Tea tree oil
Place in Therapy
Place in Therapy
Due to the lack of robust evidence on tea tree oil, there is no place of therapy that is generally accepted in the literature. As such, the following place in therapy is a recommendation of the author and not of the literature.
Its place in therapy is for mild- moderate acne because the two trials studying tea tree oil for acne consisted of patients with mild-moderate disease. According to the study, this would refer to patients with less than 50 pustules and less than 20 papules and no nodules, cysts and sinus tracts (1). This is a topical product and so, it is presumed that it may not be used with any other topical acne drugs. If a patient is using an oral drug and is considered to have mild-moderate disease, this drug should not be used due to lack of data. There is evidence that topical administration of tea tree oil results in bloodstream absorption in 10-30 minutes (2). The topical product has a great safety profile(1,2) as monotherapy so clinicians should feel comfortable recommending it, although patients should be made aware of the deficits in the available knowledge about this drug.
The systematic review states that tea tree oil can be used in pregnant women and I imagine it refers to the use of tea tree oil in dermatology only (ie. topical use). The reasoning behind this recommendation is that there “are, to date, no reports of its teratogenicity (2).” Natural Standard does not support the use of tea tree oil in pregnancy or lactation. The use in pregnancy was not specified as topical or oral and the use in lactation was specified as topical (3). The differences between the recommendations and the level of evidence surrounding pregnancy is concerning. Considering this, the safest recommendation is to avoid tea tree oil in pregnancy and lactation.
Currently, the only place in therapy for tea tree oil would be use in someone who is allergic or who did not respond to the first and second line agents. This person would also not want to see a prescriber for prescription therapy or who cannot afford prescription therapy. The future place in therapy for tea tree oil may be as second line agent if the bacteria causing acne are resistant to first line agents. Granted, this would need to be validated with literature findings.
References:
1. Enshaieh S, Jooya A, Siadar AH, Iraji F. The efficacy of 5% topical tea tree oil in mild to moderate acne vulgaris: A randomized, double blind placebo-controlled study. Indian J Dermatol Venereol Leprol. 2007;73(1):22-25.
2. Pazyar N, Yaghoobi R, Bagherani N, Kazerouni A. A review of applications of tea tree oil in dermatology. Int J Dermatol. 2013;52:784-790.
3. Basch E, Bayul TN, Costa D et al. Tea Tree Oil (Malaleuca alternifolia) [Professional Monograph]. Retrieved from: http://www.naturalstandard.com.proxy.lib.uwaterloo.ca/databases/herbssupplements/teatreeoil.asp?). Updated in 2013. Accessed February 17, 2014.
Due to the lack of robust evidence on tea tree oil, there is no place of therapy that is generally accepted in the literature. As such, the following place in therapy is a recommendation of the author and not of the literature.
Its place in therapy is for mild- moderate acne because the two trials studying tea tree oil for acne consisted of patients with mild-moderate disease. According to the study, this would refer to patients with less than 50 pustules and less than 20 papules and no nodules, cysts and sinus tracts (1). This is a topical product and so, it is presumed that it may not be used with any other topical acne drugs. If a patient is using an oral drug and is considered to have mild-moderate disease, this drug should not be used due to lack of data. There is evidence that topical administration of tea tree oil results in bloodstream absorption in 10-30 minutes (2). The topical product has a great safety profile(1,2) as monotherapy so clinicians should feel comfortable recommending it, although patients should be made aware of the deficits in the available knowledge about this drug.
The systematic review states that tea tree oil can be used in pregnant women and I imagine it refers to the use of tea tree oil in dermatology only (ie. topical use). The reasoning behind this recommendation is that there “are, to date, no reports of its teratogenicity (2).” Natural Standard does not support the use of tea tree oil in pregnancy or lactation. The use in pregnancy was not specified as topical or oral and the use in lactation was specified as topical (3). The differences between the recommendations and the level of evidence surrounding pregnancy is concerning. Considering this, the safest recommendation is to avoid tea tree oil in pregnancy and lactation.
Currently, the only place in therapy for tea tree oil would be use in someone who is allergic or who did not respond to the first and second line agents. This person would also not want to see a prescriber for prescription therapy or who cannot afford prescription therapy. The future place in therapy for tea tree oil may be as second line agent if the bacteria causing acne are resistant to first line agents. Granted, this would need to be validated with literature findings.
References:
1. Enshaieh S, Jooya A, Siadar AH, Iraji F. The efficacy of 5% topical tea tree oil in mild to moderate acne vulgaris: A randomized, double blind placebo-controlled study. Indian J Dermatol Venereol Leprol. 2007;73(1):22-25.
2. Pazyar N, Yaghoobi R, Bagherani N, Kazerouni A. A review of applications of tea tree oil in dermatology. Int J Dermatol. 2013;52:784-790.
3. Basch E, Bayul TN, Costa D et al. Tea Tree Oil (Malaleuca alternifolia) [Professional Monograph]. Retrieved from: http://www.naturalstandard.com.proxy.lib.uwaterloo.ca/databases/herbssupplements/teatreeoil.asp?). Updated in 2013. Accessed February 17, 2014.