Tea tree oil is one of the recommended topicals for onychomycosis or fingernail fungal infection by naturopathic medicine practitioners. Though different kinds of literature have been suggesting that tea tree oil is a reliable medication for fingernail fungus, it is still considered a folk remedy or nonprescription OTC product ( Arndt et al, 2013). Even though some are suggesting that using folk remedies such as tea tree oil cannot be recommended as they still lack evidence with regards to their efficacy, Arndt et al (2013) stated in their presentation in Update on Onychomycosis: Effective Strategies for Diagnosis and Treatment, that they don’t discourage people from trying these remedies. In the same report, they cited that some patients and healthcare providers have testimonies that tea tree oil can be effective if it is applied properly and consistently. When their paper was written in 2013, Arndt et al. purported that evidence-based studies that prove that nonprescription OTC products can help treat onychomycosis have not yet been conducted. Despite this, they also suggest that clinicians should know and be aware of the possible treatments that have undergone clinical trials and proven to be effective as these can be used for treating onychomycosis.
Realizing the need to have evidence-based research that shows the effect of tea tree oil as a treatment for onychomycosis, we present in this post three clinical trials that report its effect as a medication for nail fungus infection. We will also provide our observations and conclusions as to why we think some methods of tea tree oil applications on onychomycosis are more effective than others.
Antifungal properties of tea tree oil
Tea tree essential oil is extracted from Melaleuca alternifolia leaves. It has antibacterial, antifungal, and anti-inflammatory properties. It can also easily penetrate the skin hence its components can take action on the infected nails. (6)
1. topical application of tea tree oil cream for 16 weeks
Sixty patients, aged 18-80 years were chosen to participate in the study of Syed et al., (1996) and were randomly assigned to two groups, the active and placebo. The active group used a cream containing 2% butenafine hydrochloride while the other group applied the control cream or 5% tea tree oil three times a day. The results of their study showed that after 16 weeks of applying the two topical creams, 80% of the patients in the active group were cured but four of the participants experienced mild skin inflammation. Meanwhile, the patients in the placebo group showed no adverse effect but no improvement was elicited among placebo participants.
2. topical application of an oil blend with tea tree oil and vitamin E
An antifungal viscous topical with vitamin E and essential oils of lime, oregano, and tea tree has been evaluated in a 2019 Italian 12-month clinical trial. Twenty patients with mild to moderate distal subungual onychomycosis were the participants of the study. Some of the patients had dermatophyte molds and were infected with Trichophyton rubrum and Trichophyton interdigital fungus. Meanwhile, others had non-dermatophyte molds and were infected with Fusarium spp and scopulariopsis bevicaulis fungus. During the intervention, the nail oil was applied on the periungual tissues and nail plates of the patients once a day, every day for 6 months. The patients did not receive any other topical treatments. To test the efficacy of the oily product, the affected nails were evaluated before the intervention, during the 3rd and 6th month of the treatment, and 6 months after the therapy. The researchers claimed in the result’s discussion that for the first weeks of treatment, there’s already an improvement in the clinical appearance of the nails. In the 3rd month of the intervention program, 11 patients reported that they had observed improvement in their nails. After a 12-month study, the majority of the patients had a complete cure for onychomycosis. In totality, the oily product with Vitamin E cured the nail fungus of 15 patients. Meanwhile, two patients had an improvement, and one remained stable. Moreover, all patients were very satisfied with the treatment. No side effects were reported, hence the nail oil is a safe remedy for nail fungus. The researcher reported that the nail oil containing vitamin E, lime, oregano, and tea tree essential oils is effective in restructuring nail appearance. It can also be absorbed at the nail plate’s level. Furthermore, it can reduce the risks of relapses because it makes the nail resistant to infection. Plus, it can maintain its effects for a considerable amount of time. (6)
3. Topical Application of 100% tea tree oil
Two clinical studies report the efficacy of tea tree oil in treating onychomycosis.
The study of Buck et al., (1994) showed that the use of tea tree oil can improve nail appearance and manage the symptoms of onychomycosis. 117 patients were selected and randomly designated into two groups. The groups would either receive 1% clotrimazole solution or 100% tea tree oil for 6 months and apply it twice a day on the toenails with fungal infection. The improvement result between the two groups was comparable. Hence it can be concluded that tea tree oil is also as effective as the commonly prescribed medication. Buck et al., also stated in their paper that the appropriate treatment strategy in the treatment of onychomycosis includes the removal of infected skin tissue.
Tea tree oil can be used as a treatment without side effects is the finding of the research conducted by Abdelhamid (2018). 66 patients participated in their study and were treated with a topical application of 100% tea tree oil for 6 months. The results of their investigation showed that the percentage of patients who were completely cured was 27%. Meanwhile, 65% were partially cured and 8% had no response.
Based on the different clinical investigations presented above, we can observe that the topical application of 100% tea tree oil can help in treating onychomycosis. However, the use of tea tree oil seemed not to be effective if tea tree oil is only mixed with cream at a very low percentage of concentration.
While the studies above show the effectiveness of using 100% use of tea tree oil as a medication for onychomycosis, using diluted tea tree oil is also recommended by some aromatherapists to ensure safety. As care providers, we think that it’s important to consider proper guidelines as well as the concerns of the person we are helping with the treatment. We believe that it’s essential to consider and listen to the preferences of the person we are treating to know what they want and what they need. Doing this will enable us to respect their preferences about the manner they want to be treated. It is also good to submit to their preference if we’ve seen that their preference is the best approach to help them be cured. Open communication and understanding of what the person we are helping will assist us to provide a special way of treatment with TLC which we think is what patients of onychomycosis also want and need.
To see more about onychomycosis treatment using aromatherapy, visit our post about Recommended Tea tree oil dilution for onychomycosis.
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References:
- Abdelhamid D., Gomaa A., Mohammed., Eyada M., El Sweify M.A. Evaluation of the Therapeutic Efficacy of Tea Tree Oil in Treatment of Onychomycosis January 2018. International Journal of Pharmacognosy and Phytochemical Research 9(12) DOI:10.25258/Phyto.v9i12.11184
- Arndt K., LeBoit, P., Wintroub, B. Update on Onychomycosis: Effective Strategies for Diagnosis and Treatment. University of Louisville School of Medicine Continuing Medical Education. June 2013
- Syed, T. A., Qureshi, Z. A., Ali, S. M., Ahmad, S., & Ahmad, S. A. (1999). Treatment of toenail onychomycosis with 2% butenafine and 5% Melaleuca alternifolia (tea tree) oil in cream. Tropical medicine & international health: TM & IH, 4(4), 284–287. https://doi.org/10.1046/j.1365-3156.1999.00396
- Buck, D. S., Nidorf, D. M., & Adding, J. G. (1994). Comparison of two topical preparations for the treatment of onychomycosis: Melaleuca alternifolia (tea tree) oil and clotrimazole. The Journal of family practice, 38(6), 601–605
- Abdelhamid D., Gomaa A., Mohammed., Eyada M., El Sweify M.A. Evaluation of the Therapeutic Efficacy of Tea Tree Oil in Treatment of Onychomycosis January 2018. International Journal of Pharmacognosy and Phytochemical Research 9(12) DOI:10.25258/Phyto.v9i12.11184
- (6) Alessandrini, A., Starace, M., Bruni, F., & Piraccini, B. M. (2020). An Open Study to Evaluate Effectiveness and Tolerability of a Nail Oil Composed of Vitamin E and Essential Oils in Mild to Moderate Distal Subungual Onychomycosis. Skin appendage disorders, 6(1), 14–18. https://doi.org/10.1159/000503305
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