Journal of Clinical and Aesthetic Dermatology

OCT 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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34 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY October 2017 • Volume 10 • Number 10 R E V I E W S Sandalwood album oil (SAO) has been utilized topically for centuries in both Ayurvedic and traditional Chinese medicine. The oil is distilled from the heartwood of the Santalum album tree and contains over 125 structurally related compounds, with fewer than a dozen components present in concentrations greater than 1% by weight. 1 Because SAO is a significant item of commerce, used in many personal care products and perfumes, there is an international specification for the oil (ISO 3518:2002). SAO is listed in the United States Food and Drug Administration (FDA) Food Chemicals Codex as a natural flavoring ingredient, and the Australian Therapeutic Goods Administration (TGA) has classified the oil as a Listed Medicine, available as an active ingredient in many non-prescription products. Worldwide, there are more than a dozen species of sandalwood, most of which have served as sources of essential oil. However, the International Organization for Standardization (ISO) has issued standards for only two species: Santalum album and Santalum spicatum (West Australian sandalwood). Of the two species, S. album produces oil with much higher concentrations of alpha- and beta-santalol. SAO was previously produced from wild- grown trees in India, but over-harvesting and poaching has led to Santalum album trees being pushed to the brink of extinction in their native habitats. Since 1998, the trees have been listed as Vulnerable by the International Union for the Conservation of Nature, and the harvesting and export of wild-grown Indian trees is highly restricted. The trees that are currently being used to produce sandalwood album oil for pharmaceutical applications are sustainably cultivated by Quintis, Ltd. (formerly TFS Corp. Ltd.) on Australian plantations. The FDA has issued guidelines for the development of traditional medicines derived from plants. 2 Such botanicals are often mixtures of numerous active compounds acting via multiple mechanisms of action. In general, if the mixture's composition is under tight control and there are no known safety issues, botanical drugs can be studied in clinical trials as mixtures and can receive marketing approval as long as they are shown to be safe and effective. Veragen®, a green tea (Camellia senensis) extract for treatment of genital warts, and Fulyzac®, an anti-diarrheal extract from Croton lechleri, were the first two botanical drugs approved for sale in the United States under the FDA guidelines. Anti-inflammatory, anti-oxidant, and related properties of sandalwood album oil. SAO is known to mediate its anti-inflammatory properties in vitro through A B S T R A C T Many skin conditions and diseases are characterized by inflammation, infection, and hyperplasia. Safe and effective topical treatment options that can be used long- term are needed. Traditional botanical medicines, which are often complex mixtures that exert their biological activities via multiple mechanisms of action, are being studied as potential new active ingredients in dermatology. Sandalwood album oil (SAO), also known as East Indian sandalwood oil (EISO), is an essential oil distilled from the Santalum album tree and has demonstrated biological activity as an anti-inflammatory, anti-microbial, and anti- proliferative agent. Sandalwood album oil has also shown promise in clinical trials for treatment of acne, psoriasis, eczema, common warts, and molluscum contagiosum. The favorable safety profile, ease of topical use, and recent availability of pharmaceutical-grade sandalwood album oil support its broader use as the basis of novel therapies in dermatology. KEYWORDS: Santalum album oil, East Indian sandalwood oil, sandalwood oil, botanical drugs, anti-inflammatory, antimicrobial, antiproliferative, acne, psoriasis, Molluscum contagiosum, atopic dermatitis, eczema Sandalwood Album Oil as a Botanical Therapeutic in Dermatology by RONALD L. MOY, MD, and COREY LEVENSON, PhD Dr. Moy is from Facial Cosmetic Surgery in Beverly Hills, California, and Dr. Levenson is an employee of Santalis Pharmaceuticals, San Antonio, Texas. J Clin Aesthet Dermatol. 2017;10(10):34–39 FUNDING: No funding was provided. DISCLOSURES: Dr. Moy has no financial conflicts relevant to the content of this article. Dr. Levenson is an employee of Santalis Pharmaceuticals, which holds several Investigational New Drug Applications (INDs) for clinical investigations on sandalwood oil, the topic of this review. CORRESPONDENCE: Corey Levenson, PhD; Email: corey@santalispharma.com

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