Safe, inexpensive, and widely available, sunflower oil seems a reasonable consideration for any patient with impaired skin barrier, so long as there is not a known sunflower seed allergy.
Natural oils have been used as topical treatments for the skin from the earliest recorded history.[i] Sunflowers (Helianthus annus) are native to the southwest and have been used as food, medicine, and for ornamental purposes for generations.[ii]
Sunflower seed oil is rich in linoleic acid, and has been used topically in the treatment of essential fatty-acid deficiency, rapidly reversing the disease with its excellent transcutaneous absorption.[iii] More locally, these essential fatty acids can help maintain the skin barrier and decrease transepidermal water loss, both important features in thinking about skin problems such as atopic dermatitis.[iv] There is some thought that preparations with higher amounts of linoleic acid versus oleic acid may be more beneficial in this role and some clinical data that bears this out.[v]
Several studies have also suggested that sunflower seed oil has anti-inflammatory properties. Linoleic acid is the major lipid that converts to arachidonic acid, which leads to prostaglandin E2, an inflammatory modulator, possibly via peroxisome proliferative-activated receptor-a (PPAR-a) activation. These anti-inflammatory aspects are very compelling for our menagerie of inflammatory dermatoses. [v]
There is a rather amazing and somewhat bizarre line of evidence for the skin barrier enhancing properties of sunflower seed oil. A study of 497 pre-term infants deemed high-risk for sepsis were given three times daily application of sunflower seed oil versus a petroleum-based moisturizer, versus standard of care (no topical agent) to see if improving the skin barrier would prevent systemic infection. Indeed, sunflower seed oil reduced sepsis by 41 percent, with a 26 percent reduction in mortality, significantly better than no treatment and similar to the effect of the petroleum-based moisturizer, but at a fraction of the cost.[vi] No adverse events were reported, suggesting that sunflower seed oil is pretty safe, even in these most vulnerable premature infants.
A more recent study of 22 preterm infants randomized to sunflower seed oil daily or control was not as favorable: it found that skin pH actually decreased and transepidermal water loss actually increased in the sunflower group, suggesting that-in this design-sunflower seed oil actually retarded the barrier maturation in premature infants. Because it is a small study and due to the many variables, it is difficult to know what this means in light of the other data, but serves as an important reminder that the answer may not be clear-cut.[vii]
In perhaps a more relevant study, 19 adults were randomized to receive olive oil to one arm versus sunflower seed oil to the other for 4 weeks. Interestingly, the olive oil caused a worsening of the barrier function and even erythema in subjects with and without a history of AD. Sunflower seed oil, on the other hand, did not cause erythema and preserved skin barrier function while actually improving hydration.[i] Although fairly limited, these findings have prompted me to caution patients away from using topical olive oil in favor of sunflower seed oil.
The fact that some botanical oils can be detrimental and others helpful to skin barrier has been demonstrated in the mouse model as well, further bolstering these clinical findings. In a precursor study geared toward identifying safe and inexpensive vegetable oils to enhance epidermal barrier function for neonates in developing countries, several vegetable oils were tested and compared on mouse epidermis. Mustard, olive, and soybean oils were found to significantly delay recovery of epidermal barrier function compared to control and a petroleum-based moisturizer, with mustard oil showing the most detrimental effects of all. Sunflower seed oil, however, significantly improved skin barrier function recovery, with an effect that was sustained 5 hours after application.[vi]
What about in a disease state such as atopic dermatitis (AD)? Here, the evidence points to at least a modest effect for sunflower seed oil. A study of 86 children with moderate AD randomized to corticosteroids with or without a sunflower-oil-containing cream found a significant impact on lichenification and excoriation, decreased corticosteroid use, and improved quality of life compared to the control group.[viii]
Safe, inexpensive, and widely available, sunflower oil seems a reasonable consideration for any patient with impaired skin barrier, so long as there is not a known sunflower seed allergy. While many details are yet to be resolved, including the linoleic vs oleic acid content, the frequency of application, and perhaps the underlying skin issues, sunflower seed oil has been used for quite some time and will likely remain an important ally.
[i] Danby SG, Alenezi T, Sultan A, et al. Effect of olive and sunflower seed oil on the adult skin barrier: implications for neonatal skin care. Pediatr Dermatol. 2013;30(1):42-50.
[ii] Lopez Perez G, Torres Altamirano M. Indications for sunï¬ower oil concentrate in the treatment of atopic dermatitis. Rev Alerg Mex. 2006;53(6):217-25.
[iii] Lodén M, Andersson AC. Effect of topically applied lipids on surfactant-irritated skin. Br J Dermatol. 1996;134(2):215-20.
[iv] Elias PM, Brown BE, Ziboh VA. The permeability barrier in essential fatty acid deficiency: evidence for a direct role for linoleic acid in barrier function. J Invest Dermatol. 1980;74(4):230-3.
[v] Eichenfield LF, Mccollum A, Msika P. The benefits of sunflower oleodistillate (SOD) in pediatric dermatology. Pediatr Dermatol. 2009;26(6):669-75.
[vi] Darmstadt GL, Saha SK, Ahmed AS, et al. Effect of skin barrier therapy on neonatal mortality rates in preterm infants in Bangladesh: a randomized, controlled, clinical trial. Pediatrics. 2008;121(3):522-9.
[vii] Kanti V, Grande C, Stroux A, Bührer C, Blume-Peytavi U, Garcia Bartels N. Influence of sunflower seed oil on the skin barrier function of preterm infants: a randomized controlled trial. Dermatology (Basel). 2014;229(3):230-9.
[viii] Msika P, De Belilovsky C, Piccardi N, Chebassier N, Baudouin C, Chadoutaud B. New emollient with topical corticosteroid-sparing effect in treatment of childhood atopic dermatitis: SCORAD and quality of life improvement. Pediatr Dermatol. 2008;25(6):606-12.