a role for aromatherapy? Eur J Oncol Nurs 2006 Apr;10(2):140-9. View Abstract

  4. Brownfield A. Aromatherapy in arthritis: a study. Nurs Stand 1998 Oct 21-27;13(5):34-5. View Abstract

  5. Burns E, Zobbi V, Panzeri D, Oskrochi R, et al. Aromatherapy in childbirth: a pilot randomised controlled trial. BJOG 2007 Jul;114(7):838-44. View Abstract

  6. Cooke B, Ernst E. Aromatherapy: a systematic review. Br J Gen Pract 2000;50(455):493-496. View Abstract

  7. Gravett P. Aromatherapy treatment for patients with Hickman line infection following high-dose chemotherapy. Internat J Aromather 2001;11(1):18-19.

  8. Han SH, Hur MH, Buckle J, et al. Effect of aromatherapy on symptoms of dysmenorrhea in college students: A randomized placebo-controlled clinical trial. J Altern Complement Med 2006 Jul-Aug;12(6):535-41. View Abstract

  9. Hay IC, Jamieson M, Ormerod AD. Randomized trial of aromatherapy. Successful treatment for alopecia areata. Arch Dermatol 1998 Nov;134(11):1349-52. View Abstract

  10. Holmes C, Hopkins V, Hensford C, et al. Lavender oil as a treatment for agitated behaviour in severe dementia: a placebo controlled study. Int J Geriatr Psychiatry 2002 Apr;17(4):305-8. View Abstract

  11. Muzzarelli L, Force M, Sebold M. Aromatherapy and reducing preprocedural anxiety: A controlled prospective study. Gastroenterol Nurs 2006 Nov-Dec;29(6):466-71. View Abstract

  12. Smallwood J, Brown R, Coulter F, et al. Aromatherapy and behaviour disturbances in dementia: a randomized controlled trial. Int J Geriatr Psychiatry 2001;16(10):1010-1013. View Abstract

  13. Smith CA, Collins CT, Cyna AM, Crowther CA. Complementary and alternative therapies for pain management in labour. Cochrane Database Syst Rev 2006 Oct 18(4):CD003521. View Abstract

  14. Wilkinson S, Aldridge J, Salmon I, et al. An evaluation of aromatherapy massage in palliative care. Palliat Med 1999 Sep;13(5):409-17. View Abstract

  15. Wilkinson SM, Love SB, Westcombe AM, et al. Effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer: a multicenter randomized controlled trial. J Clin Oncol 2007 Feb 10;25(5):532-9. View Abstract

Copyright © 2013 Natural Standard (www.naturalstandard.com)

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.


March 22, 2017