Case Study - Topical Application - Sore on Skin

Section 1: Primary Concern

D.J. reports a sore on his leg from losing his footing and falling into the fender of his trailer.

Section 2: History of Primary Concern

D.J. reports that this incident happened about an hour ago.  He cleaned it before coming into the office.  He stated he was trying to fix one of the side walls on the trailer and lost his footing, which caused him to fall over the fender, scratching his leg on the way to the ground.  He stated that his pain level is about a 3.  He denies hitting his head or hurting any other part of his body. 

He denies going to the doctor for a consultation for his current abrasion.  The client stated that the last time he was at the doctor, he was given a clean bill of health.  

D.J. states that he has yet to try to use anything other than cleaning it with mild soap to improve the abrasion.  At this time, he denies any way that his abrasion feels worse.  He came into the aromatherapist’s office before trying anything else. 

D.J. has come to my office several times prior for different reasons, so he is familiar with complementary alternative medicine.  He declines taking any prescription medications, drinks alcohol, or uses any homeopathic remedies. D.J. admits he smokes cannabis.  He also states that he drinks caffeine.  

Section 3: Observations and Impressions  

D.J. presents to the appointment alert.  He is well-groomed.  D.J. is 5’7” and has normal muscle tone, clear skin, and reddened eyes (due to his admitted cannabis usage, he admits).  He answered questions appropriately and had good posture.  His voice sounds are clear and loud.  The client makes good eye contact.  He smells like cannabis and cologne.  The aromatherapist did not observe D.J.’s tongue or iris.  The client showed the aromatherapist the abrasion.  It is superficial and irregular in shape but similar to a triangle on the ipsilateral sural, proximal to the popliteal area, which is about 3 inches by 1 ½ inches.

• What are the goals of your support plan? The support plan aims to support wound healing. 

  
  

• What is your theory for creating a support plan for this client? The support plan should include essential oils with antibacterial, antifungal, germicidal, rubefacient, antimicrobial, antioxidant, and wound-healing properties. 

  
  

• What led you to formulate this theory? The client could use essential oils with the above properties to assist with supporting healthy wound healing. 

Section 4: Holistic Support Plan

1. MATERIALS

• Double boiler (stainless steel)

• Candy thermometer

• Oven mitts

• Lavender Lavandula angustifolia hydrosol (in case of burns)

• Measuring spoons

• Glass stirring rod.

• A small glass beaker

• A stainless steel spoon.

• An empty container with a lid (non-aluminum).

• Sweet almond Prunus amygdalus var. dulcis

• Beeswax Apis cerana 1 1/2 teaspoons

• Lavender Lavandula angustifolia essential oil

• Bergamot Citrus aurantium var. bergamia essential oil

• Thyme Thymus vulgaris CT linalool essential oil

  
  

2. APPLICATION METHODS

The client prefers a topical application method and finds it most convenient.  This method offers therapeutic benefits via skin absorption (Petersen, 2021).  This method would provide the most direct approach to support the client’s skin.

3. EXTERNAL FACTORS

D.J. prefers citrus, herbal, and floral aromas.  He reports using two of the three essential oils in the past for topical supportive options.  D.J. completed an organoleptic test with the three essential oils together and liked the three of them together.  He has had previous skin patch tests for lavender and bergamot, which were negative.  A skin patch test was administered for the thyme essential oil and returned a negative result.  He denies having any allergies to plants, nuts, or propolis.  The blend is affordable.  Bergamot can cause photosensitivity, and the application site should not be exposed to the sun for 12 hours after administration.  The other two oils can cause skin sensitivity; if skin sensitivity issues arise, the client is advised to contact the aromatherapist for instructions.  The essential oils and ointment should be kept out of reach of children.

4. YOUR REASONING

Lavender L. angustifolia has antibacterial, antimicrobial, and antiseptic therapeutic actions (Petersen, 2022).  Bergamot C. aurantium var. bergamia has analgesic, antibacterial, anti-inflammatory, antiseptic, and rubefacient therapeutic actions (Petersen, 2022).  Thyme T. vulgaris CT linalool has the following applicable therapeutic actions: anesthetic, anti-aging, antibacterial, antioxidant, antifungal, anti-inflammatory, antimicrobial, antiseptic, bactericidal, cell proliferant, disinfectant, fungicidal, germicidal, rubefacient, and tonic (Petersen, 2022).  Sweet almond P. amygdalis var. dulcis helps relieve dryness, inflammation, soreness, and skin itching (Shutes & Siegmund-Roach, 2022).  Beeswax A. cerana has antimicrobial effects (Natural Medicines, 2022).  The constituents in L. angustifolia include the ester linalyl acetate (25-45%), monoterpene beta-ocimene (5-15%), and a monoterpenol linalool (25-40%) (Petersen, 2022). Constituents found in bergamot include an ester linalyl acetate (25-30%), the monoterpenes d-limonene (35-45%) and pinene (5-10%), and the furocoumarin bergaptene (0.11-33%) (Petersen, 2022).  Thymol has the following constituents: phenols carvacrol (1-25%) and thymol (1-25%); monoterpenes para cymene (6-20%), limonene (1-20%), and gamma-terpinene (9-18.6%); and the monoterpenols borneol (1-20%), geraniol (1-35%), and linalool (1-75%) (Petersen, 2022).  Sweet almond oil has the following constituents: monounsaturated fatty acid oleic acid (60.0-86.0%) and polyunsaturated fatty acid linoleic acid (15-30%) (Shutes & Siegmund-Roach, 2022).  Beeswax is a mixture of several items: propolis, fatty alcohols, hydrocarbons, esters of fatty acids, free fatty acids, and other substances; the exact breakdown in the composition is variable between bee families and breeds (Natural Medicines, 2021).  Oxidation can occur in the lavender essential oil because of the linalyl acetate constituent.  Bergamot essential oil can cause abnormal skin pigmentation when exposed to the sun, which can increase the risk of skin cancer; avoid sun exposure for at least 12 hours, regardless of dilution.

5. FORMULAS

Lavender Ointment (3% dilution / Total mL=68.71 mL)

• Sweet almond Prunus amygdalus var. dulcis: 2 ounces (60 mL)

• Beeswax Apis cerana 1 1/2 teaspoons (7.39 mL)

• Lavender Lavandula angustifolia essential oil: 25 drops (0.83 mL)

• Bergamot Citrus aurantium var. bergamia essential oil: 10 drops (0.33 mL)

• Thyme Thymus vulgaris CT linalool essential oil: 5 drops (0.16 mL)

  
  

The aromatherapist put water in the bottom of the double boiler and turned on the burner.  When the water started showing signs of warmth (tiny bubbling), the aromatherapist placed the top of the double boiler over the bottom and added two ounces of sweet almond oil.  The aromatherapist set the candy thermometer in the oil for safety and easy temperature monitoring.  After the oil temperature reached 120 degrees, the writer added 1 1/2 teaspoons of the beeswax to the oil and stirred using the glass rod until the beeswax was melted.  Using the stainless-steel spoon, the aromatherapist scooped up a small amount of the mixture and placed it in the freezer for about a minute or two (my freezer gets items cold fast).  After this time, the aromatherapist liked the consistency of the oil and beeswax, so she added the essential oils as outlined in the materials list above.  Notably, the aromatherapist did not want to drop the essential oils in the bottle over top of the hot oil, so the aromatherapist placed all the drops in a small glass beaker and then poured the mixture of all essential oils into the oil (after removing the pan from the burner) and stirred.  The aromatherapist allowed the blend to cool for a few minutes, poured the liquid ointment into the non-aluminum container using oven mitts, and stirred.  Once the ointment had completely cooled, the aromatherapist affixed the lid and labeled the ointment.  

6. CLIENT INSTRUCTIONS

Wash hands before use.  Use a Q-tip to apply the ointment to the affected area four times daily.   

The client is scheduled for a follow-up appointment in four days. 

Section 5: Outcomes and Evaluation

The client came in for his follow-up appointment.  D.J. reported he applied the ointment as advised.  He did state a couple of times he forgot to use it, but as soon as he remembered, he applied the ointment.  The abrasion has reduced in size to 1 ½ inches by ½ inch; it is healing nicely.  D.J. would like to continue using the ointment for the next few days.  The aromatherapist agrees and advises that he should discontinue use when the abrasion is clear or when he reaches two weeks of use (whichever comes first).  He states he will come back the next time he needs aromatherapy support.

Section 6: References

Natural Medicines. (2021). Beeswax[Monograph]. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=305Links to an external site

Petersen, D. (2022). AROMA 203 aromatherapy I (20th ed.). Portland, OR: American College of Healthcare Sciences. 

Petersen, D. (2022). Aromatherapy materia medica essential oil monographs (21st ed). Portland, OR: American College of Healthcare Sciences. 

Shutes, J. & Siegmund-Roach, S. (2022). The carrier oil palette: fixed oils, butters, herbal oils, and CO2 extracts for the carrier oil palette. Aromatic Studes, LLC. ISBN: 9781737233169