Novel Antibacterial and Emollient Effects of Coconut and Virgin Olive Oils in Adult Atopic Dermatitis

Abstract

Atopic dermatitis (AD) skin is dry and readily colonized by Staphylococcus aureus (SA). Coconut and olive oils are traditionally used to moisturize and treat skin infections.
To compare virgin coconut oil (VCO) and virgin olive oil (VOO) in moisturizing dryness and removing SA from colonized AD skin.
This was a double-blind controlled trial in two outpatient dermatology clinics with adult AD patients who were diagnosed by history, pattern, evolution, and skin lesions and who were randomized to apply VCO or VOO twice daily at two noninfected sites. SA cultures, photography, and objective-SCORAD severity index (O-SSI) scoring were done at baseline and after 4 weeks.
Twenty-six subjects each received VCO or VOO. Of those on VCO, 20 were positive for SA colonies at baseline versus 12 on VOO. Post intervention, only 1 (5%) VCO subject remained positive versus 6 (50%) of those on VOO. Relative risk for VCO was 0.10, significantly superior to that for VOO (10:1, p = .0028; 95% CI, 0.01-0.73); thus, the number needed to treat was 2.2. For the O-SSI, the difference was not significant at baseline (p = .15) but was significantly different post treatment (p = .004); this was reduced for both oils (p < .005) but was greater with VCO.
VCO and monolaurin's O-SSI reduction and in vitro broad-spectrum activity against SA (given clinical validity here), fungi, and viruses may be useful in the proactive treatment of AD colonization.

Full text

STUDY
Novel Antibacterial and Emollient Effects of Coconut and
Virgin Olive Oils in Adult Atopic Dermatitis
Vermén M. Verallo-Rowell, Kristine M. Dillague, and Bertha S. Syah-Tjunäawan
Background: Atopic dermatitis (AD) skin is dry and readily colonized by
Staphylococcus aureus
{SA).
Coconut and olive oils are
traditionally used to moisturize and treat skin infections.
Objective: To compare virgin coconut oil (VCO] and virgin olive oil (VOO) in moisturizing dryness and removing SA from
colonized AD
skin.
Methods: This vt/as a double-blind controlled trial in two outpatient dermatology clinics with adult AD patients who were
diagnosed by history, pattern, evolution, and skin lesions and who were randomized to apply VCO or VOO twice daily at two
noninfected sites.
SA
cultures, photography, and objective-SCORAD severity index (0-SSI) scoring were done at baseline and after 4
weeks.
Results:
Twenty-six subjects each received VCO or
VOO.
Of those on
VCO.
20 were positive for
SA
colonies at baseline versus 12
on VOO. Post intervention, only
1
|5%| VCO subject remained positive versus 6 (50%) of those on VOO. Relative risk for VCO was
0.10, significantly superior to that for VOO
[10:1,
p = .0028; 95%
CI,
0.01-0.73); thus, the number needed to treat was 2.2. For the O-
SSI,
the difference was not significant at baseline (p = .15) but was significantly different post treatment (p ^
.004);
this was reduced
for both oils [p
•••
.005) but was greater with VCO.
Conclusion: VCO and monolaurin's 0-SSI reduction and in vitro broad-spectrum activity against
SA
(given clinical validity here),
fungi,
and viruses may be useful in the proactive treatment of AD colonization.
A
TOPIC DERMATITIS (AD) is characterized by dry
skin and the frequent isolation of Staphylococcus
aureus (SA) from infected eczema and chronic lesions and
as a colonizer of clinically uninfected atopic skin.' The
prevalence of colonization in normal skin is about 5%; in
lesional and nonlesional atopic skin of adults, children,
and infants, it is 64 to 100%.'^ Thus, based on a recent
systematic review of AD, it is felt that the use of a topical
antibiotic for treating SA infection can be effective, but the
development of resistance is a concern. Treatment of SA
colonization is not as clear-cut. The review further states
that antibiotics generally have a minimal therapeutic effect
on dermatitis without signs of infection."
A recent review on the mechanisms of disease in AD
explored
( 1 )
the role of SA colonization and infection in
helping generate the chronic inflammation characteristic
of atopic skin and (2) the role of inflammation {from SA
From the Skin and Cancer Foundation, Pasig, Philippines, and the VMV
Skin Research Centre + Clinics, Makati City, Philippines.
Address reprint requests to Vermén M. Verallo-Rowell, MD, VMV Skin
Research Centre + Clinics (VSRC), 117 C Palanca, Legaspi Village,
Mnkali, Rizal. Philippines. E-mail: vmvrnidSPgmailcom
DOI 10.2310/6620.2008.08052
& 2008 American Contact Dermatitis Society. All Rights Reserved.
and from genetic and environmental causes) that leads to
barrier dysfunction that culminates in dry skin. Rather
than endorse the more common reactive management of
AD,
the review recommended early and proactive inter-
vention with antiseptic lotions to reduce SA colonization.'*
Few evidence-based data are accepted in modern
therapeutics for the widespread traditional practice of
using coconut oil (CO) on dry infected skin.^ In a small
trial of patients with xerosis, Agero and Verallo-Rowell
found CO comparable to mineral oil in skin moisturiza-
tion and the absence of irritant effects.*" No trials have been
reported on the topical use of CO specifically for AD,
clinically infected or not.
In recent years, the term "virgin" has been used to
indicate a health-related value in coconut and olive oils.
The virgin status of olive oil is achieved by extracting the
oil 24 to 48 hours after harvest and through Good
Manufacturing Practice (GMP), including the avoidance
of heat, light, and air during processing and storage. These
precautions protect heat-sensitive phytochemicals and
help prevent the hydrolysis of triglycérides into their
component free fatty acids (FFAs), which leads to the
rancid smell of spoilage and to skin irritation.
'
The
amount of FFAs present is used to defme the degree of
virginity of the oil, as follows: ordinary, a maximum of
308Dermatitis. Vol ¡9, No 6
(November/December),
2008:
pp 308-315

Effeets
of
Coconut
and Virgin Olive Oils in Adult Atopic Dermatitis 309
3.3%;
fine virgin, a maximum of 1.5%; and virgin, less
than 1%. "Extra-virgin olive oil" (FVOO) is a retailing
name used to emphasize the fact that the oil is pressed cold
immediately after hai'vest.
Virgin coconut oil (VCO) is also processed on the day
of harvest, under similar GMP guidelines.** Unlike virgin
olive oil (VOO), which has 82% unsaturated fatty acids
(FAs),
VCO has only 8% unsaturated FAs. The other 92%
of the FAs are saturated and chemically stable such that the
standard of 0.5% FFA content in VCO is readily achieved
as long as the moisture content is kept at the standard of
0.12% or less. Since the nutmeat is exposed to its v/ater at
tropical temperatures for 10 months, extra-virgin coconut
oil (EVCO) is considered "cold pressed" when the
nutmeat is pressed at a temperature that does not exceed
39 C.'" For the objectives of this study, these differences
are minor; hence, the more common terms for these two
virgin oils—VCO and VOO—are used in this article.
Tbis 4-week randomized controlled blinded trial
compared the effects of
VCO
and VOO on SA colonization
of normal AD skin and on the extent and intensity of
objective AD parameters, using the objective SCORing
Atopic Dermatitis (SCORAD) severity index (0-SSI).
Methods
The patients came from two general dermatology clinics.
Because there were no previous topical VCO studies in
cbildren, pédiatrie subjects were not allowed by the
institutional review board of the Skin and Cancer
Foundation. Adult AD diagnoses were based on the
modified Hanifin major criteria of a history of a chronic
and relapsing course; pruritus; a pattern of facial and
extensor eczema and xerosis at a younger age, becoming
flexural at adult age; and frequent association with a family
history of AD' (Table 1).
Eligibility Criteria and Stratification
Those included were newly diagnosed patients aged 18 to
40 years and patients who were previously documented
and managed as having AD. Patients with new and old
cases of AD had low to high moderate O-SSl scores and
had not taken topical steroids or topical or oral antibiotics
for at least 2 weeks before enrollment. Excluded were those
with (1) grossly infected lesions needing oral or intrave-
nous antibiotics and ancillary therapy; (2) dermatologie
diagnoses other than AD; (3) previous hypersensitivity to
coconut or olive oil, known diabetes mellitus, or
compromised immune states. All patients who met the
criteria were oriented on the study's objectives, proce-
dures,
and expected outcomes. Informed consent for the
study and for photographs was obtained.
Prior to randomization, the participants were stratified
on the basis of age and O-SSI score, to control potential
confounding variables. The O-SSI score, at baseline and at
the end of intervention, was calculated with the formula
A/5 + 7 X B/2 (range of 0-83), where "A" represents
extent (graded 0-100, based on the rule of nines on a
front/back drawing of the patient's inflammatory lesions)
and "B" represents intensity (graded 0-18, based on a 0-3
rating of erythema/darkening, edema/papulation, oozing/
crust, excoriation, lichenification/prurigo, and dryness);
the cut-off points were mild (score < 15), moderate (15-
40),
and severe (> 40)."
Randomization, Treatment Allocation, and Blinding
The preparation of test bottles, the randomization key, and
the codes were carried out by the pharmacist of Skin
Sciences Laboratory, Inc., and was disclosed to the
investigators only at the end ot tbe study. Subjects
previously matched by age and O-SSI score underwent
simple concealed random allocation (by drawing rolled
pieces of paper labeled "A" or "B") to control or
treatment arms by the two dermatology residents, both
of whom were blind to the codes and who also dispensed
the packaged bottles according to a random listing.
Preparation and Application of Oils i
High-quality pure oils were sourced and repackaged in
uniform medicinal opaque plastic bottles with a small
opening to mask the color and scent of both oils. Unlike
the scent of ordinary CO (which is prepared with heat),
that of VCO (prepared wdthout any heat) is Hke that of
VOO (ie, botanical and musty). Upon application of either
oil,
the scent is notable but disappears within just a few
minutes. Hours later, neither the patients nor the
investigators who see them can identify either oil on their
skin by scent. VCO is clear as water and colorless; VOO is
also clear but is light yellow green. As either oil is poured
onto the hand and applied to the treatment sites, the skin's
color makes the VCO and VOO look similarly brownish
and indistinguishable from each other.
For tbe control arm, a commercial VOO was chosen on
the basis of its package literature and perceived market
value; it was then subjected to a series of microbiologie
tests to ensure that it contained no unwanted pathogens.

310
VerallO'Rowett
et al
Table
1. Demographics and Characteristics of
Patients
with Atopic Dermatitis {Modified Hanifin Criteria} in the Coconut Oil and Olive
Oil
Study Groups
Coconut
Oil
Olive
Oil
Characteristic (N
= 26)
32
± 3
29-35
13
(50%)
13
(50%)
15 ± 3
25
(96%)
12
(46%)
21
(81%)
12
(46%)
14
(54%)
(N
- 26)
31 ± 4
21-39
14
(54%)
12
(46%)
18
+ 5
23
(88%)
13
(54%)
22
(85%)
8
(31%)
18
(69%)
p
Value*
.76^
(NS)
—
.78^
(NS)
.09^
(NS)
.515^
(NS)
(NS)
0.58^
1.00^
—
.26^
(NS)
Age
in years
Mean
± SD 'J «î"
Range
.^d
Sex
Male
Female
Duration
in years (mean ± SD)
Pruritus
Lesion
morphology
Childhood:
facial/extensor
Adult:
flexures/lichenification
AD
in family
Yes
No
AD = atopic dermatitis; NS = not statistically significant.
*Significant p-value if < .05.
fComputed using statistical software Epi-Info V6 for tests of proportions, independent samples
(-test,
and chi-square test.
The VCO used by Agero and Verallo-Rowell was
processed without heat but with water-soluble food-
derived lipases. The VCO used for the intervention arm
ofthe present study was manufactured without heat under
sterile laboratory conditions that followed standard GMP,
to avoid the use of chemicals. The temperature was kept at
about 33'C and no higher than 39'"'C, temperatures similar
to those experienced under tropical sunlight. The resulting
VCO passed a series of microbiologie tests and was found
to have no unwanted pathogens.
The instructions for applying both EVCO and EVOO
were as follows: "On the affected areas that include the test
sites,
apply 5 mL of EVCO two times a day and massage
gently but thoroughly into the skin for several seconds. Do
not apply other emollients, creams, or oil-based products
that can mask the effect of the oil."
The test bottles were brought in and replaced with new
ones at each visit.
All patients were advised to practice good skin hygiene,
and all were given a bar of white baby soap to use.
SA Cultures
Collection of Skin Swabs
The two resident-investigators together selected two
clinically uninfected AD-affected sites, each with an easy-
to-identify anatomic landmark. These sites and their
identification landmarks were described on the data
collection sheet, and photographs were taken. Starting at
the center, cotton swabs soaked with sterile normal saline
solution were swept over each site (one swab for each site);
the cotton swabs were then submitted to the medical
technologist at the microbiology laboratory of the Quirino
Memorial Medical Center, Pasig, Philippines. After 4
weeks of treatment, cotton swab samples were again taken
from the identical sites ofthe first cultures and sent to the
microbiology laboratory.
Colony Growth and Growth Effectiveness
With standard laboratory technique, SA was identified as
gram-positive cocci and not resident skin flora or spurious
contamination. Colony growth yield of microorganisms
considered as significant was also based on standard
microbiologie criteria.'^
At baseline and at the end of intervention, the cultures
were examined by a medical technologist who was blind
to the treatment arms of the study. The presence of
colony counts from one or both sites was reported as
"positive"; the absence of colony counts in both sites was
reported as "negative." All colony count reports were
given to the investigators after the second set of cultures
was done.

Effects
of
Coconut
and Virgin Olive Oils in Adiili Atopic Dermatitis 311
SA colony growth effectiveness was based on the
absence of SA colonies in two separate cultures from two
separate sites of clinically noninfected atopic skin after
administration of the corresponding intervention.
Statistical Analysis
Descriptive Statistics
Descriptive statistics included (
1 )
means and their
standard deviations for categorical variables and (2)
percentage frequency distribution for categorical data.
Testing of homogeneity of samples was done with the chi-
square test for categorical data and an independent i-test
for continuous numerical data.
The proportion of significant colonies was compared
before and after the trial with nonparametric chi-square
tests.
Precision estimates were pegged at 95% confidence
limits.
All tests of significance were carried out with NCSS-
PASS software (NCSS, East Kaysvüle. UT).
I
Dropouts and Noncompliers
Patients were taught to assess their symptoms and their
skin's appearance daily. They were advised to contact the
investigators for further treatment when their condition
was rated as worse. If topical antibiotics were dispensed,
the subject was included in analysis as a dropout; patients
who failed to comply with the regimen were classed as
protocol violators.
Results
A total of 52 subjects met the inclusion criteria and were
randomized to receive topical VCO (« = 26) or VOO [n =
Table 2. Relative Risk for Colonization by
Siaphylococcus
aureus*
26).
There were no dropouts or protocol violators. Tests of
baseline homogeneity of the sample revealed no statisti-
cally significant differences in age {p = .76), sex (p ~ .78),
duration of illness (p — .09), pruritus (p - .515), lesion
morphology (p — .58), or family history of atopic
dermatitis (p = .26) (see Table 1).
The clinically noninfected sites that were (1) chosen
and recorded for culture swabs at baseline; (2) identified
from photographs, drawings, and anatomic landmarks
after 4 weeks of intervention with VCO or VOO, and (3)
reswabbed, were the following: antecubital (VCO, 16;
VOO,
14), popliteal (VCO, 8; VOO, 9), and trunk (VCO,
2;
VOO, 3).
SA Culture Growth Effectiveness
Assessment of the growth effectiveness of the SA cultures
was based on the SA culture results (positive or negative
colonies) at baseline as compared with postintervention
results. Of the 20 patients whose cultures were positive and
who were randomized to VCO, 1 subject (5%) remained
positive; of the 12 patients whose cultures were positive
and who were randomized to the VOO arm, 6 (50%)
remained positive. Compared to the VOO arm, the
calculated relative risk of nontreatment was 0.10 among
those in the VCO arm and was thus superior to that of the
control arm. The risk of nontreatment with VOO was 10
times higher (or l/.lO), relative to the VCO arm. The
calculated absolute risk reduction was —.45, which means
that just two subjects needed to be treated with the VCO
(number needed to treat [NNT] = 2) to prevent one
treatment failure (or failure to sterilize cultures) (Table 2).
Group
VCO
Total
VOO
Total
SA{+)
SAi-)
SA(+)
SA(-)
Baseline
20 (77%)
6 (23%)
26 (100%)
12 (46%)
14 (54%)
26 (100%)
SA (+)
1 (5%)
—
6 (50%)
—
Post
Intervention
SA (-)
19 (95%)
—
6 (50%)
—
Total
20
6
26
12
14
26
Relative
Risk'^
Rt = 1/20 - 0.05
—
Re = 6/12 - 0.50
—
RR = 0.10 (95% CI, .01-0.73) p = .0028
Re = risk of [+) colonies witb virgin olive oil treatment; RR = relative risk; Rt = risk of (+) colonies with virgin coconut oil treatment; SA -
Staphylocçccus
aureus;
VCO = virgin coconut oil; VOO = virgin olive oil.
"Based on positive/negative colony readings (number and percentage) at baseline and 4 weeks after topical u.se of VCO versus VOO.
^Rt (.O5)/Rc (.50) = 0.10 (< 1, treatment benefits; > 1, treatment is harmful); absolute risk reduction (ARR) = Rt - Re; number needed to treat is 1/ARR
= 2.2.

312VeraUo-Rowell et al
Effect on O-SSI Score
At baseline, no significant difference was seen between the
O-SSI scores of the two treatment arms (p = .15), but
postintervention scores differed significantly
(—4.1;
p —
.004).
Postintervention SCORAD index scores were lower
for both oils but were statistically lower in the CO group
(Table 3 and Fig 1). The composite interpretation of
SCORAD index scores for both groups was from high
moderate to low moderate for the VCO group and
"worsened" for tbe VOO group (Fig 2).
Discussion
Antimicrobial Action of FAs from Edible Oils
VCO has a long tradition of use in treating infections. Like
all edible oils, VCO is made up of triglycérides, each one
with a simple glycerol core of three carbons, to each of
which an FA is attached. In the stomach and the upper
part of the small intestine, ingested VCO is digested by
Upase enzymes into di- and monoglycerides, glycerol, and
FFAs.''
Lipases are also present in the aerobic organisms of the
normal skin flora. Holt reported that from the normal skin
of adults and children, almost all 42 strains of isolated
Micrococcaceae Sarcina, 40% of 50 aerobic skin diphther-
oids,
and 20% of 58 aerobic nasal diphtheroids produced
strong or active lipases. The author postulated that action
of these lipases on skin lipids accounts for the production
of FAs that acidify the skin (average hydrogen ion
concentration [pH], 5.5) and provide the surface of the
skin its "acid mantle." "*
Similarly, we postulated that these lipases (and those
known to he produced by SA)^^ may hydrolyze the
triglycérides of topical VCO to levels higher than the 1 to
7%
monoglycerides and the 0.5% FFAs that are normally
present in unhydrolyzed VCO.'
G
GROUP
Cocorutoll
Olive oil
Post intervention
Figure 1. Changes in objective SCORAD index .scores from baseline
to after intervention.
Studies on lipids in the 1960s by Kabara and colleagues
showed medium-chain (C-8 to C-14) FAs and their
monoglycerides to have antimicrobial effects against
several laboratory organisms.''^ In the 1990s> more
laboratory studies confirmed the antimicrobial activity of
these lipids against gram-positive and some gram-negative
organisms (including Neisseria
gonorrhoeae,^^
Helicobacter
pylori}'^
and Chlamydia trachomati^^) as well as Candida
d/ÍJictJíís yeast^' and enveloped viruses."^^
Since 1998, some clinical studies have confirmed these
laboratory data, specifically data on monolaurin, the
monoglyceride of lauric acid from VCO. A 2% gel
preparation of Lauricidin (Skin Sciences Laboratory, Inc,
Pasig City, Philippines), which contains 90% pure
monolaurin, significantly degermed SA cultured from
health workers' hands after hospital duty.^^
Another study cultured the skin lesions of 100 pédiatrie
patients. The top isolates were SA, coagulase-negative SA,
Table 3. Objective SCORAD Index Scores at Baseline and Post Intervention
Objective
SCORAD Index VCO Group fN ^ 26) (%) VOO Group (N = 26) (%) Mean
Difference
(%) p Value
Baseline
Post intervention
Mean difference
Percent reduction
39.2 ± 6.4
22.6 ± 3.6
16.6
46.8
36.6 ± 6.3
26.7 ± 5.7
9.9
30.1
2.6
4.1.15 (NS)
.004*^
NS = not statistically significant; SCORAD = SCORing Atopic Dermatitis; VCO = virgin coconut oil; VOO = virgin olive oil.
*Significant difference at p < .05.
*Mann-Whitney U test.
The drop in objective SCORAD index score from baseline was statistically significant within both the VOO group (36.6 to 26.7 points) and the VCO group
[39.2 to 22.6 points), botb Wilcoxon signed ranks {p < .005), although percent reduction with VCO Is more than that with VOO.

Effects
of
Coconut
and Vir^n Olive Oils in Adult Atopic Dermatitis 313
Figure 2. A, Non-infeaed atopic dermatitis site before treatment with virgin coconut oil, SCORAD 35. B, The same site 4 weeks after treatment
with virgin coconut oil, SCORAD 20. .
Streptococcus spp, Enterobacter spp, and Escherichia
vulneris. The sensitivity of these organisms to penicillin,
oxacilhn, erythromycin, fusidic acid, mupirocin, and
vancomycin varied significantly, demonstrating low to
high susceptibility, across the different isolates (Fisher
exact test = 0.000; p < .05). In marked contrast, sensitivity
to monolaurin did not significantly differ across the
different bacterial isolates (Fisher exact test = 0.110; p >
.05),
reflecting high antibacterial activity. There also was a
statistically significant and marked difference in resistance
rates.
SA, coagulase-negative SA, and
Streptococcus
spp did
not exhibit any resistance to monolaurin as opposed to the
varying resistance observed with the other antibiotics in
this study.^"
Still another study showed significant activity against
SA by 13 lauric monoester formulations in vitro and in
vivo in
Mechanism of Action of Monolaurin
The mechanism of action (MOA) of monolaurin as an
antimicrobial is "novel" in that it differs from that of most
conventional antibiotics. A recent review of the many lipid
studies conducted during the last 50 years (mostly in the
laboratory), showed similar study results and similar
proposed MOAs for the antimicrobial effects observed.^''
A common hypothesis explains the antimicrobial effects of
monolaurin and the other medium-chain monoglycerides
as being based on their capacity to alter the bacterial cell
envelope. It is postulated that by virtue of size, these lipids
are small enough to be readily dissolved in the lipid phase,
to penetrate and physically disrupt cell membranes, and to
inhibit enzymes involved in energy production and
nutrient transfer, leading to reversible and irreversible
changes that may lead to the death of the cell. A
sophisticated electron microscopic and two-color fluor-
escent assay showed that on contact with these mono-
glycerides, bacteria show visible changes by 5 minutes and
shrinkage and disintegration of cell membranes after 10
minutes, leading to the death of the bacteria.''
Conversely, conventional antibiotics are ionized mole-
cules that do not readily bridge the membrane barrier
because of charge or size and that act more on bacterial
enzymes (although more antibiotics with similar action on
the bacterial cell wall, called "novel," have been described
recent
ly^**).
Concurrent with this MOA in explaining the significant
difference in the antimicrobial action of
VCO
versus VOO
is the difference in the sizes of their monoglyceride FAs.^^
After lipase hydrolysis, all FAs produced by VOO are long-
chain FAs, mostly C-18 (C-16 to C-24, except for 0.1% C-
14).
VCO produces 82% medium-chain FAs, mostly C-12
(C-6 to C-14) FA. This may also explain the initial
observations and pilot studies that prompted this study. At
the authors' clinics, consistent improvement or clearing of
infiamed or mildly to moderately infected psoriasis and
AD lesions was noted after VCO application.^"
VCO Natural FAs and AD Dry Skin
Emollients are a standard of care for prevention of dryness,
steroid-sparing effect, and maintenance therapy in
AD.
Fixed
vegetable oils coat the skin, occluding and protecting it by
slowing down transepidermal water loss and increasing

314
Veraño-Rowell
et al
hydration within the stratum corneum and top layers of the
dermis. They also "glue down" dry and desquamating skin
cells,
making the skin look less rough and scaly." ' The AD
patients who were treated with VCO in this study had
significantly lower objective SCORAD scores for dryness and
dryness-related conditions, such as excoriation and licheni-
fication, and for erythema, edema, and papulation.
Adverse Reactions to Olive Oil, VCO, and
Monolaurin
Olive oil is a very weak irritant, and adverse side effects from
topical use are rare. Of 21 patients with reported cases of
contact allergy to olive oil, 4 patients had occupation-
related hand eczema;
1
of these 4 had positive patch-test and
use-test results after 2 days."'^ One possible cause for these
reactions may have been the gallates—-antioxidants that may
be used to stabilize the mostly monounsaturated (and some
polyunsaturated) FAs of olive oil—that have been reported
to produce contact dermatitis.^^ Antioxidants are not
needed for (nor added to) stable and saturated VCO.
VCO has caused no reported contact dermatitis and
should not be mistaken for the cocamides, which are VCO
FAs treated with amidoamines. These popular surfactants
and foam boosters in shampoos and cleansers have
increasingly been reported to produce allergic reactions.
However, a double-blind controlled pilot retest study of 12
patients previously allergic to cocamidopropyl betaine
(CAPB) found that only 3 patients (25%) had doubtful
reactions. The authors concluded that the results sub-
stantiated previous experience that doubtful and mild
reactions to CAPB may represent irritant rather than true
allergic reactions.^'^ In this patch-testing study and in a
toxicology report that implicated the nitrosylation of the
FAs as a cause of reactions, the test results for CO and
lauric acid were negative.^^
The inadvertent intake of topical VCO and monolaurin is
safe:
CO has a long dietary history among tropical people,
and monolaurin is a component of breast milk. Since 1964,
monolaurin has been "generally recognized as safe" (GRAS)
by the US Food and Drug Administration. A similar safety
record has been shown in animals for which monolaurin
constitutes up to 25% of the total diet.^^ The extensive topical
use of VCO and the topical and oral use of monolaurin in our
clinics have caused no adverse reactions.^"
j
Conclusion
A history of safe topical use and no known or reported
cases of contact dermatitis, along with its dual effects as
moisturizer and antiseptic, opens up more research and
clinical possibilities for virgin coconut oil (VCO) and
monolaurin. In the laboratory, VCO and monolaurin have
also shown antimicrobial effects on fungi"^^ and enveloped
viruses^'^ that (like Staphylococcus aureus) may infect or
colonize sites of atopic dermatitis.
Acknowledgments
Patients were seen and examined at the two charity clinics
of the Skin and Cancer Foundation, Inc., in Pasig, Rizal,
and Makati, Rizal, Philippines. The microbiologie testing
was done at the microbiology laboratory of the Quirino
Memorial Medical Center, Pasig, Rizal, Philippines.
Skin Sciences Laboratory, Inc., of Pasig, Rizal,
Philippines, provided material support by supplying and
packaging virgin coconut oil and virgin olive oil in
uniform bottles.
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