Inside Popular Botanical Ingredients in Pediatric Skincare Products

Pediatric Skin Care

Inside Popular Botanical Ingredients in Pediatric Skincare Products Feverfew, colloidal oatmeal, and sunflower seed oil may provide benefits for children with eczematous skin conditions.

By Jeanine B. Downie, MD

otanical extracts have been used on the skin for millennia. Contemporary written reports and Baccumulated evidence tell us that Cleopatra used botanical-based topical formulations for cosmetic purposes and to condition her skin. Today, the US cosme- ceutical (a moniker developed to describe specialty cosmetic products formulated with pharmaceutical grade ingredients and/or pharmaceutical-type manufacturing standards) market is an estimated $5.8 to $10 billion industry, and a majority of those products are built upon botanical extracts. Botanical ingredients are also now incorporated into many mass-market skincare products, including several products developed specifically for children. Following botanical ingredients ingested orally or applied is a look at some of the more popular botanical topically, there are generally few published con- ingredients used in pediatric skincare products. trolled trials of finished formulations. So, for The emphasis is on topical application and skin- example, while there is good scientific evidence care formulations, not on oral botanical-based sup- that topically applied aloe vera confers local anti- plements. inflammatory effects,1 it is less clear what concentration of aloe vera is necessary to confer those Understanding the Research benefits or whether any particular aloe-containing When it comes to topically-applied botanical ingre- lotion is more beneficial than another. dients, it is important that an individual evaluating Furthermore, when it comes to botanical ingre- products keep in mind the limitations of the avail- dients, the quality of the raw botanical material is able data. While there are often many published a crucial consideration. Chemical composition of studies documenting the biological activities of the soil, soil quality, and other environmental fac-

July/August 2010 | Practical Dermatology for Pediatrics | 19 Pediatric Skin Care

tors influence the quality of a plant, either posi- tively or negatively. Furthermore, botanical com- pounds within plants, once harvested, are suscepti- ble to oxidation and may quickly degrade, depend- ing on cold, heat, humidity, light exposure, etc. This requires harvesters to handle materials in a timely and well-controlled manner throughout the process of collecting and synthesizing plant extracts.2 Many respected manufacturers derive botanical ingredients only from specific, controlled crops to ensure quality and consistency. These important considerations are not necessari- Topical application of feverfew extract has been shown to provide ly limitations of topical botanicals, as many high- anti-inflammatory effects. quality botanical-based skincare formulations are currently on the market. These have demonstrated clinical effectiveness, achieved high levels of patient tion in release of pro-inflammatory cytokines. In and physician endorsement, and in many cases have vivo, PFE-feverfew reduced DNA damage and controlled data to support their efficacy. Physicians hyperplasia following UV exposure. There was also interested in learning more about specific formula- a reduction in UV-induced skin erythema as a tions can contact the manufacturers with requests result of PFE-feverfew application.5 for information. Trusted manufacturers test their fin- Another trial confirmed the ability of PFE-fever- ished formulations in controlled trials. These may few to inhibit the activity of pro-inflammatory not always be as rigorous as pharmaceutical drug tri- enzymes and the release of pro-inflammatory als, but they are generally well-designed and reli- mediators from macrophages and from human able. Results may not be published in the literature, peripheral blood mononuclear cells. In vivo, PFE- but data often are provided to enquiring physicians feverfew inhibited dermatitis in two different for evaluation. murine models.6 Most feverfew-containing skincare products are Feverfew intended for anti-aging use or to manage adult der- A popular topical botanical currently is feverfew matoses, such as rosacea. However, given its effi- (Tanacetum parthenium), a member of the sun- cacy in combating dermatoses in vivo, there is flower family. Feverfew's common name derives increasing interest in using feverfew for atopic der- from its ancient oral use as a fever reducer. The matitis and “sensitive skin.” PFE-feverfew is for- antioxidant-rich botanical is shown to have anti- mulated into the Aveeno Active Naturals line in inflammatory and anti-cancer properties and is their “Ultra-Calming” products. These include a used as an oral supplement to treat migraine facial cleanser, daily facial moisturizer with SPF, headaches.3 and a sunscreen, which are not necessarily mar- One challenge associated with the topical appli- keted for children, but may be suitable for use on cation of feverfew derivatives is the risk of parthe- eczema-prone skin. nium dermatitis, a common allergic reaction to plants.4 A novel parthenolide-free extract of fever- Colloidal oatmeal few (PFE-feverfew) compound has removed the Use of finely ground colloidal oatmeal (Avena sati- parthenolide component to obviate the sensitiza- va L.) to soothe skin is an ancient practice, and the tion potential. In one study, the agent had in vitro use of oatmeal baths is still common to help con- anti-inflammatory effects, as indicated by a reduc- trol pruritic, inflammatory skin manifestations like

20 | Practical Dermatology for Pediatrics | July/August 2010 Pediatric Skin Care

With a long history of use, colloidal oatmeal may reduce itch and Essential fatty acids in sunflower seed oil may support proper epi- increase skin moisturization. dermal functioning. poison ivy and chicken pox. Colloidal oatmeal ble low-cost moisturizers, but studies suggest vari- functions as a cleanser, moisturizer, buffer, as well ability in their effectiveness. For example, applica- as a soothing and protective anti-inflammatory tion of sunflower (Helianthus annuus) seed oil was agent.7 Colloidal oatmeal has been used to treat shown to accelerate epidermal barrier function atopic dermatitis and inflammatory skin diseases repair in mouse models, while other botanical oils and is known to repair barrier dysfunction, reduce actually delayed repair.9 When sunflower seed oil skin inflammation and irritation.2 was applied three-times daily to preterm infants in The anti-pruritic effects of colloidal oatmeal one study, it was shown to improve overall skin were demonstrated in a study of burn wounds. health and reduce nosocomial infections compared Patients who applied to healing burn wounds a to controls.10 topical moisturizer containing colloidal oatmeal Sunflower seed oil contains high levels of essen- reported significantly less itch and used fewer anti- tial fatty acids, including linoleic acid. A novel histamines than patients who used the vehicle sunflower oleodistillate (SOD) has been shown to moisturizer without colloidal oatmeal.8 increase epidermal lipid synthesis and to reduce Colloidal oatmeal also provides protective and inflammation both in vitro and in animal models. moisturizing benefits, thought to derive from the In one study, an SOD 2% emulsion demonstrated high concentration of starches and beta-glucans moisturizing properties in 20 adult volunteers with that hold water.7 The botanical is high in oat phe- atopic skin and was found to have a strong steroid- nols, some of which are strong ultraviolet sparing effect. Other studies in infants and babies absorbers and under investigation as sunscreen with AD have shown a positive impact on quality- ingredients.7 of-life parameters.11 Colloidal oatmeal is featured in Aveeno Baby Sunflower oleodistillate is the primary compo- Soothing Relief products, including creamy wash, nent of Stelatopia products from Mustela, which bath treatment, and moisture cream, as well as include moisturizing cream, cream cleanser, and Aveeno Baby Daily Care washes and moisturizer. milky bath oil. Aveeno Daily moisturizing lotion and Aveeno Eczema Care also feature colloidal oatmeal. Lavender and Chamomile Lavender (Lavandula angustifolia or Lavandula offici- Sunflower seed oil nalis) takes its name from the Latin word “to Botanically-derived oils have been studied as possi- wash,” presumably because it was commonly used

July/August 2010 | Practical Dermatology for Pediatrics | 21 Pediatric Skin Care

Tea Tree Oil: A Potential Allergen Although no widely-marketed products for children contain tea tree oil, the botanical agent is increasingly popular as a topical antiseptic and antimicrobial. A number of washes, shampoos, and anti-acne formulations are available and marketed to reduce risks of cutaneous bacterial and fungal infections or treat acne, despite limited positive data. Due to its popularity, the agent may attract the interest of some parents or teen patients. Tea tree oil has been associated with high and increasing rates of Lavender oil aromatherapy has been shown to reduce anxiety and allergic contact may promote sleep. reactions.25-27 Given this rate of allergic reactions,21 although no widespread reports of reactions and the lavender allergy are in the literature. In fact, in limited evidence to mouse models, topical application of lavender oil support its utility, was shown to inhibit immediate type allergic reac- tea tree oil should tions.22 not be widely rec- Chamomile (Matricaria recutita) contains the ommended for chil- flavinoid apigenin, which is suggested to have anti- tumor effects.23 Chamomile also has anti-inflamma- dren at this time. tory, antimicrobial, and wound-healing benefits.24 Aveeno Baby Calming Comfort bath and lotion contain lavender extracts for fragrance. Nature's as a fragrance in baths. Lavender oil is shown to Baby Organics makes a wash with lavender and have strong antioxidant properties.12 Orally, laven- chamomile. Aquaphor Baby Gentle Wash and der oil supplementation has been associated with Shampoo contains chamomile, as does Mustella anti-inflammatory and analgesic effects.13 Topically baby shampoo. applied lavender oil has shown antimicrobial effects14,15 and is under investigation as an anti-tick Potential Adjuncts treatment.16 Fearful of irritants and allergens, parents often fret Despite these potential uses for topical lavender about which products to use to bathe and moisturize oil, currently its primary use in skincare products their children. Use of a gentle, soap-free, moisturiz- is as an anxiolytic and sleep-promoting fragrance. ing cleanser is always appropriate. However, if par- Studies have shown that lavender oil aromatherapy ents are interested in “natural” or botanical skincare, effectively reduces anxiety in mouse models of the accumulated evidence suggests that some prod- induced anxiety with demonstrated effects on neu- ucts may be worthwhile. For patients with “sensitive rotransmitters such as dopamine, serotonin, and skin,” eczema, atopic dermatitis, or any acute or their derivatives.17 In various trials, lavender aro- chronic, inflammatory, pruritic skin condition, prod- matherapy has been shown to reduce anxiety ucts containing feverfew, colloidal oatmeal, or sun- among dental patients,18 pre-surgical patients,19 and flower seed oil may be useful adjuncts to other ther- test-taking graduate nursing students.20 apeutic interventions. The listing of brands and Studies show that unstable lavender oil exposed product lines provided here is not exhaustive. to oxidation has the potential to induce allergic Patients may use alternative products, but they and

22 | Practical Dermatology for Pediatrics | July/August 2010 Pediatric Skin Care

health in developing countries. Acta Paediatr. 2002;91(5):546-54. 10. Darmstadt GL, Badrawi N, Law PA, Ahmed S, Bashir M, Iskander I, Al Said D, El Kholy A, Husein MH, Alam A, Winch PJ, Gipson R, Santosham M. Topically applied sunflower seed oil prevents invasive bacterial infections in preterm infants in Egypt: a randomized, controlled clinical trial. Pediatr Infect Dis J. 2004 Aug;23(8):719-25. 11. Eichenfield LF, McCollum A, Msika P. The benefits of sunflower oleodistillate (SOD) in pediatric dermatology. Pediatr Dermatol. 2009 Nov-Dec;26(6):669-75. 12. Yang SA, Jeon SK, Lee EJ, Shim CH, Lee IS. Comparative study of the chemical composition and antioxidant activity of six essential oils and their components. Nat Prod Res. 2010;24(2):140-51. 13. Hajhashemi V, Ghannadi A, Sharif B. Anti-inflammatory and analgesic properties of the leaf extracts and essential oil of Lavandula angustifolia Mill. J Ethnopharmacol. 2003 Nov;89(1):67-71. Chamomile is thought to have anti-inflammatory, antimicrobial, and 14. Kunicka-Styczy_ska A, Sikora M, Kalemba D. Lavender, tea tree and lemon oils as wound-healing benefits. antimicrobials in washing liquids and soft body balms. Int J Cosmet Sci. 2010 Jun 21. Epub should carefully evaluate the offerings with the guid- 15. Lodhia MH, Bhatt KR, Thaker VS. Antibacterial activity of essential oils from pal- marosa, evening primrose, lavender and tuberose. Indian J Pharm Sci. 2009 ance of their physician. Generally, consumers do Mar;71(2):134-6. best to choose established brands and/or those that 16. Pirali-Kheirabadi K, Teixeira da Silva JA. Lavandula angustifolia essential oil as a provide detailed data about the performance of their novel and promising natural candidate for tick (Rhipicephalus (Boophilus) annulatus) specific formulations. control. Exp Parasitol. 2010 Apr 28. Epub Lavender and chamomile-containing formula- 17. Tsang HW, Ho TY. A systematic review on the anxiolytic effects of aromatherapy on tions may have less utility in terms of promoting rodents under experimentally induced anxiety models. Rev Neurosci. 2010;21(2):141- 52. skin health, but these products appear to do no 18. Kritsidima M, Newton T, Asimakopoulou K. The effects of lavender scent on dental harm to the skin and may have calming and sooth- patient anxiety levels: a cluster randomised-controlled trial. Community Dent Oral ing benefits for children, especially young babies.■ Epidemiol. 2010 Feb;38(1):83-7. 19. Braden R, Reichow S, Halm MA. The use of the essential oil lavandin to reduce Dr. Downie has served as a consultant/lecturer or researcher preoperative anxiety in surgical patients. J Perianesth Nurs. 2009 Dec;24(6):348-55. for Johnson & Johnson. 20. McCaffrey R, Thomas DJ, Kinzelman AO. The effects of lavender and rosemary 1. Wu J. Anti-inflammatory ingredients. J Drugs Dermatol. 2008 Jul;7(7 Suppl):s13-6. essential oils on test-taking anxiety among graduate nursing students. Holist Nurs Pract. 2009 Mar-Apr;23(2):88-93. 2. Farris PK. Natural Ingredients and their Application sin Dermatology. Practical Dematology. 7(2):51-54. 21. Hagvall L, Sköld M, Bråred-Christensson J, Börje A, Karlberg AT. Lavender oil lacks natural protection against autoxidation, forming strong contact allergens on air expo- 3. Schiapparelli P, Allais G, Castagnoli Gabellari I, Rolando S, Terzi MG, Benedetto C. sure. Contact Dermatitis. 2008 Sep;59(3):143-50. Non-pharmacological approach to migraine prophylaxis: part II. Neurol Sci. 2010 Jun;31 Suppl 1:S137-9. 22. Kim HM, Cho SH. Lavender oil inhibits immediate-type allergic reaction in mice and rats. J Pharm Pharmacol. 1999 Feb;51(2):221-6. 4. Sharma VK, Sethuraman G. Parthenium dermatitis. Dermatitis. 2007 Dec;18(4):183- 90. 23. Li B, Birt DF. In vivo and in vitro percutaneous absorption of cancer preventive flavonoid apigenin in different vehicles in mouse skin. Pharm Res. 1996 5. Martin K, Sur R, Liebel F, Tierney N, Lyte P, Garay M, Oddos T, Anthonavage M, Nov;13(11):1710-5. Shapiro S, Southall M. Parthenolide-depleted Feverfew (Tanacetum parthenium) pro- tects skin from UV irradiation and external aggression. Arch Dermatol Res. 2008 24. Jarrahi M. An experimental study of the effects of Matricaria chamomilla extract Feb;300(2):69-80. on cutaneous burn wound healing in albino rats. Nat Prod Res. 2008 Mar 20;22(5):422-7. 6. Sur R, Martin K, Liebel F, Lyte P, Shapiro S, Southall M. Anti-inflammatory activity of parthenolide-depleted Feverfew (Tanacetum parthenium). Inflammopharmacology. 25. Simpson EL, Law SV, Storrs FJ. Prevalence of botanical extract allergy in patients 2009 Feb;17(1):42-9. with contact dermatitis. Dermatitis. 2004 Jun;15(2):67-72. 7. Kurtz ES, Wallo W. Colloidal oatmeal: history, chemistry and clinical properties. J 26. Rutherford T, Nixon R, Tam M, Tate B. Allergy to tea tree oil: retrospective review Drugs Dermatol. 2007 Feb;6(2):167-70. of 41 cases with positive patch tests over 4.5 years. Australas J Dermatol. 2007 May;48(2):83-7. 8. Matheson JD, Clayton J, Muller MJ. The reduction of itch during burn wound healing. J Burn Care Rehabil. 2001 Jan-Feb;22(1):76-81 27. Zug KA, Warshaw EM, Fowler JF Jr, Maibach HI, Belsito DL, Pratt MD, Sasseville D, Storrs FJ, Taylor JS, Mathias CG, Deleo VA, Rietschel RL, Marks J. Patch-test results of 9. Darmstadt GL, Mao-Qiang M, Chi E, Saha SK, Ziboh VA, Black RE, Santosham M, the North American Contact Dermatitis Group 2005-2006. Dermatitis. 2009 May- Elias PM. Impact of topical oils on the skin barrier: possible implications for neonatal Jun;20(3):149-60. Erratum in: Dermatitis. 2009 Oct;20(5):300.

July/August 2010 | Practical Dermatology for Pediatrics | 23