THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE

Volume 22, Number 3, 2016, pp. 252–253 Case Study

ª Mary Ann Liebert, Inc.
DOI: 10.1089/acm.2015.0208

Cedarwood Oil as Complementary Treatment

in Refractory Acne

Lauren A. Hassoun, BS,1 Jennifer N. Ornelas, BA, MAS,1 and Raja K. Sivamani, MD, MS, CAT2

Abstract

Acne vulgaris is a widely prevalent chronic skin disease. Although multiple treatments are available, acne can
sometimes be refractory to these treatments. The use of alternative medical therapies has increased within
dermatology and for acne. This case report describes a patient in whom the addition of cedarwood oil was
helpful in controlling acne.

Introduction daily. Spironolactone was increased to 100 mg daily, and tre-

A cne vulgaris is a widely prevalent skin disease
that affects multiple ethnicities and individuals of differ-
ent age groups. While acne most commonly affects adoles-
cents and young adults, it often persists into adulthood and can
be distressing at any age.1 Typical therapies for acne include
topical antibiotics, retinoids, and benzoyl peroxide, as well
as systemic antibiotics, spironolactone, and retinoids.2 How-
ever, the use of botanicals and alternative therapies is increas-
ing within dermatology,3–5 including for the treatment of acne.6
This case report describes an adult with acne vulgaris that
persisted despite conventional therapy and improved with
the addition of topical cedarwood oil.
Case Presentation
A 35-year-old woman with a history of polycystic ovarian
syndrome and hidradenitis suppurativa presented to a der-
matology clinic with multiple lesions on her face, chest, and
upper back consistent with flared acne vulgaris. In the past
she had tried doxycycline and minocycline, with good
control of her hidradenitis suppurativa but without good
control of her acne. Although she was taking doxycycline,
100 mg every other day, at the time of presentation, this
flare was attributed to her change in oral contraceptive
therapy from 3 mg drospirenone/2 lg ethinyl estradiol to
levonorgestrel/ethinyl estradiol tablets, 0.15 mg/0.03 mg,
and ethinyl estradiol tablets, 0.01 mg. She began receiving
adapalene, 0.1% gel, applied nightly to her face and chest
and spironolactone, 50 mg daily, and her doxycycline dos-
age was increased to 100 mg daily.
One month later, her acne had worsened and more lesions
were noted on examination. Her doxycycline dose was not
increased because she had previously not tolerated 200 mg
tinoin 0.05% cream was substituted for adapalene gel. Three
days after her visit, the patient reported a heavy menstrual
period after being amenorrheic for 13 to 14 years. This was
attributed to spironolactone, which was subsequently dis-
continued. She noted continued worsening of the acne on her
face and chest and subsequently began applying cedarwood oil
mixed with tretinoin cream; she added several drops of ce-
darwood oil to the amount that she applied to her face and chest.
At her next follow-up 4 weeks later, the patient had sig-
nificantly improved acne: Her face was clear, and she had
rare open and closed comedones on the chest with no pap-
ules (Fig. 1). Her clinical improvement was attributed to the
addition of cedarwood oil to her acne treatment.
Discussion
Cedarwood (Juniperus virginiana) oil is an example of an
essential oil, defined as a hydrophobic component that contains
aroma compounds derived from plants via steam or physical
distillation.7 Essential oils differ from fixed oils primarily be-
cause of their volatile nature. Despite the lack of consistent
clinical evidence establishing their effectiveness, they have long
been valued for their medicinal applications. However, there
is insufficient evidence regarding the safety of cedarwood
oil. Reported adverse effects are primarily limited to allergic
reactions and irritation,8 but pregnancy and breast-feeding are
contraindications.9 There is also a potential interaction with
barbiturates and other sedatives, principally based on the phar-
macology of the compounds rather than documented cases.10
Cedarwood oil has antimicrobial properties. It is effective
against Escherichia coli O157:H7, Bacillus subtilis, and Pseu-
domonas aerginosa.11 Although the mechanism of antibacterial
activity is not well established, it is thought to be attributed to its

1
School of Medicine, University of California-Davis, Sacramento, CA.
2
Department of Dermatology, University of California-Davis, Sacramento, CA.

252
CEDARWOOD OIL AS COMPLEMENTARY TREATMENT IN REFRACTORY ACNE
FIG. 1. Clinical images of chest acne. (A) Acne lesions on
the chest before cedarwood oil use. (B) Chest acne 2 weeks
after initiation of cedarwood oil use. (C) Chest acne 4 weeks
after initiation of cedarwood oil use.
constituents, thujol, cedrol, and a- and b-cedrene.11 A likely
mechanism is the disturbance of the cytoplasmic membrane due
to the penetration of some of the oil’s components.11
Additionally, cedarwood oil, among other essential oils,
exhibited antibacterial activity against Streptococcus mutans
in in vitro studies performed by Chaudhari et al.; it may
therefore represent a potential alternative therapy for oral
infections.12 The major components, cedrol and thujopsene,
are hypothesized to be responsible for cedarwood oil’s an-
tifungal properties, namely against Gloeophyllum trabeum
and Trametes versicolor.13 Cedarwood oil’s antibacterial
properties may explain the positive effect it had on the acne
of the patient described here.
With regard to other dermatologic diseases, a double-
blind, randomized controlled trial of patients with alopecia
areata demonstrated that a mixture of essential oils (thyme,
rosemary, lavender, and cedarwood) in a mixture of carrier
oils (jojoba and grapeseed) massaged into the scalp was
more effective than use of carrier oils alone.14
This case presents an interesting scenario in which a
patient’s moderate acne significantly improved in associa-
tion with the use of cedarwood oil to standard topical and
oral therapies. It remains unknown which of its constituents
and quantity may have been responsible for the clinical
improvement observed in this patient.
Conclusion
Acne vulgaris is the most common skin condition in the
United States. While many patients use standard therapies,
such as antibiotics, retinoids, and antiandrogens, with great
success, some patients experience only minimal improve-
ment or are resistant to treatment. There is a growing in-
terest in complementary and alternative medicine among
253
patients in all fields of medicine. While this case stimulates
further investigation, cedarwood oil requires further re-
search before it can be assessed for its role in acne vulgaris.
Author Disclosure Statement
No competing financial interests exist.
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Address correspondence to:
Raja K. Sivamani, MD, MS, CAT
Department of Dermatology
University of California-Davis
3301 C Street, Suite 1400
Sacramento, CA 95816
E-mail: rksivamani@ucdavis.edu