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PRODUCT ALLERGEN WATCH

Mentha piperita (Peppermint)


Elise Herro and Sharon E. Jacob

PEPPERMINT (Mentha piperita) is a popular herb that can be used in numerous forms (ie, oil, leaf, leaf extract, and leaf water).
Peppermint oil has the most uses, and use data on the oil are considered relevant to the leaf extract formulations as well. This herbal
preparation is used in cosmeceuticals, personal hygiene products, foods, and pharmaceutical products for both its flavoring and
fragrance properties. Peppermint oil possesses a fresh sharp menthol odor and a pungent taste followed by a cooling sensation. It
also has a variety of therapeutic properties and is used in aromatherapy, bath preparations, mouthwashes, toothpastes, and topical
preparations. Topical preparations of peppermint oil have been used to calm pruritus and relieve irritation and inflammation. Their
frequent application to impaired skin could contribute to the sensitization rates seen. Numerous allergic contact dermatitis reactions
to peppermint oil have been described, many of which are linked to both perioral and intraoral disorders. Although peppermint oil is
known for its many properties, its role as a sensitizer should be recognized so as to aid in the diagnosis of both dermatitis and oral
conditions and to allow the initiation of proper avoidance measures.

EPPERMINT (Mentha piperita, of the Labiatae or amounts of menthol (3560%) and menthone (15
P Lamiaceae family) is a well-known plant that is used
in numerous forms (ie, oil, leaf, leaf extract, and leaf
30%)2,3 but also constituents such as menthyl acetate,
eucalyptol, limonene, and pulegone.13,7
water).1,2 It is a perennial herb native to Mediterranean Pulegone is a recognized hepatotoxin and possible
Europe but currently cultivated in many parts of the neurotoxin. It is found in young peppermint leaves and is
world. Of interest, it is a hybrid of spearmint (Mentha later metabolized to menthol; depending on the origin of
spicata) and water mint (Mentha aquatica)24 and is the oil, however, there is a residual concentration of 1 to
synonymous with Mentha oil, Mentha piperita oil, and oil 4%.1 Because of its toxicity profile, the concentration of
of peppermint.1,2 It is said that the term Mentha is pulegone is limited to 1% or less, especially because
derived from Greek mythology, being the name of the menthol has been shown to enhance the penetration and
nymph whom Pluto pursued. Upon discovery, Plutos absorption of other substances.1,3 With this knowledge and
wife, Persephone, trampled Mentha into the ground, from data submitted to the Cosmetic Ingredient Review
turning her into mint.2,5,6 (CIR) by the Cosmetic, Toiletry and Fragrance Association
Although there are many uses for the different forms of reporting peppermint oil concentrations used in products
Mentha piperita, this article will focus on the oil because it to be 3% or less in rinse-off formulations and 0.2% or less
has the highest usage and is the most evaluated substance. in leave-on formulations, the CIR Expert Panel concluded
The oil is extracted by steam distillation from the above- that Mentha piperita (oil, leaf, leaf extract, and leaf water)
ground plant just before the plant flowers. It is a colorless is safe for use in cosmetic formulations.1,8
or pale yellow liquid with a fresh sharp menthol odor and Despite the CIRs report, there is evidence that Mentha
a pungent taste; when applied to the skin, it causes a piperita oil can cause both dermal irritation and sensitiza-
cooling sensation.1,2 Notably, peppermint oil contains tion.1,3 Patch testing with peppermint oil should be done
more than 30 known components, with substantial with a concentration of 2% in petrolatum, according to
the International Contact Dermatitis Research Group.1
From the Division of Pediatric and Adolescent Dermatology, University of
Menthol has also been shown to be an irritant that
California, San DiegoRady Childrens Hospital, San Diego, CA. produces a burning sensation at concentrations of 5% and
Address reprint requests to Sharon E. Jacob, MD, Assistant Professor of 10% (the opposite of its cooling effect at lower
Medicine and Pediatrics (Dermatology), University of California, San concentrations).1 Despite a study using the Kligman
DiegoRady Childrens Hospital, 8010 Frost Street, Suite 602, San Diego, maximization protocol with 8% peppermint oil and
CA 92123. E-mail: sjacob@contactderm.net eliciting no sensitization,1 there are numerous reports of
DOI 10.2310/6620.2011.10080 ACD reactions to 2% peppermint oil.1,9 Of note, the first
# 2010 American Contact Dermatitis Society. All Rights Reserved. description of ACD from mint (specifically peppermint)

Dermatitis, Vol 21, No 6 (November/December), 2010: pp 327329 327


328 Herro and Jacob

appeared in 1940.7 ACD reactions to the individual Table 2. Examples of Products That Contain Peppermint Oil As a
constituents (such as menthol) have also been Flavorant
observed.1,10,11
Mouthwashes
Peppermint oil is currently used in cosmetic, personal Breath fresheners
hygiene, food, and pharmaceutical products for both its Toothpastes
flavoring and fragrance properties1,3,9 (Table 112 and Table Chewing gums
2). In 1991, the US Food and Drug Administration (FDA) Dental floss
labeled peppermint oil as safe and effective for use as both Teas
a topical and inhaled antitussive but cautioned its use as an Confections
expectorant, nasal decongestant, mouthwash, or digestive Dissolving oral thin strips
aid.1 In 1998, the FDA reported 102 formulations of
various products that contained peppermint oil.1 for those with liver, gallbladder, or bile duct disorders.3 Its
Topical preparations of peppermint oil have been used use also should be avoided in children younger than 7
to calm pruritus and relieve irritation and inflammation2,4 years because it may cause breathing difficulty.2,4
and are often marketed with an emphasis on their fresh
Of interest, ACD reactions to both peppermint and
and cooling effect. Peppermint oil has a variety of
menthol have been reported in association with ingestion.
therapeutic properties (analgesic and anesthetic, antiseptic,
For example, Vermaat and colleagues reported on a patient
antispasmodic, mentally stimulative, vasoconstrictive, and
who experienced a 6-year history of vulvar ACD due to the
usefulness as a decongestant and expectorant) when used
peppermint oil in her daily herbal tea. No oral symptoms
in aromatherapy, bath preparations, mouthwashes, tooth-
were reported, possibly indicating a systemic contact
pastes, and topical preparations.1,2,4,9 In addition, pepper-
dermatitis affecting the genital region from urinary
mint oil has been used to relax gastrointestinal (GI)
excretion of the metabolized allergen.13
smooth muscle and thus to aid in treating spastic colon
Peppermint is also used in topical medicaments, such
and irritable bowel syndrome.1,3 Notably, because of its
as the flurbiprofen local-action transcutaneous (LAT)
effect on the GI tract, caution is urged in patients with GI
patch. Foti and colleagues reported a case of severe ACD
reflux or hiatal hernia.3 Furthermore, according to the
in the lumbar region following multiple applications of the
German Commission E, peppermint oil is contraindicated
patch for pain. The patch contained both peppermint oil
and menthol owing to their anesthetic properties and
Table 1. Examples of Personal Care Products That Contain ability to augment topical drug penetration. Patch testing
Peppermint Oil revealed allergy to peppermint oil and menthol as well as
Product* Form to the LAT patch itself.11
Noxzema Instant Shave-Regular Aerosol
Sensitivity to both peppermint oil and menthol has been
Noxzema Sensitive Skin Cream-Jar Cream reported in patients with perioral dermatitis, stomatitis,
Noxzema Shaving Cream, Regular Aerosol burning mouth syndrome (BMS), recurrent oral ulcers
Noxzema 2 in 1 Astringent Pad (ROUs), and oral lichenoid reactions (OLRs).7,9 Morton and
Noxzema Medicated Instant Shave, Extra Aerosol colleagues evaluated patients who had BMS, ROUs, and
Sensitive Skin OLRs and found that at a mean follow-up of approximately
Vaseline Intensive Care Solutions Smooth Feet Cream 32 months, 4 of 9 patients (44%) reported clearance of their
Fixodent Denture Adhesive Powder, Extra Hold Powder condition whereas 2 patients reported substantial improve-
Fixodent Complete Denture Adhesive Cream Tube
ment in their symptoms following their avoidance of
Fixodent Complete Denture Adhesive Cream Tube
menthol and peppermint.9 Patients had noted symptoms
Paul Mitchell Tea Tree Special Shampoo Liquid
Sea Breeze Astringent Oily Skin Liquid
lasting up to 8 years, and some required systemic steroids.
Revlon Professional Cuticle Massage Night Cream Cream Upon implementation of an avoidance regimen, however,
Clearasil StayClear Deep Clean Astringent Liquid symptoms ceased in as few as 3 days. Among the three
Icy Hot Medicated Patch Patch, cream participants who did not report symptomatic improvement,
Selsun Blue Medicated W/Menthol Dandruff Cream one chose not to avoid either peppermint or menthol and
Shampoo reacted to both; another improved when her mercury-
Adapted from Peppermint oil.12 containing amalgam dental restorations were removed. Pep-
*May be discontinued. permint and menthol are on the growing list of allergens
Mentha piperita (Peppermint) 329

(such as benzoic acid, cinnamon, propylene glycol, and sorbic 4. Peppermint: University of Maryland Medical Center. 2010. Avail-
acid) that have been linked to BMS and ROUs. Of note, able at: http://www.umm.edu/altmed/articles/peppermint-000269.htm
(accessed August 27, 2010).
Fleming and Forsyth reported the case of a woman who had a
5. Mentha: New World Encyclopedia. 2008. Available at: http://
9-year history of BMS and OLRs for whom late delayed www.newworldencyclopedia.org/entry/Mentha (accessed August
readings were necessary to detect peppermint and menthol.10 27, 2010).
Because of peppermint oils popularity and wide use as 6. Willmont D. Peppermint (Mentha piperita). National Association
a flavoring, fragrance, and therapeutic agent, its role as a for Holistic Aromatherapy. Available at: http://www.naha.org/
potential sensitizer should be recognized. ACD due to top_10_peppermint.htm (accessed August 27, 2010).
7. Wilkinson SM, Beck MH. Allergic contact dermatitis from menthol
peppermint oil has been well documented in individuals
in peppermint. Contact Dermatitis 1994;30:42, doi:10.1111/j.1600-
with both dermatitis or disorders of the oral mucosa. An 0536.1994.tb00728.x.
appreciation of peppermint oil as a potential allergen can 8. Quick reference table Cosmetic Ingredient Review reports through
thus lead to the initiation of a proper avoidance regimen. June 2010. Cosmetic Ingredient Review (CIR) Safety. 2010. Avail-
able at: http://www.cir-safety.org/staff_files/PublicationsListDec2009.
pdf (accessed August 27, 2010).
Acknowledgments 9. Morton CA, Garioch J, Todd P, et al. Contact sensitivity to menthol
and peppermint in patients with intra-oral symptoms. Contact
Financial disclosures of authors and reviewer(s): None Dermatitis 1995;32:2814, doi:10.1111/j.1600-0536.1995.tb00781.x.
reported. 10. Fleming CJ, Forsyth A. Short communication: D5 patch test
reactions to menthol and peppermint. Contact Dermatitis 1998;38:
337, doi:10.1111/j.1600-0536.1998.tb05770.x.
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