Aromatherapy treatment of severe oral mucositis

AROMATHERAPY TREATMENT

OF

SEVERE ORAL MUCOSITIS PETER

GRAVETT

The first of a series of fouq this article discusses the use of essential oils in the treatment of this chemotherapy-induced condition.

Ed ighty

patients

cancer

were treated

dose

cell

rescue.

severe

and stem

cells,

induction

Thirty-two

high

aromatherapy

48

There

with

patients

mouthwashes

differences those

treated

and

proprietary

were

the

two

patients

no

who

as

had

mouthwashes

universally

aromatherapy

preparation.

stem

recovery

from

preceding

conditioning.

Amgen)

300

was

(n=48)

given

control

group

received with

(Corsodyl

from

conventional

gesia

which

oral

paracetamol

controlled

ranged

from

infusion

with

to increase

for cancer, treatment aggressive

(GCSF)

longer

cation

mixed

together

boiled

warm water. All patients

the

of cancer

incidence

A recent

and

a major

treatment. of

40%

chemotherapy, patients

factors

oral

compli-

Although

mucositis

for standard

100%

oral

of

is dose

transplant

suffer with this complication. review

(Kathaus

studies of 22 different

protocols

the

for

treatment

of oral mucositis

no clearly optimal treatment

All patients received nation

cytotoxic

mouthwashes

morning, settling

after each

meal

in the

the instructions

mouth

minute

with

the

and

but with

for

emerging.

supralethal

combi-

chemotherapy

also been

Tea tree essential oil has received

much

infections

(Concha

1998).

have shown a

wide

range

including

properties ulcers.

Its

surfaces

has

and it can be

vaginal

infections

and

pruritis.

All the patients

of activity

Candida species

against

et al., fungi

(Hammer

doi:l0.1054/ijar.2000.0023,

suffered

with mucositis

et

available

aromatherapy with respect

ters observed

and

of the skin and mucosa studies

and

demonstrated

by

has shown

and there are no significant

antibacterial

agent for treating

In vitro

and

and healing

on mucosal

to treat

groups

antifungal

antiseptic

1

we allowed gargling.

as a natural

used

as a topical

wounds

effectiveness

against

et al., 1993).

oil has been

infections

chronic

between

attention

It has

of antibac-

were to wash mixture

and then spit it out, although

subsequently

for

used

and before

at night (total five times daily).

Initially, the

on waking

et al, 1999)

cites 49 separate prophylaxis

their

and glossitis.

and

activity

and stem cell rescue,

used

for

and sores,

et al., 1996) and

for mouth

are

ulcers

antifungal

good antiseptic

or myaloablation

oil has been

terial activity (Pattnaik

Citrus bergamia 1 drop of

in

a strong

Pelargonium graveolens 1 drop a tumbler

use

as a treatment

a wide range

Bergamot

in half

essential

wounds,

aromatherapists

1 drop

alternijolia

that it

for

Candida albicans (Viollon

(n=32)

cells

surfaces.

used

??

has become

approximately

With

Melaleuca

denuded

0

limiting

mucositis

??

appropriate

Geranium

used a blend of oils:

more

and epithelial

be

burns,

been

against

et al, 1997) suggesting

demonstrated

patient

has

(Faoagali

growth

of haematopoietic

myelosuppression no

has become

over the past decade.

the advent factors

the cure rate

fibroblasts

of

allergy (Rubel

concern cytotoxicity

also in stomatitis

(PCA). group

and

about

traditionally

continuous

administration

1998)

et

reports

may not treat-

occasional

to

(Harkenthal

have been

adverse effects including

treating

as well as anal-

The aromatherapy In an attempt

+5

mouthwashes

or Difflamm)

There

human

of patients

proprietary

diamorphine

day

and bacteria

expressed

mg subcuta-

rescue until engraftment.

al., 1998) al., 1999). et al.,

GCSF

neously

ment

the

autlogous blood

following

observed

preferred

during

dose

although previously

with

perioheal

chemotherapy

The

with conventional

rescue

collected

(Filgrastin

significant

groups,

treatment

using

acted

in the parameters

between

by

cryopreserved

developed

patient

were

controls.

followed

chemotherapy mucositis.

patients

breast

with high

Every

oral

received

with

Those ously

proprietary a

who

had

conventional

previmouth-

preferred

preparation antiseptic

burning

control parame-

1).

universally

aromatherapy

online

to those

patients

received

washes

cause

(Table

differences and

the

since

the

preparations

can

discomfort

and

at http://www.idealibrary.com

on

IDEkl@

of Antimicrobial

genie organisms. Journal

Chemoth~apy 88 (10) : 489492. ??

Hammer,

activity

et

al.

Melaleuca

??

M.,

Comparative

kanuka

already

fragile

substantial

to an

able

There

was a

mixtures.

There

have

controlled

trials

relating

generally

antiseptic

mucosa.

difference which

treatment,

damage in the

at

cost

retail

of

prices

worked out at 11 pence per day for the

been

essential

saline

oils

and

conventional

210

pence

treatment.

for

No evidence

of toxicity was seen in either group.

Oral mucositis dose

is recognised

limiting

toxicity

chemotherapy

1999).

As well as causing

and dysphagia,

of

constitutes

25-50% an

barrier

risk factor for septi-

focus

of

to

infection

damage also predisposes

colonization

bacterial

flora

incidence

of

increased

with

an

abnormal

as well as yeasts. invasive

The

mycosis

has

in line with the intensity treatment.

Almost

systemic candidiasis

of

all cases of

originate

from the

oral cavity. Supportive has

been

according hygiene tant

care for oral mucositis

mostly

empirical

and

to local

preference.

Oral

has been recognized in

mucositis

preventing and infection,

a wide selection

been

some

to this,

have not than

(Foote,

with powerful peroxide

1994).

agents

such

may even delay

healing

by preventing

mucosal

eration

(Feber,

Some

1996).

regen-

attempts

have been made to use medication anti-ulcerative

properties

have been

marginal

associated

with

but

with

but

effects

and may even be

an increased

risk

of

infection.

blind

placebo-controlled

investigated

the

compared

induced

by

of

trial

between was

demonstrated

the two protocol

arms (Fidler

demonstrate parameters

any

differences

observed

patient preference the

aromatherapy adopted

but

in

the

because

of

and cost advantages, protocol

as the standard

wash preparation

has

now

mouth-

for my patients.

and there

of mouthwashes

are avail-

mouthwash

mucositis. ??

of 5-FU-induced

Faoagali,

J., et al. (1997)

ment for burns?

Burns 23(4):

Feber,

T.

(1996)

in

oral

??

Foote,

Antifungal

J.M.,

et

al.

activity of Melaleuca

(1998) alterni-

folia (tea tree) oil against various patho-

Management radiation.

R.L.,

Randomised mouthwash

of

Clinical

et

trial

al.

of

for alleviation

mucositis.

(1994)

a chlorexidine of radiation-

Journal of Clinical

Oncology 12: 2630-2633. ??

Karthaus,

there

et al. (1999)

new

ten

??

Prophylaxis

of chemooral

and radio-

mucositis

strategies?

Transplantation ??

Bone

-

S.,

et

al.

and antifungal

essential

oils

in

(1996) activity of

vitro.

Microbios

et al. (1998)

Tea tree

: 237-246.

Rubel,

D.M.,

oil allergy: what is the offending Report

are

Marrow

24: 1095-l 108.

Pattnaik,

of three

allergy

and

Australasian

agent?

cases of tea tree

review Journal

of

oil

literature.

of Dermatology

39

(4): 244-247. Viollon,

Chaumont,

Concha,

treat-

349-351.

Oncology 8: 106-111.

C. J.

nistic properties, ??

Does tea

in the topical

mucositis

??

oral

Cancer 77 (3): 522-525.

tree have a place

??

as imporprogressive

of a chamomile

prevention

86 (349)

This small study has also failed to

been

evaluation for

Antibacterial

et al., 1996).

oil.

Prospective

therapy-induced

the two groups.

eucalyptus

460-463.

P, et al. (1996)

and treatment

equally

tea tree

Fidler,

??

mouthwash

chemotherapy,

(1999)

oil, Manuka oil,

and

chamomile

who had oral mucositis

difference

between

3 double-

clinical

use

with a placebo

in 164 patients

No

phase

oil, niaouli oil

induced

A well-designed

al.

study on the in vitro anti-

Pharmazie 54(6):

antiseptic

mixtures

solution

randomized

et al., 1999).

Mucosal

cancer

pathogens.

mucosal

have been reported

oral

(Karthaus to

the

Of patients with febrile

caemia,

pain

on

shown to be more effective

Treatment

of commensal

an important

infection. show

severe

and opportunistic

Disruption

et al.,

the oral cavity is colo-

nized by large numbers bacteria

intensive

(Karthaus

based

as hydrogen

as a major

of

cancer

usually

et

activity of Australian

oil, cajeput

add chemical

spp.

Chemotherapy

591-595.

Harkenthal,

bacterial

possibly

(tea tree) oil and

against Candida

of Antimicrobial

Journal

In-vitro

oils, in particular

alternifolia

tea tree products

42(5):

(1998)

of essential

and

Leger

P. (1993).

The

D., antago-

in vitro,

of ‘specified

natural volatile compounds

with respect

to

germs

of

vaginal

flora.

Planks

Medicinales Phytotherapie 26: 17-22.