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Coconut oil for skin: eczema trials, acne caveats, and which oil to use

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Coconut oil has been a moisturizer in the tropics for centuries.

That's not marketing. It's how a 2004 dermatology trial opened, before noting that there were, at the time, no clinical studies proving it worked or was safe (Agero 2004). Today the internet has picked a side for you either way: coconut oil heals eczema, or coconut oil clogs every pore on your face. If you have dry skin, a child with eczema, or breakout-prone skin, you deserve better than either slogan.

Three moves. What's claimed. What the trials found. And which coconut oil to use, where, and where not.

Part 1: The claims

Coconut oil for skin is sold on four promises:

  1. It moisturizes dry skin.
  2. It helps eczema (atopic dermatitis).
  3. It fights bacteria on the skin.
  4. It helps acne, or, from the other camp, it causes acne.

The first three have trials behind them. The fourth is mostly argument.

Part 2: What the research shows

Dry skin: as good as mineral oil

The 2004 trial randomized 34 people with mild to moderate xerosis (dry, rough, scaly skin) to apply virgin coconut oil or mineral oil to their legs twice daily for two weeks. Both oils improved skin hydration and surface lipids. There were no differences in water loss or skin pH, meaning neither harmed the skin barrier, and there were no adverse reactions. The authors concluded coconut oil was as effective and safe as mineral oil as a moisturizer (Agero 2004).

That's a modest finding. Mineral oil is a cheap, well-established moisturizer. Matching it is a pass, not a win.

Eczema in children: the strongest result

Then the pediatric trial landed.

In a 2014 randomized, double-blind trial in Manila, 117 children with mild to moderate eczema applied either virgin coconut oil or mineral oil for eight weeks. Eczema severity scores (SCORAD) dropped 68% in the coconut oil group versus 38% in the mineral oil group. Transepidermal water loss, a measure of how leaky the skin barrier is, fell from about 26.7 to 7.1 with coconut oil, versus 24.1 to 13.6 with mineral oil. Skin hydration rose more with coconut oil too (Evangelista 2014).

That's a meaningful difference, measured both by doctors and by instruments.

Here's why it might work. Healthy skin is like a brick wall: skin cells are the bricks and fats are the mortar. In eczema, the mortar is patchy, so water escapes and irritants get in. A moisturizer fills the gaps. The trial suggests virgin coconut oil fills them better than mineral oil does, at least in mild to moderate eczema in children.

Bacteria: a promising adult study

Staphylococcus aureus is a bacterium that commonly colonizes eczema-prone skin, and a 2008 trial targeted it directly. That trial in adults with eczema compared virgin coconut oil with virgin olive oil. Of those using coconut oil, 20 had S. aureus at the start; afterward, only 1 did. In the olive oil group, 12 started positive and 6 stayed positive. Coconut oil also improved eczema scores more than olive oil (Verallo-Rowell 2008).

It's a small study, 26 people per group. But it fits the eczema trial's direction.

Why the eczema trial isn't the final word

It's tempting to read a 68% drop and stop there. Don't, yet.

First, it's one trial of 117 children (Evangelista 2014). Strong designs can still produce results that don't replicate. Second, the comparison was mineral oil, a basic moisturizer, not the ceramide creams or prescription treatments many dermatologists use today. "Better than mineral oil" doesn't mean "better than your current cream." Third, it lasted eight weeks, and eczema is a condition that waxes and wanes over years. Fourth, the children had mild to moderate eczema. We can't assume the same result in severe cases.

The adult bacteria trial has its own limits. Only 26 people per group, and the groups didn't start even: 20 coconut oil users had S. aureus at baseline versus 12 olive oil users (Verallo-Rowell 2008).

None of this cancels the findings. It sets their size. Coconut oil has decent evidence as a gentle, cheap moisturizer for mild eczema. It hasn't been shown to replace medical care.

Acne: where the argument outruns the evidence

This is where you'll find the loudest opinions and the weakest evidence.

The pro-acne argument usually cites lauric acid, coconut oil's main fat. A 2009 study in the Journal of Investigative Dermatology found lauric acid killed the acne-linked bacterium (then called Propionibacterium acnes) in lab dishes at lower concentrations than benzoyl peroxide, and reduced bacteria and inflammation in mice (Nakatsuji 2009). That study tested purified lauric acid, not coconut oil, and not on human faces.

The anti-coconut argument says coconut oil is "comedogenic," meaning it clogs pores. We searched for clinical trials testing coconut oil's pore-clogging potential on human facial skin and found none we could verify. The ratings you'll see online usually aren't linked to a trial.

So the honest answer on acne is: unknown. Lab data on one of its fats is promising. Human evidence doesn't exist.

Our cautious read: if you're prone to breakouts, don't put coconut oil on your face until better evidence exists. Use it on your body, where the moisturizer trials were done (Agero 2004).

What reviews say

A 2017 review of topical plant oils included coconut oil among the oils with evidence for anti-inflammatory effects, wound healing and skin barrier repair (Lin 2017). A 2019 narrative review summarized the evidence for coconut oil in atopic dermatitis as "limited but consistent" (Wallace 2019). That's a fair label for this whole field: small trials, two of the key ones run in Manila, all pointing the same way (Evangelista 2014; Agero 2004).

Part 3: Which coconut oil to use

For eczema and dry skin: virgin coconut oil

The trials used virgin coconut oil (Evangelista 2014; Verallo-Rowell 2008; Agero 2004). That's what we recommend for skin, with nothing added.

Dr. Bronner's Organic Virgin Coconut Oil is our top pick for skin: organic, unrefined, and a single ingredient.

Viva Naturals Organic Extra Virgin Coconut Oil is the value option in larger tubs if you're moisturizing a child's whole body daily.

Nutiva Organic Virgin Coconut Oil is the benchmark jar we use across the site. Any of the three matches what the trials tested.

Fractionated coconut oil: a different product

Fractionated coconut oil is sold as a liquid, lighter version of coconut oil, often used as a massage oil or carrier oil. It's a processed product, different from the virgin oil used in the eczema trials, and we found no trial testing fractionated coconut oil for eczema.

If you want it as a light body oil, Plant Therapy Fractionated Coconut Oil and NOW Solutions Liquid Coconut Oil are widely used options. Just don't expect it to behave like the oil in the trials.

A coconut balm

Kopari Coconut Melt is a coconut-based body balm. We're still reviewing its full ingredient list. For eczema-prone skin, stick with plain virgin coconut oil, which is what was tested.

How to use it

  1. Patch-test first. Apply a small amount to your inner arm for a few days. The 2004 trial patch-tested everyone before starting (Agero 2004).
  2. Apply to damp skin after a shower to help lock in moisture.
  3. For a child with eczema, the trial applied oil over eight weeks (Evangelista 2014). Talk to your pediatrician first, especially if your child's eczema is moderate to severe, infected, or on prescription treatment.
  4. Keep a separate jar for skin so you're not dipping fingers into your cooking oil.

Who should be careful

Coconut allergy is possible. If you notice redness, itching or rash after applying it, stop. If eczema is severe, weeping or infected, see a doctor; coconut oil was tested in mild to moderate cases only (Evangelista 2014).

The bottom line

For dry skin, virgin coconut oil is a safe, effective moisturizer. For mild to moderate eczema, especially in children, it has the best trial evidence of any coconut use we've found. For acne, nobody knows, so keep it off breakout-prone faces for now.

Tonight, after a shower, rub a pea-sized amount of Dr. Bronner's Organic Virgin Coconut Oil into one dry patch, like your shins or elbows, and compare it with the other side after a week.

This article is for general education and is not medical advice. If you have a health condition, take medication, or are pregnant, talk to a doctor or registered dietitian before changing your diet or skincare.

Sources

  1. Agero AL et al. (2004). A randomized double-blind controlled trial comparing extra virgin coconut oil with mineral oil as a moisturizer for mild to moderate xerosis. Dermatitis. PubMed: https://pubmed.ncbi.nlm.nih.gov/15724344/ | DOI: https://doi.org/10.2310/6620.2004.04006
  2. Evangelista MT et al. (2014). The effect of topical virgin coconut oil on SCORAD index, transepidermal water loss, and skin capacitance in mild to moderate pediatric atopic dermatitis: a randomized, double-blind, clinical trial. Int J Dermatol. PubMed: https://pubmed.ncbi.nlm.nih.gov/24320105/ | DOI: https://doi.org/10.1111/ijd.12339
  3. Verallo-Rowell VM et al. (2008). Novel antibacterial and emollient effects of coconut and virgin olive oils in adult atopic dermatitis. Dermatitis. PubMed: https://pubmed.ncbi.nlm.nih.gov/19134433/
  4. Nakatsuji T et al. (2009). Antimicrobial property of lauric acid against Propionibacterium acnes: its therapeutic potential for inflammatory acne vulgaris. J Invest Dermatol. PubMed: https://pubmed.ncbi.nlm.nih.gov/19387482/ | DOI: https://doi.org/10.1038/jid.2009.93
  5. Lin TK et al. (2017). Anti-Inflammatory and Skin Barrier Repair Effects of Topical Application of Some Plant Oils. Int J Mol Sci. PubMed: https://pubmed.ncbi.nlm.nih.gov/29280987/ | DOI: https://doi.org/10.3390/ijms19010070
  6. Wallace TC et al. (2019). Health Effects of Coconut Oil-A Narrative Review of Current Evidence. J Am Coll Nutr. PubMed: https://pubmed.ncbi.nlm.nih.gov/30395784/ | DOI: https://doi.org/10.1080/07315724.2018.1497562

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