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She showed a positive reaction at the prick tested site to Dhanwantharam thailam and Eladi coconut oil at 30 minutes [Figure 4]. [Table 1] lists the reactions seen at the prick tested sites.Ayurvedic oil is made by cooking Ayurvedic plants in one of the base oils like sesame oil or coconut oil.

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She was advised that she may continue the aromatherapy with the medications to which she tested negative by patch testing.

Two weeks after stopping systemic corticosteroids, patch testing was done with each of the three oils "as is" with petrolatum as control.

Dhanwantharam thailam named after the patron deity of Ayurveda is the most popular massage oil and found to be useful in rheumatic and neurological disease. The ingredients of this massage oil are listed in [Table 2].

Eladi coconut oil which contains a variety of herbal essences in coconut oil is considered to be a "safe" massage oil for routine aromatherapy for adults and children. Adverse reactions to topical and systemic Ayurvedic medications are observed but have not been properly documented or reported.

Thus it becomes more important to recognize that the seemingly "safe" herbal remedy can also cause an adverse reaction.

It would be wise to recommend patch testing and prick testing with the constituent oils to detect sensitization and recommend the oils which tested negative for massage aromatherapy. Ayurvedic medication is very popular in the treatment of painful joint and muscle ailments.

The results were interpreted as recommended by the ICDRG.

The patches were applied using aluminium chambers on micropore tape (Systopic Pharmaceuticals, New Delhi, India) and were removed after 2 days.

This report hopes to create awareness of the rare possibility of adverse reactions to Ayurvedic medication.

A 52-year old lady with rheumatoid arthritis undergoing massage aromatherapy with a combination of 3 ayurvedic oils (Dhanwantharam thailam, Eladi coconut oil, and Murivenna) presented two weeks later with generalized erythema and intense pruritus.

Allergic contact dermatitis to Valiyanarayana thailam was the first reported case to ayurvedic oil.