Herbal Medicines Poster Abstract
Roxy Hedges, Laura Galvao, Maryam Ebrahim
Question
How effective is Tea Tree Oil for treatment of Acne?
Mechanism of Action
Tea tree has antibacterial and anti fungal properties that allow for minimizing redness and swelling caused by these pathogens. Terminen-4-ol reduces the production of IL-1, IL-8, IL-10, and prostaglandin E2.
Side Effects
Some common side effects include local irritation or inflammation, allergic contact dermatitis, and skin dryness.
Drug Interactions
There are no known drug interactions with tea tree oil.
Studies
- In Hammer et al’s review “Treatment of acne with tea tree oil (melaleuca) products: a review of efficacy, tolerability and potential modes of action”, we learn that 5% tea tree oil cream can be used in mild to moderate acne. For mild to moderate acne, tea tree oil is better than benzoyl peroxide lotion when used for inflamed lesions. Tea tree oil was used twice a day for 8 weeks, and had less oiliness than benzoyl peroxide. However, tea tree oil also had more reported burning and stinging. This study looked at seven publications from 1990-2014 to determine evidence of tea tree oil used to treat acne. Most of the seven studies were comparative, three were randomized controlled trials. It wasn’t mentioned what they meant by comparative, so that would be a limitation as well as using a study from 1990 since that would be outdated.
- In Ahmad et al’s review “Treatment of acne with tea tree oil (melaleuca) products: a review of efficacy, tolerability and potential modes of action” we learn that tea tree oil can be used for mild to moderate acne. However, tea tree oil is associated with dermal burning and stinging so it is advised to test on a small area first, but otherwise is a great natural product to use to fight acne. This is a review of 40 studies ranging from 1990-2018 looking for evidence of efficacy of tea tree oil to treat mild-moderate acne. The study did not list limitations, but it did list issues that frequently occur with tea tree such as environmental factors that may play a role in increasing sensitivity and adverse effects to tea tree oil.
Conclusion
Tea tree oil combats bacteria, fungus, and other pathogens found on the skin, reducing inflammation. It has been effective for and can be used to treat mild-moderate acne. Due to its potential to cause dermal irritation, using a strength of 5% or lower is ideal and should be tested on a small part of skin before general use. We learned that tea tree oil fights inflammation mostly by attacking the pathogens at fault, but also by acting as a sort of superficial prostaglandin inhibitor. We also learned that tea tree oil is comparable to other acne treatments.
References
- Hammer, K. A. (2015). Treatment of acne with tea tree oil (melaleuca) products: a review of efficacy, tolerability and potential modes of action. International journal of antimicrobial agents, 45(2), 106-110.
- Ahmad, S., & Popli, H. (2019). A review on efficacy and tolerability of tea tree oil for acne. Journal of Drug Delivery and Therapeutics, 9(3), 609-612.
- (2021, April, 26). Natural Medicines Database. Tea Tree Oil. https://naturalmedicines.therapeuticresearch.com/search.aspx?q=tea+tree+oil&go.x=9&go.y=0
- Natural Products Database, Tea Tree Oil
- (2020, Nov 14). Tea Tree Oil. Mayo Clinic. https://www.mayoclinic.org/drugs-supplements-tea-tree-oil/art-20364246
- Dover, J. S. (2019, September, 26). Up-To-Date. Light-based, adjunctive, and other therapies for acne vulgaris
Responses
Hello Laura, Roxy, and Maryam – what are the two main things you learned from preparing and developing this topic?
We learned that tea tree oil fights inflammation mostly by attacking the pathogens at fault, but also by acting as a sort of superficial prostaglandin inhibitor. We also learned that tea tree oil is comparable to other acne treatments.
We learned that tea tree oil fights inflammation mostly by attaching the pathogens at fault, but also by acting as a sort of superficial prostaglandin inhibitor. Also, we learned that tea tree oil is comparable to other acne treatments. In addition, in one of the review literature study, Comparative trials showed that tea tree oil products were better than placebo and were equivalent to comparators including 5% benzoyl peroxide and 2% topical erythromycin. While clinical studies provide useful data but more studies are required in this topic.
Hello Laura, Roxy, and Maryam – can you please provide more details on the studies you evaluated? (study design, number of subjects, study duration, primary endpoint, strengths/limitations, results/conclusions?)
Of course! For the Hammer article, it was a review of seven publications. Three were double-blinded, one investigator-blinded, one open-label, one case-control, and one that was not stated. Most of them were comparing tea tree oil to 5% benzoyl peroxide, 2% topical erythromycin, or even LFCO extract and the study lasted from 4-8 weeks. The endpoint in most of the studies included in the review was a decrease in the amount of lesions from baseline. Adverse effects from tea tree oil included oiliness, minor pruritus, stinging or burning. Studies ranged from 20-61 subjects in each group. All of the studies looked only at mild to moderate acne. The overall conclusion was that tea tree oil reduces the number of acne lesions and is comparable to 5% benzoyl peroxide and 2% topical erythromycin. The review authors hypothesized that this conclusion is because of the anti-inflammatory and anti-microbial properties of tea tree oil. Some limitations could be that acne treatments can take up to 2 or more months to see improvement, and no studies looked past 2 months. Strenghts of this review were that they looked at a variety of acne products to compare to tea tree oil.
The other article we included, by Ahmad, Afsana, and Popil was also a review for tea tree oil. This is a review of 40 studies ranging from 1990-2018 looking for evidence of efficacy of tea tree oil to treat mild-moderate acne. Endpoint of the studies was a decrease in the number of lesions. The study did not list limitations, but it did list issues that frequently occur with tea tree such as environmental factors that may play a role in increasing sensitivity and adverse effects to tea tree oil. Strengths of this would also be that the studies compared tea tree oil to a variety of different acne products.
In comparison to benzoyl peroxide what were the details that led the authors to state the results were better? Is terminen-4-ol the active ingredient? What is the availability of this product in this country? What is the cost?
So there was actually conflicting information between all the studies the two reviews we cited looked at, but generally they all said it was the same if not better than benzoyl peroxide. Terminen-4-ol is one of the active ingredients and from what we gathered was the most abundant one. Tea tree oil is widely available and isn’t very much, I saw a 10 ml bottle of it for $8 at walmart. You don’t need much of it for each use.
based on the double blind study, the result of comparison between the use of Tea Tree oil(5% gel)(n=58) and Benzoyl peroxide 5%(n=61), it was observed that TTO has an Efficacy (mean reduction in total lesion count (%) ) of (29.3 %) as compared to BP with the
based on the double-blinded study comparing the efficacy of a 5% tea tree oil water-based gel and a 5% benzoyl peroxide water-based lotion in patients with mild-to-moderate acne .Products were applied twice daily for 8 weeks and patients were observed at 1, 2 and 3 months. At 3 months, both treatments resulted in significant reductions in lesion counts from baseline. But for inflamed lesions, benzoyl peroxide performed significantly better than tea tree oil at 1, 2, and 3 months. For tea tree oil, the mean number of inflamed lesions was reduced by ca. 49% after 3 months compared with ca. 68% for benzoyl peroxide. There was no significant difference between treatments for non-inflamed lesions, with a mean reduction of ca. 28% in the tea tree oil group and 35% in the benzoyl peroxide group. Skin oiliness differed significantly between groups at 1, 2 and 3 months, with less oiliness experienced in the benzoyl peroxide group. Adverse events such as dryness, stinging and burning were reported significantly more in the benzoyl peroxide group (79% of patients) than in the tea tree oil group (44% of patients).
Terminen-4-ol is the biggest active ingredient. You can get Tea Tree Oil at most drugstores usually pretty cheap (the price for 10ml is $8.00).
I look forward to the responses to the questions I have asked (in the reply section). Thank you.
I have not heard of this product before so I was intrigued by the poster. So it appears the product is similar to benzoyl peroxide based on the non-inferiority study. Can you explain what a non-inferiority study is and comment on if this was a good study design for this comparison? Thank you.
Hi Dr. Malone,
The two studies we mentioned in our poster were reviews that looked at several other studies on tea tree oil. Many of these were randomized controlled trials. All had differing conclusions, but the overall theme of them was that tea tree oil is as good if not better than benzoyl peroxide. I do think that doing a non-inferiority study is beneficial since the results from small studies seem to be all over the place as noted in the review articles and at the very least helps provide a basis that tea tree oil is at least just as good as other acne medications.
Could you evaluate the anti-bacterial properties of tea tree oil?
Yes, tea tree oil has activity against Mycobacterium, Escherichia coli, Haemophilus influenzae, Streptococcus pyogenes, and Streptococcus pneumoniae. Generally speaking tea tree appears to compromise the bacterial membrane causing the cell to lyse. It also causes leakage of K ions and inhibits cellular respiration.
virto data now supports the long-held beliefs that TTO has antimicrobial and anti- inflammatory properties. but there is still a lack of clinical evidence showing efficacy against bacterial, fungal or vitral infections despite some of the progress. Large randomized clinical trials are required to evaluate it in much depth.
Great job you guys, I love this topic! My mom swears by tea tree oil for all types of skin conditions. It definitely seemed to help my acne when I was a teenager. I always thought it was probably all placebo effect, but maybe it had more real benefit than I thought. Just curious, did you come across any efficacy data for tea tree oil and eczema? My mom swears by it for that too haha.
we didn’t particularly take a look at the efficacy data for tea tree oil and eczema. But based on what is available on the net, it indicates that Tea tree oil has healing components that can help reduce the symptoms and severity of eczema flares. These may include: anti-inflammatory properties that lessen irritation and ntifungal properties that may help reduce itching.
Hi Emma! I did not see any data on tea tree oil and eczema while working on this. Sorry!
I honestly love it too! My mom and grandma always told me to put it on zits when I got them. As far as efficacy data for eczema go, I haven’t been able to find anything definitive but some sources say it helps with inflammation. This may be due more to its antibacterial and anti fungal properties though. It may be helpful in speeding up the healing process due to these things, but again I would check to make sure it doesn’t irritate your skin first!
Awesome, thanks for the responses you guys!
Did you come across any information about how much tea tree oil needs to be ingested to cause the neurological adverse effects? I was just curious if it was a small enough amount to be ingested by someone applying it to their face and having some go into their mouth.
Hey Tera! I did not see anything about ingesting tea tree oil. I think it could definitely be a concern if you got a lot in your mouth, but you could always call the poison control center!
the only thing i found was that the ingestion of 10–25 ml has resulted in ataxia, drowsiness, disorientation, or coma for 2 days; recovery was full without complications in one case:A 4-year-old boy took a small quantity of tea tree oil and within 30 minutes became ataxic and shortly thereafter progressed to unresponsiveness; he was endotracheally intubated and his neurological status improved gradually over 10 hours.
Hello Laura, Roxy, and Maryam!
How often would you recommend a patient to apply tea tree oil to help clear their acne?
What recommendations would you make for a patient asking what they should look for when purchasing tea tree oil?
With most acne treatments, you’ll want to use the treatment every day for best results. Tea tree oil can take about 12 weeks for your skin to show the benefits. If you’re looking to buy tea tree oil to use on your skin, buy the purest oil available. Make sure the label says it’s 100 percent tea tree oil.
The studies we looked at used between 2-5% tea tree oil. The bottles usually come with droppers so you just put a drop or two and apply it to face, repeating when needed. Only a small amount is necessary.
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