Chamomile
Matricaria chamomilla
Evidence Rating
C Moderate
Confidence Level
High
Medium-High
Traditions
Western
Last Updated
2/9/2026
Summary
German chamomile is arguably the most comprehensively studied and widely recognized topical anti-inflammatory herb in European phytotherapy. It holds approvals from Commission E, ESCOP, and EMA (including "well-established use" status for some preparations). Active compounds alpha-bisabolol and chamazulene provide demonstrable anti-inflammatory activity. Clinical evidence supports efficacy comparable to low-potency hydrocortisone for eczema. Chamomile has an excellent safety profile, with only rare allergic reactions in Asteraceae-sensitive individuals.
⚠️
Drug Interactions
This herb has significant drug interactions. Do not use if you are taking medications without consulting a healthcare provider first. See detailed interaction information below.
Regulatory Status
| Regulatory Body | Status |
|---|---|
| Commission E (Germany) | ✓ Approved |
| ESCOP (European) | ✓ Approved |
| EMA/HMPC (EU) | ✓ Approved |
Metadata
| Field | Value |
|---|---|
| Common Names (English) | German Chamomile, Wild Chamomile, Blue Chamomile |
| Common Names (German) | Kamille, Echte Kamille, Matricaria |
| Botanical Name | Matricaria chamomilla L. (syn. M. recutita L., Chamomilla recutita) |
| Plant Family | Asteraceae (Compositae) |
| Parts Used | Flower heads (Matricariae flos); Essential oil (Matricariae aetheroleum) |
| Evidence Quality Rating | Moderate-Strong — Triple regulatory approval including well-established use; comparative clinical trials; extensive pharmacological data |
Approved Indications
Commission E (Germany)
- Approved for external use
- Indications: Skin and mucous membrane inflammations; bacterial skin diseases including oral cavity and gum diseases; inflammatory diseases and irritations of the respiratory tract (inhalation); diseases of the anal and genital area (baths and irrigation)
ESCOP (European Scientific Cooperative on Phytotherapy)
- Approved for topical use
- Indications: Minor inflammations and irritations of the skin and mucous membranes
- Chamomile was one of the first herbs evaluated by ESCOP
EMA/HMPC (European Medicines Agency)
- Dual classification: Well-Established Use (for some preparations) AND Traditional Use
- Cutaneous use indications:
- Add-on treatment of irritation of skin and areas around anus and genitals (once serious conditions excluded)
- Minor inflammation of the skin (sunburn) and superficial wounds
- Small boils (furuncles)
Agreement/Disagreement Between Bodies
- Strong agreement across all three bodies on skin and mucosal inflammation
- Commission E is broadest, explicitly including bacterial skin diseases
- EMA provides the most nuanced classification with both well-established and traditional use pathways
- All agree on appropriateness for ano-genital area inflammatory conditions
Conditions Treated
Primary (Monograph-Supported)
- Minor skin inflammations (dermatitis, irritation, sunburn)
- Mucosal inflammations (oral, pharyngeal, ano-genital)
- Superficial wounds
- Small boils (furuncles)
Secondary (Clinical/Traditional Use)
- Atopic eczema / atopic dermatitis
- Contact dermatitis
- Radiation dermatitis (radiodermatitis)
- UV-induced erythema
- Diaper dermatitis
- Phlebitis
- Peristomal skin complications
- Psoriasis [PRELIMINARY]
Mechanism of Action
Key Active Compounds
- Alpha-bisabolol (levomenol) — sesquiterpene alcohol; primary anti-inflammatory; granulation tissue promoter; FDA GRAS status
- Chamazulene — formed during steam distillation from matricine; anti-inflammatory, antioxidant (gives essential oil its blue color)
- Apigenin — flavonoid; anti-inflammatory, anti-spasmodic, anxiolytic
- Quercetin — flavonoid; antioxidant, anti-inflammatory
- Coumarins (herniarin, umbelliferone) — mild anti-inflammatory
- Mucilages — emollient, soothing
Mechanisms
- Anti-inflammatory: Alpha-bisabolol and chamazulene inhibit leukotriene synthesis, providing anti-inflammatory action. Apigenin inhibits COX-2 and NF-kB. [Source: PMC5074766]
- Antioxidant: Multiple flavonoid-mediated free radical scavenging pathways
- Wound healing: Bisabolol promotes granulation tissue formation; flavonoids inhibit histamine release from leukocytes
- Antimicrobial: Moderate activity against Gram-positive bacteria and Candida spp.
- Anti-pruritic: Reduces histamine-mediated itching
- PI3K/Akt/mTOR inhibition: Essential oil shown to alleviate psoriatic-like inflammation by inhibiting PI3K/Akt/mTOR and p38MAPK signaling [Source: PMC10785696]
Clinical Evidence Summary
Key Clinical Trials and Evidence
| Study | Design | N | Condition | Result |
|---|---|---|---|---|
| Aertgeerts et al. (1985) | RCT, comparative | — | Eczema | Chamomile cream comparable to 0.25% hydrocortisone |
| Glowania et al. (1987) | RCT | — | Dermabrasion wounds (tattoo removal) | Chamomile extract superior to control for wound drying and epithelialization |
| Maiche et al. (1991) | RCT | — | Radiation dermatitis | Chamomile cream did not prevent radiation skin reactions |
| Fidler et al. (1996) | RCT | — | Radiation mucositis | Chamomile mouthwash did not reduce 5-FU mucositis |
| Patzelt-Wenczler & Ponce-Poschl (2000) | RCT, double-blind | — | Eczema | Kamillosan cream non-inferior to 0.5% hydrocortisone |
Systematic Review Findings
- Srivastava et al. (2010) systematic review: Confirmed anti-inflammatory, antioxidant, and mild astringent properties of chamomile for skin conditions
- Evidence for UV erythema, contact dermatitis, eczema, and wound healing is consistent but comes from mostly small trials
Evidence Assessment
- Eczema: Best evidence — comparable to low-potency hydrocortisone in multiple trials
- Wound healing: Positive evidence from animal models and small clinical studies
- Radiation dermatitis: Mixed results across trials
- Oral mucositis: Negative results for chemotherapy-induced mucositis
- Overall: Consistent anti-inflammatory evidence across multiple skin conditions; trial quality is moderate
European vs US/Anglophone Consensus
| Aspect | European Position | US/Anglophone Position |
|---|---|---|
| Regulatory status | Approved by Commission E, ESCOP, EMA (well-established + traditional use) | GRAS for cosmetic use; no FDA therapeutic monograph |
| Clinical use | Standard topical anti-inflammatory in dermatology; Kamillosan widely prescribed | Primarily used in cosmetics and self-care; limited clinical adoption |
| Clinician awareness | Very high — foundational herb in German phytotherapy | Moderate — recognized but rarely prescribed by dermatologists |
| Evidence perception | Accepted evidence-based medicine | Increasingly recognized; still considered “complementary” |
| Product quality | Pharmaceutical-grade standardized preparations | Variable quality; many cosmetic-grade products |
Safety Profile
Contraindications
- Known hypersensitivity to Asteraceae (Compositae) family
- Cross-reactivity possible with ragweed, chrysanthemums, marigolds, daisies
- Avoid eye area (may cause eye irritation)
Drug Interactions
- Topical use: No significant drug interactions reported
- Theoretical (primarily oral): May increase bleeding risk with anticoagulants (warfarin, aspirin, NSAIDs) — not clinically relevant for topical use
Side Effects
- Rare: Allergic contact dermatitis (primarily in Asteraceae-sensitized individuals)
- Very rare: Severe hypersensitivity/anaphylaxis (documented case reports, extremely uncommon)
- FDA classifies alpha-bisabolol as GRAS
- Cosmetic Ingredient Review: Matricaria recutita deemed safe and non-irritating
Pregnancy/Lactation
- Topical use: Generally considered safe
- Oral use: Traditionally avoided during pregnancy (theoretical uterine stimulant effect); insufficient evidence to confirm or refute risk
- Lactation: Compatible with topical use; caution with oral use (insufficient data)
Clinical Dosage
Topical Preparations
| Form | Dosage/Concentration | Notes |
|---|---|---|
| Ointment/cream | 3-10% chamomile extract | Kamillosan cream is benchmark product |
| Essential oil (bath) | 10-15 drops in bathtub | For eczema/dermatitis; soak 15-20 min |
| Compress | 3-10% infusion | Apply to affected area |
| Infusion (topical wash) | 3-10 g flowers per 100 mL water | For wound cleansing |
| Gargle/mouthwash | 8 g flowers per 1000 mL water | For oral mucosal inflammation |
| Steam inhalation | 6 g flowers per hot water | For respiratory tract |
Key Commercial Products (Europe)
- Kamillosan (ointment, solution) — benchmark product; contains alpha-bisabolol and chamazulene
- Kamillan (liquid)
- Various pharmacy-compounded preparations
Sources
- EMA European Union Herbal Monograph on Matricaria recutita L., flos (First Version)
- EMA page: Matricariae flos and Matricariae aetheroleum
- Commission E Monograph: Chamomile flower
- ESCOP Monograph: Matricariae flos
- Srivastava et al. (2010). Chamomile: A systematic review. PMC5074766
- Patzelt-Wenczler & Ponce-Poschl (2000). Kamillosan cream study
- Aertgeerts et al. (1985). Chamomile vs. hydrocortisone
- Altmeyers Encyclopedia: Chamomile real
- PMC10785696: PI3K/Akt/mTOR inhibition by chamomile essential oil
Connections
- Compare with Witch Hazel for overlapping eczema/dermatitis indications
- Compare with Calendula for wound healing overlap (both Asteraceae)
- Both chamomile and calendula require Asteraceae allergy screening