By Adam Vo*

Keywords: coconut oil, skin disease, personal experience, doctor-patient communication, eczema, moisturizer, skin care, dermatologist, skin, natural, doctor’s apostolic function

Abstract

This is a personal vignette of a student’s unusual encounter involving coconut oil, while shadowing the local dermatologist in Southern California. The narrator juxtaposes his childhood experiences as a dermatology patient with his adolescent experiences as a medical shadow. On a journey to discover the role of coconut oil in dermatological practice, the student learns about the various benefits of coconut oil, ranging from treatment for an array of skin disorders to a daily moisturizer. After an extensive literature review, the narrator’s appreciation for coconut oil increases, eventually leading his entire family to be devout coconut oil’s users. This personal narrative is written to inspire others to utilize coconut oil as a possible natural skincare product.

As I swung the glass doors open into the local dermatology clinic for my first shadowing experience, I noticed two things: the modern interior and the clean, barren walls. As an eczema patient since birth, I have visited several dermatology clinics, all of which were unlike this particular one. From my experience, a typical dermatology clinic showcases a wide array of the clinicians’ favorite skincare lines and photographs displaying models with flawless skin. Sitting in that waiting room, I realized it was quite rare to see an interior lacking advertised skin products, posters promoting their favorite brands, and messages for perfect skin.

But I didn’t have time to wonder why this was the case, as the doctor beckoned me in to watch her first patient. The patient was a middle-aged blond lady, with black Ray-ban sunglasses and a brown Gucci handbag. She explained to the doctor that she had an infection on her lip and eczema on her neck. A section of her lip was swollen red, and her neck had red and brown patches with small bits of blood.  For the infection, she was given an ointment. And for her eczema, I had expected the doctor to prescribe a cream or medicated moisturizer that I had received for years as a severe eczema patient myself. However, the doctor instead suggested the lady use coconut oil. The doctor suggested applying it at least once a day in a layer that completely coated the affected area. The doctor explained that the patient should use it almost as a lotion or moisturizer. The lady had a blank expression but nodded politely in response. The doubt in her eyes was clear, but she took note of the suggestion. The patient then questioned if the doctor meant the cooking type, and the doctor laughed, answering “Yes, the cooking type.” The dermatologist went on to explain that coconut oil is great for the skin and that she has been using it and suggesting its use for years. I hesitantly wrote down in my notes “Coconut oil for eczema?” and watched as the appointment finished moments later.

The next patient was a young boy with his father. The young boy wore a blue long sleeve t-shirt with a Gap design across the front and black sweatpants. His father wore a blue collared Polo shirt with blue jeans. The boy’s eyes were wide as his father frantically explained how the boy had developed rashes all over his body. The rashes were oval, red, and puffy; they sat in isolated patches on his stomach, arms, and legs. The boy wiggled in his chair, unable to still sit. It was clear that the rash was extremely itchy, as he scratched from his stomach to his legs and back to his arms. As the doctor began examining the rashes, she explained that the rashes were something similar to chickenpox and were a result of his body reacting to a virus. Once again, she suggested the use of coconut oil at least once a day over the affected area. As my eyes turned from the patient to the doctor, I stood quietly in the corner looking quite confused. “Surely, coconut oil would not be sufficient to cure the boy’s widespread rashes,” I thought. However, the doctor stood steadfast in her decision and suggested the father purchase a tub of oil at a local grocery store.

Within an hour of shadowing the dermatologist, I had seen her prescribe coconut oil to treat eczema and a relative of chickenpox. “What is coconut oil? What does it actually do? And is it that good?” I quickly jotted down these questions in my book, as I left the clinic. That evening, I researched the properties of coconut oil, and what I discovered astounded me.

Dr. Frances Prenna Jones, a cosmetic doctor based in London, stated, “Coconut oil is a great emollient if the barrier function of your skin is disturbed. It’s great at repairing and restoring skin quickly, since it is rapidly absorbed into the epidermis” (Driver 2020). I continued to read that coconut oil is a great moisturizer for the skin. This is a benefit derived from coconut oil’s moisture trapping properties (Lapidos 2019). However, this is only true for normal to dry skin.

In addition, the literature confirms that coconut oil reduces inflammation, relieves pain, and is antimicrobial. As an effect of reducing inflammation, coconut oil is useful in the treatment of psoriasis, contact dermatitis, eczema, and acne (Neilands 2018). In a study published in Pharmaceutical Biology, virgin coconut oil showed anti-inflammatory effects on chemically induced swelling and analgesic effects on acid-induced writhing in rats (Intahphuak 2009). Moreover, in users with normal to dry skin, coconut oil helps treat the patient’s acne with its antimicrobial properties (Neilands 2018). In other cases where users have more oily skin, the oil can cause breakouts due to its comedogenic properties (pore blocking) (Driver 2020).

The extensive benefits of coconut oil range widely for everyone, but particularly for skincare, the advantages are highly variable based on skin type. Fortunately, coconut oil has limited risks associated with its application, and it remains to be an effective natural alternative for moisturizing skin. Unfortunately, there is a limited amount of literature promoting the use of coconut oil for skin treatment. In addition, limited studies have explored the direct effects of coconut oil on the skin.

A month later, my family made a trip to Costco. As I walked down the cooking aisle, I noticed a tub of white coconut oil at the bottom of the shelf. I remembered what the dermatologist had recommended to her patients. Quickly motioning my parents over, I explained to them how the dermatologist I had shadowed used this oil as a treatment for various skin disorders. My parents were so stunned that coconut oil could be highly effective for cooking as well as for skincare. We bought the tub and arrived home. The tub was divided into smaller containers for each family member to take one container of coconut oil for their skin. My parents and I immediately applied the oil and our skin felt very moist and smooth. At first, we were skeptical of how long-lasting this effect would be, but in the morning our skin still felt extremely smooth. For me, my eczema on my elbow had gotten significantly less dry, and my parents gushed over their smooth skin.  After experiencing its miraculous effects, my family and I became devout users of coconut oil, applying it as our daily moisturizer.

Not too long after my Costco trip, I came in to shadow my local dermatologist once again. The big glass doors welcomed me in to see the professional interior and plain walls. However, unlike my first time coming in, I understood why the dermatologist didn’t have any promotional displays. Whenever the opportunity arose, she promoted inexpensive and natural coconut oil.

References:

1. Intahphuak S;Khonsung P;Panthong. Anti-Inflammatory, Analgesic, and Antipyretic Activities of Virgin Coconut Oil. 29 Dec. 2009, pubmed.ncbi.nlm.nih.gov/20645831/.
2. Driver, George. “Every Way You Could (And Should) Use Coconut Oil On Your Skin And Hair.” ELLE, ELLE, 22 Apr. 2020, www.elle.com/uk/beauty/body-and-physical-health/a34531/coconut-oil-uses-and-benefits-for-skin-and-hair/.
3. Rachel Lapidos. “What to Know before You Slather Coconut Oil onto Your Face.” Well+Good, 24 Jan. 2020, www.wellandgood.com/good-looks/coconut-oil-for-face/.
4. Neilands, Adam. “How Coconut Oil Can Help With Acne, Eczema and Psoriasis.” Kelapa Organics Australia, 21 Sept. 2018, www.kelapa.com.au/blogs/news/how-coconut-oil-can-help-with-acne-eczema-and-psoriasis.

*Author Bio:Adam Vo is an aspiring dermatologist from Southern California. He is currently a premedical, high school student who spends time shadowing his local dermatologist, reading the current literature on skin disorders, and volunteering at nursing homes. His main interest is to treat skin disorders that he suffered from as a child and incorporate integrative medicine into his future practice as a physician.

Emeritus Editors note:
I am honored that the the Editors remembered a superannuated dermatologist on Norfolk Island and asked me for a comment. It was a pleasure to read this fine article by a future dermatologist! I hope some respectful suggestions will be of value.

1. There have been few studies and coconut oil’s efficacy. A pound cost around 12 US Dollars, so what pharmaceutical company is going to underwrite an expensive head-to-head trial with a topical corticosteroid?  Coconut oil may indeed be helpful for some patients but it will never be rigorously studied.

2. The dermatologist Adam was shadowing when recommending coconut oil to many of her patients was providing an example of what Michael Balint called, “The Physician’s Apostolic Function.”¹ Her own powerful belief in the healing properties of this product led her to advise it to patients; and because they had faith in her as their healer it may have actually worked by the placebo effect. Long before physicians had effective therapies, the power of their belief in the potions that they prescribed had curative value. William Osler wrote: “Often the best part of your work will have nothing to do with powders or potions, but with the exercise of an influence of the strong upon the weak, of the righteous upon the wicked, the wise upon the foolish.”
Nuff said…  Adam, good luck on your journey. I look forward to reading more essays from you.

1.  Understanding the dynamics of the patient-physician relationship: balancing the fiduciary and stewardship roles of physicians. Balint JA, Shelton WN. Am J Psychoanal. 2002 Dec;62(4):337-46.