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Journal of Agronomy, Technology and Engineering Management
ISSN 2620-1755
J Agron Technol Eng Manag 2024, 7(1), 998-1020. https://doi.org/10.55817/ASIJ6404 www.fimek.edu.rs/jatem
Review
Inhalation and Topical Application of Rose Essential
Oil – A Systematic Overview of Rosa damascena
Aromatherapy
Ana Miljković 1, Milica Aćimović 2,*, Biljana Božanić Tanjga 3,4, Biljana Lončar 5,
Vidak Raičević 1, Olja Šovljanski 5, Vanja Travičić 5, Milada Pezo 6 and Lato Pezo 7
1 Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia.
2 Institute of Field and Vegetable Crops, Maksima Gorkog 30, 21000 Novi Sad, Serbia.
3 Pheno Geno Roses Ltd., Maršala Tita 75, 23326 Ostojićevo, Serbia.
4 Faculty of Agriculture, University of Novi Sad, Trg Dositeja Obradovića 8, 21000 Novi Sad, Serbia.
5 Faculty of Technology, University of Novi Sad, Bulevar cara Lazara 1, 21000 Novi Sad, Serbia.
6 “VINČA” Institute of Nuclear Sciences, University of Belgrade, Mike Petrovića Alasa 12-14, 11351
Belgrade, Serbia.
7 Institute of General and Physical Chemistry, University of Belgrade, Studentski trg 12-16, 11000 Belgrade,
Serbia.
* Correspondence: milica.acimovic@ifvcns.ns.ac.rs
Received: 12 November 2023; Accepted: 5 February 2024
Abstract: The purpose of this systematic overview is to establish the impact of inhalation and topical
application of Rosa damascena essential oil in aromatherapy practice. A bibliometric analysis using
the different scientific databases was conducted to examine scientific documents related to “rose
aromatherapy” and “Rosa damascena aromatherapy”. Microsoft Excel and VOSviewer software were
used to extract and visualize information. Founded on a review of 93 papers, the scent of rose
essential oil has applications in aromatherapy for reducing anxiety, alleviating pain, improving
sleep quality, as well as alleviating physiological symptoms during menopause and PMS. It aids in
mitigating stress and reducing stress and reducing depression and fatigue, for relaxation and
improving cognitive function, among other benefits. Ultimately, rose essential oil is safe and suitable
for self-administration via inhalation or topical application, either alone or with other essential oils.
Keywords: Rosa damascena; essential oil; pain relief; anxiety reduction.
1. Introduction
Aromatherapy is the therapeutic use of essential oils [1]. However, aromatherapy cannot cure
the disease, but it is effective in alleviating the symptoms that accompany the disease such as stress,
anxiety, depression, nausea and vomiting, pain, etc. [2]. Inhalation is the most popular and safe
method for administering essential oils. It is an effective way to change emotions or state of mind,
suitable for treating physical or mental disorders, as well as other functions under the control of the
autonomic nervous system [3, 4]. For this purpose, essential oils can be applied as room scents via
lamp diffusion method, aroma candles, room sprays, etc. [5], or personal inhalers such as vapour
balm, lipstick-sized nasal inhaler, or simply by direct inhalation (from a piece of gauze, tissue, or
cotton pad) [2]. Another widely used method in aromatherapy for essential oils is topical application,
primarily through massage [6]. Apart from these two methods, there is a third approach to applying
essential oils in aromatherapy practice, which involves oral consumption. However, oral use should
be done under the supervision of professionals [7].
J Agron Technol Eng Manag 2024, 7(1), 998-1020. https://doi.org/10.55817/ASIJ6404 999
Roses have been known since ancient times, among Mesopotamian, Assyrian, Minoan,
Egyptian, and Chinese civilizations as ornamental plants [8]. They also used roses as edible and
medicinal plants and produced "Rosaceum Oleum" by macerating fresh rose petals in olive oil [9]. The
process of obtaining essential oil from roses was discovered in the 7th century, marking the rise of
roses as an important agricultural herb [10]. Although the Damask rose (Rosa damascena Mill.) is
considered a superior essential-oil-bearing rose, other scented roses are also used for essential oil
production [11, 12]. Today, Bulgaria and Turkey stand out as the most significant producers of rose
essential oil, rose water, absolute, and concrete. These are important raw materials for the perfume,
cosmetics, and pharmaceutical industries [11, 13].
Taking into account that the content of rose oil in fresh flowers is relatively low (0.3–0.4 mL/kg),
industrial distillation today requires a process called cohabitation (re-distillation of hydrosol) [14, 15].
By mixing the primarily obtained essential oil with the redistilled (second or indirect) oil, rose otto
(attar) is prepared [16]. This blend exhibits a much more natural and more decadent aroma compared
to the primary oil [17]. Rose Otto is usually available in the commercial market. The scented water
(which remains after re-distillation of hydrosol), which mainly contains phenyl-ethyl alcohol, is
known as rose water [18]. Moreover, pure rose oil is very expensive, but in aromatherapy practice, it
is commonly used diluted in the concentration of 1-10% in jojoba, sweet almonds, or evening
primrose oil [19-27].
The aim of this paper is to conduct a comprehensive review of the application of rose essential
oil, renowned in aromatherapy for its pleasant smell. The focus is on its application through
inhalation and massage. Furthermore, doses and blending with other essential and fatty oils are also
investigated in this review. In addition, the potential aromatherapeutic application of rose water is
also reviewed in this paper. Previous review papers have been published on the traditional and
phyto-pharmacological uses of damask rose [28-30], its efficacy in essential oil aromatherapy [31-32],
and its effects on treating anxiety, depression, and stress [33, 34], improving sleep quality [35],
alleviating pain severity [36-38], as well as its application in treating burn patients [39]. There was no
intention to duplicate these studies, but rather to provide a comprehensive overview of the use of
rose essential oil in aromatherapy practice, specifically focusing on inhalation and topical application.
2. Materials and Methods
Science Direct, Web of Science, PubMed, and SID databases were reviewed in English (abstract
or full text) in November 2023 without limiting the search by date and using queries “rose
aromatherapy” and “Rosa damascena aromatherapy” in the title, abstract and keywords. The collected
publications were evaluated and categorized according to an annual number of documents and
distribution across countries. Microsoft Excel was used to process the data and generate graphical
representations for easy interpretations (Figures 2 and 3). For keyword analysis and visualization,
VOSviewer was utilized, a computer program designed for displaying large bibliometric maps in an
easy-to-interpret manner.
3. Results
To identify trends in Rosa damascena essential oil use in aromatherapy, the VOSviewer program
was used to represent the author and index keywords. To perform a general analysis, a search was
conducted 102 times in the titles and abstract (Supplementary Table 1). As observed in Figure 1, Rose
aromatherapy according to abstracts, was distributed in seven different clusters. In the red cluster,
the words “Rosa damascena” and “sleep quality” were the most frequently mentioned. Some words
with less occurrence, such as “improvement”, “adult” and “child” also occurred. The terms with the
highest frequency in the violet cluster corresponded to “nurse” and “job stress”. In the light blue
cluster, dominates words such as “inhalation”, “stress” and “depression”, while in the dark blue
cluster are “pain intensity”, “pain anxiety” and “burn patients”. The most frequent terms in the green
cluster were “labor”, “labor pain”, “active phase” and “blood pressure”. In the yellow cluster, the
most frequently used words are “massage”, “menstrual pain” and “primary dysmenorrhea”.
J Agron Technol Eng Manag 2024, 7(1), 998-1020. https://doi.org/10.55817/ASIJ6404 1000
Figure 1. Co-occurrence analysis of the terms in “Rosa damascena aromatherapy” research according
to abstract. The frequency of occurrence is represented by the size of the circle beneath each word.
Different colours were employed to depict distinct clusters of highly related keywords, facilitating
their categorization. The VOSviewer software was utilized to represent the term cloud, with data
collected from the Scopus database.
Over the past decade, there has been a significant increase in interest in the use of rose essential
oil in aromatherapy, especially during the COVID-19 pandemic (2019-2021) (Figure 1; Supplementary
Table 1). The majority of the studies focusing on rose aromatherapy were conducted in Iran (63),
followed by Turkey (11), Indonesia (6), Japan (3), Egypt (2), South Korea (2), Brazil, China, Germany,
India, UK and Thailand (Table 1). This distribution can be attributed to the cultural significance of
the rose, particularly in Iran and other Islamic countries, where it is known as the “Flower of Prophet
Mohammad” [40].
Figure 2. Trends in rose aromatherapy during the years (2002-2023).
J Agron Technol Eng Manag 2024, 7(1), 998-1020. https://doi.org/10.55817/ASIJ6404 1001
Based on a review of 93 papers, that include animal studies, controlled clinical trials, and quasi-
experiments, it is clear that rose essential oil possesses significant potential in both topical application
and inhalation aromatherapy (Table 1).
Table 1. Review of research studies on the effects of rose aromatherapy (the results are listed according to
the year of publication, from the oldest to the newest, and within one year in alphabetical order).
Referenc
e
Country
Design
Treatments
Participants
Application/dose
Results
[41]
Japan
Experimental study
1.peper, 2.estragon,
3.fennel,
4.grapefruit, 5.rose,
6.patchouli,
7.control
43 healthy females
EO dissolved at a
concentration of 2%
in triethyl citrate,
applied to a piece of
absorbent cotton
fatted under the
subject's nose to
inhale for 3 min
Decrease
sympathetic activity,
and decrease
adrenaline
concentration
[42]
Brazil
Animal study
1.aromatherapy,
2.control
Adult male rats
Inhalation of
different
concentrations of
rose EO: 1, 2.5, and
5% w/w for 7 min
An anxiolytic effect
similar to diazepam
[43]
Iran
In vitro study on
guinea pig tracheal
chain
1.rose ethanolic
extract, 2.rose
essential oil, 3.saline
(negative control),
4.theophylline
N/A
Except for control,
the investigated
concentration was:
0.25, 0.5, 0.75, and
1.0 %
Relaxant effects
[44]
UK
Animal study
1.aromatherapy,
2.diazepam
Gerbils
Inhalation via an
electric vapouriser
and aroma stone
Anxiolytic effects
[45]
Turkey
Animal study
1.aromatherapy,
2.control
14 Male Wistar rats
Inhalation
Improving learning
and memory
[19]
South Korea
Pilot-controlled
clinical trial
1.aromatherapy,
2.control
52 climacteric
women
Massage on the
abdomen, back, and
arms with EO blend:
lavender, rose
geranium, rose, and
jasmine in almond
and primrose oils,
once a week for 8
weeks
Effective treatment
of menopausal
symptoms such as
hot flushes,
depression, and pain
in climacteric
women
[20]
Thailand
Clinical study
1.aromatherapy,
2.control (sweet
almond oil)
40 healthy
volunteers
1 ml of 20% rose EO
in sweet almond oil
by self-massage for
5 min, then covered
by plastic film
Relaxing effect
(decreased breathing
rate, blood oxygen
saturation, and
systolic blood
pressure)
[21]
South Korea
Clinical trial
1.self-aromatherapy
massage, 2.placebo,
3.control
55 female nurses
Self-massage with
3% EO blend (R.
centifolia, R.
damascena, clary
sage, rose geranium,
and ginger in a ratio
of 0.5:0.1:1:1:1)
Decrease menstrual
pain and the level of
anxiety
J Agron Technol Eng Manag 2024, 7(1), 998-1020. https://doi.org/10.55817/ASIJ6404 1002
diluted in almond,
jojoba, and evening
primrose oil (8:1:1)
[46]
Japan
Animal and human
study
N/A
Male Wistar rats and
27 healthy women
Inhalation
In rats and humans
chronic stress-
induced disruption
of the skin barrier
can be limited or
prevented by
inhalation rose EO
[1]
Turkey
Experimental study
1.control,
2.formaldehyde
(FA), 3.FA+rose EO
21 albino Wistar rats
Inhalation rose EO
Protective effects
against testicular
damages caused by
FA
[47]
Iran
Clinical trial study
1.aromatherapy+foot
bath, 2.foot bath,
3.control (routine
care)
120 nulliparous
women
Inhalation during 10
minutes at the
beginning of the
active phase and the
beginning of the
transitional phase
Reduce anxiety
[48]
Turkey
Double-blind,
randomized placebo-
controlled study
1.conventional
therapy+placebo,
2.conventional
therapy+rose
80 patients with
renal colic
Inhalation of 2%
rose EO via
electronic vapourizer
Reduce renal colic
pain
[49]
Iran
Randomized clinical
trial
1.aromatherapy,
2.control
80 primiparous
women
Inhalation and foot
bath with rose EO
for 10 min at the
beginning of the
active phase and
then at the onset of
the transitional
phase of labor
Improve the quality
of maternal and
neonatal health
[22]
Egypt
Randomized blind
clinical trial of
cross-over design
1.aromatherapy
massage, 2.placebo
(massage)
95 nursing students
suffering of primary
dysmenorrhea
Massage with EO
blend: cinnamon,
clove, rose, and
lavender in almond
oil
Alleviate menstrual
pain, its duration,
and excessive
menstrual bleeding
[50]
Turkey
Animal study
1.control, 2.chronic
mild stress (CMS),
3.CMS+rose orally,
4.CMS+rose
inhalation
32 male rats
Inhalation 0.15
ml/kg for 28 days
Protective effects on
oxidative stress in
depression
[23]
Iran
Randomized clinical
trial
1.aromatherapy
massage, 2.massage,
3.control
87 postmenopausal
women
Aromatherapy
massage for 30 min
twice a week for 4
weeks with EO
blend (lavender,
geranium, rose, and
rosemary in a ratio
4:2:1:1 diluted in
almond (90%) and
evening primrose oil
(10%) at a final
concentration of 3%
Improve
physiological
symptoms during
menopause
(depressive mood,
irritability, anxiety,
mental exhaustion)
J Agron Technol Eng Manag 2024, 7(1), 998-1020. https://doi.org/10.55817/ASIJ6404 1003
[51]
Iran
Randomized
controlled trial
1.aromatherapy,
2.control
60 patients
hospitalized in the
coronary care unit
Inhalation of 3 drops
of rose EO via a
piece of paper towel
placed near pillow
during night time for
3 days
Improve sleep
quality
[52]
Japan
Clinical study
1.orange, 2.rose,
3.control
20 female students
Inhalation for 90 s
Induces
physiological and
psychological
relaxation
[53]
Iran
Randomized clinical
trial
1.aromatherapy,
2.control
80 primiparous
women
Inhalation and foot
bath with rose EO
Relief labor pain
[24]
Iran
Randomized
controlled trial
1.rose EO massage,
2.unscented almond
oil massage,
3.massage only
group
75 students
All three groups
received massage on
their first day of
menstruation in two
subsequent cycles
Reduce the severity
of primary
dysmenorrhea
[54]
Germany
Patient-blinded,
randomised
crossover, pilot trial
1.aromatherapy,
2.control
27 depressed female
inpatients (18-49
year)
Inhalation during the
night for 3
consecutive nights
Positive influence on
mood and sleep
quality
[55]
Iran
Randomized clinical
trial
1.aromatherapy,
2.blindfold
60 patients
hospitalized in
cardiac care unit
Inhalation of rose
EO during 3 nights
Improve sleep
quality
[56]
Iran
Double-blind,
placebo-controlled
clinical trial
1.aromatherapy,
2.control (almond
oil)
64 children (3-6
years)
Inhalation from the
eye pad from the 30
cm distance
Reduce
postoperative pain in
children
[25]
Iran
Randomized
controlled trial
1.self-massage with
almond oil, 2.self-
massage with rose,
3.control
75 students with
primary
dysmenorrhea
Massage with 5
drops of 4% rose EO
in almond oil for 15
min
Reduce severity of
primary
dysmenorrhea
[57]
Iran
Randomized clinical
trial
1.aromatherapy,
2.control (distilled
water)
60 preterm neonates
Inhalation of 2 drops
of 10% rose EO
from the pad eye
located at a distance
of 30 cm from the
head
Reduce apnea
attacks, bradycardia,
and SpO2 in preterm
infants
[58]
Iran
Randomized clinical
trial
1.aromatherapy,
2.control
50 patients with
second and third-
degree burn wounds
Inhalation 5 drops of
40% rose EO diluted
in water
Relief pain intensity
[59]
Iran
Randomized
controlled trial
1.aromatherapy,
2.control
120 postmenopausal
women (45-55
years)
Inhalation 2-3 drops
EO blend: lavender,
fennel, geranium,
and rose
Improve sexual
function in
postmenopausal
women
[60]
Iran
Single-blind
randomized clinical
trial
1.aromatherapy
massage,
2.inhalation
aromatherapy,
3.control
90 patients with
burns
Inhalation with EO
blend (rose and
lavender),
Massage with
lavender EO
Reduce anxiety and
pain
[61]
Turkey
Randomized clinical
research trial study
1.diclofenac sodium
(75 mg i.m.)+saline,
2.diclofenac
sodium+rose
aromatherapy
100 patients (19-30
years) with primary
dysmenorrhea
Inhalation of 2%
rose EO via an
electric vaporizer
Rose aromatherapy
is effective as
adjuvant to
conventional
treatment methods
J Agron Technol Eng Manag 2024, 7(1), 998-1020. https://doi.org/10.55817/ASIJ6404 1004
for pain relief
associated with
primary
dysmenorrhea
[62]
Iran
Non-randomized
clinical trial
1.aromatherapy,
2.control
80 elderly patients
underwent knee
arthroplasty surgery
Inhalation of 3-4
drops of rose EO
and 5 cc normal
saline
Reduce
postoperative pain in
the elderly
[63]
Iran
Clinical trial
1.aromatherapy,
2.control
60 patients under
hemodialysis
treatment
Inhalation 3 drops of
2% rose EO attached
to the patient collar
Decrease depression,
anxiety, and stress in
hemodialysis
patients
[64]
Iran
Quasi-experimental
study
1.lavender, 2.rose,
3.control
37 nurses working in
the emergency
department
Inhalation
Decrease fatigue rate
in work
environments
[65]
Iran
Clinical trial
1.rose, 2.lavender,
3.control
90 hemodialysis
patients
Inhalation of 3 drops
of EO from the piece
of cloth attached to
the patient's collar
Improve cognitive
function
[26]
Iran
Randomized
controlled clinical
trial
1.topically rose EO,
2.placebo, 3.control
(no intervention)
120 women with
pregnancy-related
lower back pain
Topically
application of 7
drops rose EO
diluted in 100 cm3
almond oil without
massage 2 times
daily for 4 weeks
Reduce pregnancy-
related low back
pain intensity
[66]
Iran
Clinical trial
1.aromatherapy,
2.control
60 elderly
individuals with
chronic
musculoskeletal pain
Inhalation via linen
handkerchief with 3
drops of rose EO
during 3 weeks
Reduce pain
[67]
Indonesia
Quasy-experiment
with one group pre-
test post-test with
control
1.aromatherapy,
2.control
30 elderly with
hypertension
Inhalation of 2 drops
of rose EO from the
tissue during 3
consecutive days
Lowering blood
pressure in elderly
with hypertension
[68]
Iran
Clinical trial
1.rose, 2.lavender,
3.combination,
4.control (distilled
water)
120 primiparous
women
Inhalation 0.1ml EO
(concentration 1.5%)
+2ml distilled water
from the gauze
attached to the collar
Reduce pain severity
[69]
Iran
Randomized clinical
trial
1.aromatherapy,
2.control (normal
saline)
110 nulliparous
women
Inhalation of 2 drops
of rose EO from the
cotton gauze
attached to the
patient's collar
Reduce pain severity
and anxiety
J Agron Technol Eng Manag 2024, 7(1), 998-1020. https://doi.org/10.55817/ASIJ6404 1005
[70]
Iran
Clinical trial
1.aromatherapy,
2.control (sesame
oil)
70 nursing students
Inhalation EO blend:
7 drops of 10%
lavender and 3 drops
of 10% rose poured
on a non-absorbent
pad placed 20 cm
from the student
Decrease vital signs,
effective for
mitigating exam
anxiety
[71]
Iran
Triple-blind
randomized clinical
trial
1.aromatherapy,
2.control (sweet
almond oil)
64 female students
with premenstrual
syndrome
10 drops of 4% rose
EO were placed on a
pad and inhaled for
5 min from a
distance of 30 cm
for 5 days
Reduce the severity
of psychological and
physical symptoms
of PMS
[72]
Iran
Experimental pre-
test/post-test
evaluation
1.aromatherapy
30 children (5-12
years) with sleep
disorder
Inhalation of 5 drops
of 10% rose EO on a
cotton ball before
sleep for 20 min
Decrease resistance
to sleep, nightmares,
and waking up
during the night
[73]
Iran
Clinical trial
1.lavender, 2.rose,
3.control (distilled
water)
60 primiparous
women
Inhalation every 15
minutes during the
active phase of labor
Decrease pain
severity
[74]
Turkey
Prospective,
randomized
controlled trial
1.control, 2.placebo,
3.rose
99 patients
undergoing
septorhinoplasty/rhi
noplasty
Inhalation via
ultrasonic nebulizer
for 15 min before
intervention
Reduce preoperative
anxiety
[75]
Iran
Randomized clinical
trial
1.rose, 2.Benson
relaxation technique,
3.combination,
4.control
132 burn patients
Inhalation 5 drops of
40% rose EO
The combination of
rose aromatherapy
and Benson
relaxation technique
has synergistic
effects in reducing
pain anxiety
[76]
Iran
Single-blinded
randomized clinical
trial
1.aromatherapy,
2.control
66 patients
undergoing CABG
surgery
Inhalation 3 drops of
4% rose EO 10 min
night before
intervention
No effect
[77]
Iran
Randomized clinical
trial study
1.aromatherapy,
2.control
60 nurses from the
emergency
department
N/A
Reduce anxiety
[78]
Iran
Double-blind
clinical trial
1.rose (4%), 2.neroli
(0.5%), 3.control
(sweet almond oil)
95 students
Inhalation 10 drops
of EO on the eye pad
and place it at a
distance of 30 cm
from the nose for 5
min
Effective in
improving the
symptoms of PMS
(more effective than
neroli)
J Agron Technol Eng Manag 2024, 7(1), 998-1020. https://doi.org/10.55817/ASIJ6404 1006
[79]
Iran
Randomized
controlled clinical
trial
1.rose (5%), 2.rose
(10%), 3.control
54 cancer patients
Inhalation 5 drops
from cotton ball for
20 min before
sleeping for 2 weeks
Improve sleep
quality
[80]
Turkey
Randomized 4-arms
placebo-controlled
study
1.lavender, 2.rose,
3.ginger, 4.placebo
(water)
184 patients
underwent general
anaesthesia
Inhalation for 5 min
2 drops of EO onto
gauze pad
Aromatherapy
reduces
postoperative nausea
and vomiting.
However, rose EO
shows weak activity
[81]
Iran
Clinical trial
1.aromatherapy,
2.control
62 hypertension
patients
Inhalation of 3 drops
of rose EO twice a
day for two weeks
from a piece of
cotton
Aromatherapy
decreases systolic
blood pressure,
therefore it is an
effective
supplementary
treatment for
hypertension
[82]
India
Randomized
controlled trial
1.lavender, 2.rose,
3.control
72 orthodontic
patients
Inhalation via candle
warmer for 15 min
Reduce anxiety
among orthodontic
patients
[83]
Indonesia
Quasi experiment
pre-test/post-test
1.rose 2.relaxation
(foot soaking in
warm water)
30 postoperative
patients
N/A
Reduce
postoperative pain
[84]
China
Animal study
1.control, 2.model,
3.diazepam, 4.low-
dose aromatherapy,
5.medium-dose
aromatherapy,
6.high-dose
aromatherapy
48 mices
Inhalation during 7
consecutive days for
60 min 1% EO blend
(lavender, sweet
orange, sandalwood,
frankincense, neroli,
rose, and agarwood
in ratio
10:4:2:1.6:1.2:1:0.6)
diluted in Tween 80
solution
EO blend namely
Anshen possesses
sedative and
hypnotic effect
[85]
Iran
Double-blind
randomized clinical
trial
1.lavender, 2.rose,
3.control
90 mothers with C-
section
Inhalation cotton
ball with 3 drops of
EO at a distance of
10cm for 30 min
Reduce post-
caesarean overt
anxiety and pain
intensity (better than
lavender)
[86]
Iran
Double-blind
randomized placebo
trial
1.aromatherapy,
2.control (almond
oil)
60 patients
undergoing inguinal
hernia repair surgery
Inhalation of 5 drops
of rose EO on a
cotton ball and
attached to a patient
collar or pillow
Relieving mild to
moderate
postoperative pain
[87]
Iran
Quasi-experimental
study
1.aromatherapy,
2.control
80 elderly patients
(60-90 years) after
Inhalation of 4 drops
rose EO and 5ml
Reduce
postoperative
J Agron Technol Eng Manag 2024, 7(1), 998-1020. https://doi.org/10.55817/ASIJ6404 1007
knee replacement
surgery
normal saline from
the gauze
anxiety in elderly
patients
[88]
Iran
Single-blind
randomized
controlled clinical
trial
1.aromatherapy,
2.control (distilled
water)
98 patients
undergoing coronary
angiography
Inhalation 5 drops of
40% rose EO for 20
min before
intervention
Decrease anxiety
[89]
Iran
Double-center
randomized
controlled trial
1.routine care,
2.placebo (water),
3.rose, 4.lavender
160 patients
undergoing open-
heart surgery (OHS)
Inhalation cotton
swab with 3 drops
(0.2 ml) EO
Reduce extubation
time, surgical site
pain severity, and
anxiety in patients
undergoing OHS
[90]
Indonesia
Quasi-experiment
with pre-test/post-
test design
1.lavender, 2.rose,
3.control
54 women giving
birth
N/A
Decrease pain
intensity, in the first
phase of labor (but
lower than lavender)
[91]
Iran
Clinical trial
1.aromatherapy,
2.control
90 patients
undergoing
abdominal surgery
Inhalation for 20
min, 1h before
intervention
Decrease anxiety
[92]
Iran
Randomized
controlled trial
1.progresive muscle
relaxation,
2.aromatherapy,
3.control
90 patients
undergoing general
surgery
Inhalation for 20
min, 1h before
intervention
Reduce anxiety,
stress, and
depression in
patients undergoing
general surgery
[93]
Iran
Single-blind
randomized clinical
trial
1.aromatherapy,
2.placebo (distilled
water), 3.control
120 patients with
burns less than 30%
Inhalation 6 drops of
40% rose EO
Reduce pain
intensity and state
anxiety in burned
patients
[94]
Indonesia
Quasi experiment
with pre-test/post-
test designs
1.rose, 2.lavender
30 postoperative
patients
Inhalation for 20
min 5 drops of EO
via humidifier
Reduce pain in
postoperative
patients
[95]
Iran
Randomized
controlled study
1.aromatherapy+war
m foot bath, 2.warm
foot bath, 3.control
(routine labor care)
120 primiparous
women
Inhalation for 10
min at the beginning
of the labor and in
the transition phase
Decrease pain
severity
[96]
Iran
Clinical trial
1.aromatherapy,
2.control
60 patients at
intensive care unit
Inhalation of 3 drops
of 10% rose EO
from gauze for 20
min 3 times daily
No effect
[97]
Iran
single-blind
randomized clinical
trial
1.rose, 2.control
(water)
98 patients
undergoing coronary
angiography
Inhalation 5 drops of
40% rose EO for 20
minutes
Decrease stress and
anxiety severity and
improve
hemodynamic
parameters of
patients undergoing
coronary
angiography
J Agron Technol Eng Manag 2024, 7(1), 998-1020. https://doi.org/10.55817/ASIJ6404 1008
[98]
Iran
Randomized clinical
trial
1.lavender, 2.rose,
3.control
97 patients
undergoing coronary
artery bypass graft
(CABG) surgery
Inhalation during 5
consecutive nights
Positive effects on
sleep quality of
CABG patients
[99]
Iran
Randomized
controlled trial
1.aromatherapy,
2.control
60 nurses
Inhalation of cotton
swab impregnated
with 2 drops of 40%
rose EO
Reduce occupational
stress in nurses
[100]
Iran
Randomized clinical
trial
1.aromatherapy,
2.placebo
80 patients with
acute myocardial
infarction
Inhalation of 3 drops
of rose EO three
times a day for 3
days
Reduce anxiety
[101]
Iran
Single-blinded
clinical trial study
1.aromatherapy,
2.control (sesame
oil)
70 nursing students
Inhalation for 10
min EO blend: 7
drops of 10%
lavender and 3 drops
of 10% rose, poured
on a non-absorbent
pad placed 20cm
from the nose
Reduce anxiety
[102]
Iran
Randomized
controlled trial
1.aromatherapy,
2.control (distilled
water)
60 patients
hospitalized in the
cardiac care unit
Inhalation 5 drops of
40% rose EO
Reduce anxiety and
increase sleep
quality
[103]
Iran
Quasi-experimental
study
1.rose, 2.Citrus
aurantium
60 elderly people
Inhalation of 10%
rose EO from the
pillow for three
nights before
sleeping
Improve sleep
quality
[104]
Iran
Quasi-experimental
study
1.rose, 2.Citrus
aurantium
60 elderly people
Inhalation of 10%
rose EO from the
pillow for three
nights before
sleeping
Reduce anxiety
[105]
Iran
Clinical trial
1.aromatherapy,
2.control
70 patients
undergoing
gastrointestinal
endoscopy
Inhalation of 2 drops
of 10% rose EO
from a cotton ball
attached to the
patient's collar
Reduce pre-
endoscopic anxiety
of the patients
[106]
Turkey
Randomized
controlled
experimental study
1.aromatherapy,
2.control
131 students
Inhalation via
diffuser: 3 drops
pure rose EO for 30
min
Rose EO did not
affect immediate
learning (working
memory), but, it can
help to remember
previously learned
information more
J Agron Technol Eng Manag 2024, 7(1), 998-1020. https://doi.org/10.55817/ASIJ6404 1009
easily during
continuous
application
[107]
Iran
Randomized double-
blinded, parallel-
group controlled
trial
1.sweet orange,
2.rose, 3.placebo
(distilled water)
120 undergoing
open abdominal
surgery
Inhalation of 4 drops
of gauze attached to
the collar for 30 min
Effective in reducing
pain severity after
open abdominal
surgeries (but less
effective than sweet
orange)
[108]
Iran
Cross-over study
1.aromatherapy,
2.metoclopramide
40 women with
pregnancy nausea
and vomiting
Inhalation during 5
days
Decrease anxiety
and depression in
patients with
pregnancy nausea
and vomiting
[109]
Indonesia
Pre experiments
approach, one group
pre-test/post-test
design
1.aromatherapy
28 menopausal
women
N/A
Lowering blood
pressure in
menopausal women
[110]
Iran
Randomized clinical
trial
1.aromatherapy,
2.control (saline)
60 operating room
nurses
Inhalation for 10
min
Reduce anxiety and
job stress and
improve accuracy
among operating
room nurses
[111]
Iran
Randomized
controlled trial
1.aromatherapy,
2.control
74 patients receiving
hemodialysis
Inhalation of 3 drops
each night for one
month
Reduce the severity
of fatigue in patients
receiving
hemodialysis
[112]
Iran
Controlled-
randomized trial
1.aromatherapy,
2.control
38 preoperative
patients
Inhalation of 3 drops
of rose EO from
cotton ball for 30
min
Reduce preoperative
anxiety level
[113]
Iran
Randomized, non-
blinded, parallel-
group controlled
trial
1.aromatherapy,
2.placebo (paraffin
oil)
80 operating room
personnel
Inhalation of 2 drops
for 10 min at the
beginning of the
morning shift, then
attach absorbent
cloth impregnated
with 5 drops for 30
consecutive nights.
Reduce state anxiety
and improve sleep
quality
[27]
Egypt
Quasi-experiment
with pre-test/post-
test design
1.aromatherapy
massage, 2.massage
(control)
74 menopausal
women
Back and arm
massage for 20 min
with EO blend:
lavender, clary sage,
jasmine, and rose in
almond oil, twice a
week for 5 weeks
Effective in easing
somatic menopausal
symptoms
[114]
Turkey
Randomized
controlled trial
1.Su Jok,
2.aromatherapy,
120 women who had
Cesarean delivery
Inhalation for 30
min 3 drops of EO
Effective in reducing
post-Cesarean pain
J Agron Technol Eng Manag 2024, 7(1), 998-1020. https://doi.org/10.55817/ASIJ6404 1010
3.aromatherapy+Su
Jok, 4.control
blend (lavender,
rose, and eucalyptus)
were put on gauze
and fixed to the
patient's collar with
a bandage
[115]
Iran
Randomized clinical
trial
1.aromatherapy,
2.control
100 patients
undergoing lower
extremity
orthopaedic surgery
Inhalation of 2 drops
from napkin for 10
min before
intervention
Reduce anxiety and
pain
[116]
Iran
Interventional study
1.breast milk,
2.Lavandula
stoechas, 3.rose,
4.control
100 preterm infants
N/A
Decrease preterm
infants' venipuncture
pain
[117]
Turkey
Comparative mixed-
method design
1.hand-holding,
2.rose, 3.control
126 patients
Inhalation of 2 drops
of EO via the inner
side of surgical face
mask
Reduce pain
associated with
peripheral
intravenous catheter
insertion
[118]
Turkey
Randomized
controlled clinical
trial
1.aromatherapy,
2.control (standard
analgesics)
86 women with
primary
dysmenorrhea
symptoms
Inhalation of rose
EO (2ml) dissolved
in ethyl alcohol
(20ml) and distilled
water (78ml) from a
piece of paper
handkerchief
Effective in pain
relief in primary
dysmenorrhea
[119]
Iran
Randomized
placebo-controlled
trial
1.lavender, 2.rose,
3.placebo
118 nurses
Inhalation for 2
hours a day for four
weeks
Relieving symptoms
of job stress and
improving comfort
at the workplace
[120]
Iran
Clinical trial
1.aromatherapy,
2.control
75 eligible mothers
Inhalation 5-10 min
of 10% rose EO for
10 consecutive
nights
Reduce anxiety in
mothers of
premature infants
[121]
Iran
Cross-over clinical
trial study
1.aromatherapy,
2.breast milk odor
40 neonates
Inhalation of two
drops of rose EO
Reduce pain and
crying due to blood
sampling in neonates
[122]
Iran
Randomized
controlled trial
1.aromatherapy,
2.placebo (water)
60 burn patients
Inhalation 5 drops of
40% rose EO
Reduce anxiety and
improve sleep
quality
[123]
Indonesia
Pre-experimental
design with a two-
group pre-test/post-
test approach
1.aromatherapy,
2.control
40 maternity
mothers
Inhalation 4 drops
rose EO into the
water via an
ultrasonic diffuser
Reduce pain severity
during 1st active
phase of labor
J Agron Technol Eng Manag 2024, 7(1), 998-1020. https://doi.org/10.55817/ASIJ6404 1011
4. Discussion
It is known that olfactory through inhalation of odors has diverse physiological effects on the
human brain, endocrine, and immune systems [41]. According to the data presented in Table 1, the
most common applications of rose essential oil in aromatherapy practice are for pain relief (33 papers)
and for reducing anxiety (referring to 33 papers). Additionally, it is commonly used for improving
sleep quality (10 papers), mitigating stress (7 papers), reducing depression (6 papers), alleviating
physiological symptoms during menopause and PMS (5 papers), relaxation (4 papers), lowering
blood pressure, decrease breathing rate and blood oxygen saturation (4 papers), improving life
quality and well-being (3 papers), improving cognitive function (2 papers), decreasing fatigue (2
papers), improving sexual function (2 papers), and one paper refers reducing apnea attacks,
bradycardia and SpO2 of preterm infants, while in three papers, there is no activity or weak activity
of rose essential oil in aromatherapy (Figure 3).
Figure 3. Summary of research studies on the effects of rose aromatherapy according to Table 1 (some
activities are mentioned in one paper multiple times). Other activities include lowering blood
pressure, improving male sexual function, and reducing apnea attacks, bradycardia, and SpO2 in
preterm infants.
There are several systematic reviews and meta-analyses of rose aromatherapy that summarizes
anxiolytic, antidepressant, and anti-stress effects, as well as improving sleep quality [33, 34, 35, 39],
and pain [36, 37, 38]. This indicates that rose essential oil can be successfully applied to burn patients
to alleviate pain intensity after dressing and help reduce pain-related anxiety [58, 60, 75, 93, 122],
systematically reviewed by Farzan et al. 2023 [39].
Based on our review of papers dealing with rose aromatherapy, it can be concluded that the
largest number of papers refer to alleviation of various types of pain (Figure 4a), such as
postoperative pain (10 papers; [56, 62, 83, 85, 86, 89, 94, 107, 114, 115]), labor pain (7 papers; [53, 68,
J Agron Technol Eng Manag 2024, 7(1), 998-1020. https://doi.org/10.55817/ASIJ6404 1012
69, 73, 90, 95, 123]), menstrual pain (6 papers; [21, 22, 24, 25, 61, 118]), burns (4 papers; [58, 60, 75, 93]),
intervention pain such as venipuncture, blood sampling or peripheral intravenous catheter insertion
(3 papers; [116, 117, 121]), musculoskeletal pain such as chronic pain in elderly individuals or
pregnancy-related low back pain (2 papers; [26, 66]) and renal colic pain (one paper [48]). Rose
essential oil can be applied as an effective aromatherapy treatment for reducing anxiety (Figure 4b).
A review conducted by Guo et al. 2020 [124] identifies rose essential oil as the third most commonly
used aroma preparation for significantly improving preoperative anxiety, following lavender and
citrus. According to our review, 11 papers refer to the aromatherapy application of rose essential oil
for anxiety reduction during the preoperative and postoperative period [74, 85, 87, 88, 89, 91, 92, 97,
105, 112, 115], among burn patients (4 papers; [60, 75, 93, 122]), work-related stress among nurses [77,
110, 113], menstrual and menopausal anxiety [21, 23], pregnancy and maternity anxiety [108, 120],
labor anxiety [47, 69], exam anxiety among students [70, 101], cardiac patients [100, 102],
hemodialysis [66], orthodontic patients [82], elderly [104], and two animal studies [42, 44].
Figure 4. The benefits of Rosa damascena essential oil referenced in the papers (based on Table 1 and
Figure 3) for A) Alleviation of various types of pain and B) Reduction of anxiety caused by various
conditions.
Rose aromatherapy exhibits great potential in women’s health, for treating menopausal
symptoms [19, 23, 27, 59, 109], reducing menstrual pain [21, 22, 24, 25, 61, 118], and improving
symptoms of PMS [71, 78]. Furthermore, rose essential oil is effective in reducing anxiety and labor
pain [47, 53, 68, 69, 73, 90, 95, 123], decreasing anxiety and depression during pregnancy [108],
alleviating pregnancy-related back pain [26], reducing post-Cesarean anxiety and pain intensity [85,
114], and mitigating anxiety in mothers of premature infants [120]. Moreover, aromatherapy using
rose oil reduces apnea attacks, bradycardia, and SpO2 of preterm infants [57], and decreases preterm
infants' venipuncture pain [116]. It has also shown the potential to decrease resistance to sleep,
nightmares, and nighttime awakenings in children with sleep disorders [72].
In addition, rose essential oil is effective in reducing renal colic pain in chronic kidney disease
patients [48]. It has also shown the potential to improve cognitive function and decrease depression,
anxiety, and stress in hemodialysis patients [63, 65]. Additionally, in the elderly, rose aromatherapy
is effective in reducing pain and anxiety, improving sleep quality, and lowering blood pressure in
elderly individuals with hypertension [62, 66, 67, 87, 103, 104].
The most common method for administering rose aromatherapy is through inhalation (referred
to in 78 papers), followed by topical application (9), while in 6 papers aromatherapy method is not
specified (Table 1). For inhalation, essential oil is mainly used in concentrations of 1-10%, sometimes
up to 40%. The duration ranges from 90 seconds to 1 hour, or it may last all night. For massages, rose
essential oil is used at a final concentration of 3-4%, and applied for 5-15 min. In aromatherapy, rose
essential oil can be used alone or in combination with other oils (Figure 5). Floral oils such as clary
sage [21, 27], neroli [84], lavender [19, 22, 23, 27, 59, 60, 70, 84, 101, 114], geranium [19, 21, 23, 59] and
jasmine [19, 27], or spicy essential oil such as ginger [21], cinnamon [22], clove [22] and fennel [59],
woody oils like sandalwood and agarwood [84], go well with rose oil in aromatherapy. Sweet orange
(fruity note), frankincense (earthy), rosemary (herbal), and eucalyptus (medicinal) oils can be blended
with rose oil effectively [23, 84, 114].
J Agron Technol Eng Manag 2024, 7(1), 998-1020. https://doi.org/10.55817/ASIJ6404 1013
Figure 5. Essential oils that go well with Rosa damascene.
In addition to essential oil, rose water, is also a valuable raw material in aromatherapy practice
[125]. For example, inhalation of rose water from absorbent cotton handkerchiefs before sleeping and
before the dialysis process for a duration of 15-20 min over four weeks, noticeably reduces anxiety in
hemodialysis patients [126]. Furthermore, the act of rubbing the palms of the hands and inhaling rose
water for 3 min has a positive effect on reducing pain and anxiety in the patient after surgery [127].
Additionally, inhaling rose water during the phase of labor reduces pain severity in nulliparous
women [128, 129]. Aromatherapy with rose water, performed for three consecutive nights among
women during the puerperium period, has been observed to improve sleep quality [130].
Additionally, inhalation of lavender essential oil diluted in rose water via cloths on the mouths (10
breaths before sleeping) and then placed next to the pillow in pregnant women at 35-37 weeks,
decreases postpartum depression [131].
5. Conclusions
In light of its aromatic attributes, safety profile, and facile application, rose oil emerges as a viable
adjunctive or non-pharmacological modality for ameliorating anxiety, alleviating pain, attenuating
physiological symptoms associated with menopause and premenstrual syndrome (PMS), enhancing
sleep quality, mitigating stress, ameliorating depressive states, fostering relaxation, optimizing
cognitive functions, diminishing fatigue, and affording relief across a spectrum of diverse conditions.
Furthermore, avenues for future research should explore the precise mechanisms underlying the
therapeutic effects of rose. A multidisciplinary approach encompassing pharmacological,
neurobiological, and psychosocial perspectives should be instrumental in advancing the scientific
understanding and clinical application of rose oil as a complementary therapeutic agent.
J Agron Technol Eng Manag 2024, 7(1), 998-1020. https://doi.org/10.55817/ASIJ6404 1014
Funding: This research was funded by Ministry of Education, Science and Technological Development of the
Republic of Serbia [grant numbers 451-03-68/2023-14/200032 (M.A.), 451-03-47/2023-01/200134 (B.L.; O.Š.; V.T.),
451-03-47/2023-01/200017 (M.P.), 451-03-47/2023-01/200051 (L.P.)] and Provincial Secretariat for Higher
Education and Scientific Research, Autonomous Province of Vojvodina, Republic of Serbia [Grant number 142-
451-2658/2021-01/1 (B.B.T.)].
Conflicts of Interest: The authors declare no conflict of interest.
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