Allergic contact dermatitis from essential oil in consumer products: Mode of uses and value of patch tests with an essential oil series. Results of a French study of the DAG (Dermato-Allergology group of the French Society of Dermatology).

OBJECTIVE: To analyse the clinical characteristics and sensitivity of an essential oil patch test series (EOS) in patients sensitized to their own essential oils (EOs). METHOD: We analysed the clinical data and patch test results obtained with the European baseline series (BSE) and an EOS, as well as the mode of use of EOs, through a questionnaire included in the patient file. RESULTS: The study included 42 patients (79% women, average age 50 years) with allergic contact dermatitis (ACD), 8 patients required hospitalization. All patients were sensitized to the EO they used, primarily lavender (Lavandula augustifolia, 8000-28-0), tea tree (Melaleuca alternifolia leaf oil, 68647-73-4), ravintsara (Cinnamomum camphora oil, 92201-50-8), and 2 cases were attributed to helichrysum (helichrysum italicum flower absolute, 90045-56-0). 71% had positive patch tests to fragrance mix I or II, 9 only to the EOS and 4 only with their personal EO. Interestingly, 40% of patients did not spontaneously mention the use of EOs, and only 33% received advice on their use at the time of purchase. CONCLUSION: Patch tests with the BSE, limonene and linalool HP, and oxidized tea tree oil is sufficient to detect most EO-sensitized patients. The most important is to test the patient's own used EOs.

Spreading Allergic Contact Dermatitis to Tea Tree Oil in an Over-the-Counter Product Applied on a Wart.

Tea tree oil is an essential oil obtained by distillation from the leaves and terminal branchlets of Melaleuca alternifolia and is now present in numerous products for body care and self-medication. We report a case of allergic contact dermatitis to tea tree oil in a young man who was applying a lotion containing tea tree oil on a wart localized on the plantar aspect of the right big toe, which had previously been treated with cryotherapy. He developed a severe eczematous eruption on the right foot and the right leg, with subsequent id reactions affecting the right thigh, the contralateral lower limb, the trunk and the upper limbs. The lotion was discontinued, and the dermatitis resolved after topical corticosteroid therapy. Patch testing with the aforementioned lotion 10% pet. and oxidized tea tree oil 5% pet. identified tea tree oil as the culprit agent of the dermatitis. This case report confirms that products made of natural ingredients, often perceived to be harmless, can cause allergic reactions.

A topical gel of tea tree oil nanoemulsion containing adapalene versus adapalene marketed gel in patients with acne vulgaris: a randomized clinical trial.

Adapalene is used for treatment of acne vulgaris, a common dermatological disease. Nano-based carriers have been developed to improve solubility and bioavailability of adapalene and other acne treatment drugs. In our previous report, tea tree oil nanoemulsion containing adapalene gel (TTO NE + ADA Gel) showed appropriate physical and biological properties such as stability, viscosity, pH, size, morphology and biocompatibility in an animal model. The present study was designed to assess efficacy and safety of the TTO NE + ADA Gel in comparison with 0.1% adapalene marketed gel (ADA Marketed Gel). A total of 100 patients were randomized to receive TTO NE + ADA Gel or ADA Marketed Gel, once daily at night, for 12 weeks. Analysis for efficacy was conducted by acne lesion count (total, inflammatory and non-inflammatory) and acne severity index at weeks 4, 8 and 12 using generalized estimating equation along with the safety assessments in each measurement for assessing dryness, erythema, burning sensation and irritation. Significantly better reduction in total, inflammatory, and non-inflammatory acne lesions were reported for TTO NE + ADA Gel as compared to the ADA Marketed Gel overall and on each measurement occasion (p value < 0.001 for all). Mean acne severity index also reduced with TTO NE + ADA Gel significantly in comparison with ADA Marketed Gel (p value < 0.001). Dryness was the most common adverse effect reported in both groups and it was higher in TTO NE + ADA Gel group. In conclusion, TTO NE + ADA Gel compared to ADA Marketed Gel appears more effective in the treatment of acne vulgaris, with no important change in adverse effects.

Corneal Effects of Tea Tree Oil.

PURPOSE: The purpose of this study is to report a case of corneal epithelial defects resulting from topical treatment of blepharitis with tea tree oil (TTO). METHODS: A 44-year-old man with a 1 year history of blepharitis non-responsive to eyelid hygiene was found to have signs of Demodex infestation. He was treated with a topical, off-label 50% TTO solution. Shortly afterward, the patient complained of bilateral ocular discomfort. RESULTS: Slit-lamp examination revealed conjunctival injection and a corneal epithelial defect in both eyes. Treatment with lubricant, antibiotic, and steroid eye drops as well as bandage contact lenses was required to facilitate corneal healing. CONCLUSIONS: Topical use of off-label, 50% concentration TTO can result in corneal epithelial defects. Eye care professionals should remain aware of this risk and only use approved, low-concentration TTO products when treating Demodex-related blepharitis.

The relationship between lavender and tea tree essential oils and pediatric endocrine disorders: A systematic review of the literature.

OBJECTIVES: Essential oils are common ingredients in personal care products, little is known about the effects of chronic exposure to these ingredients in human health. It has been suggested that these two essential oils cause prepubertal gynecomastia and premature thelarche in children. The purpose of this study was to systematically review the evidence related to the proposed link between these essential oils and endocrine disruption METHODS: This study sought to investigate the proposed link between LEO and TTEO and endocrine disrupting outcomes by identifying and evaluating the clinical evidence regarding this topic. Studies qualified if the participants included prepubertal children who have experienced either prepubertal gynecomastia or premature thelarche. The Case Series Critical Appraisal Tool (CSCAT) was used to identify the reliability of the identified case series. The potential for evidence of causality was evaluated using the tool proposed by Murad. RESULTS: A total of four manuscripts were identified, describing a total of eleven cases reported to have experienced both the exposure and the outcome. Reporting of inclusion, demographic data, clinical data, and the potential for causality was found to be insufficient. This study did not find evidence to support the claim that tea tree essential oil is related to endocrine disruption in children, and little to no evidence to substantiate the proposed link between lavender essential oil and endocrine disruption in children. CONCLUSION: Because this potential link remains a concern among pediatric care providers and parents, epidemiological research to address the proposed link is needed.

Comparison of Efficacy and Safety of Two Tea Tree Oil-Based Formulations in Patients with Chronic Blepharitis: A Double-Blinded Randomized Clinical Trial.

INTRODUCTION: It was aimed to evaluate the efficacy of two tea tree oil (TTO)-based cleansing gels in chronic blepharitis patients. METHODS: Group-1 (basic gel containing 3%(w/w)-TTO) included 50 eyes of 25 patients and group-2 (advanced gel containing 3%(w/w)-TTO plus essential oils and vitamins) included 48 eyes of 24 patients. Ocular Surface Disease Index (OSDI), tear breakup time (TBUT), ocular surface staining pattern, Schirmer's test, impression cytology, Demodex presence and TNF-α, IL-6, IL-1ß levels were evaluated at the first visit and 1 month after treatment. RESULTS: In both groups, the mean OSDI score decreased (p1:0.001, p2:0.001), TBUT increased (p1:0.002, p2:0.004). In group-1, Demodex presence decreased from 42% to 27.8%; in group-2 from 54.2% to 20.6% (p1:0.302, p2:0.004). IL-1ß and IL-6 decreased in group-2 (p1:0.002, p2:0.050). TNF-α decreased in both groups (p1:0.001, p2:0.001). CONCLUSION: Both formulations improved ocular surface parameters. Group 2 showed more reduction in tear cytokines and Demodex count.

The efficacy and safety of permethrin 2.5% with tea tree oil gel on rosacea treatment: A double-blind, controlled clinical trial.

BACKGROUND: Rosacea is a chronic skin condition that typically affects the face and it results in redness and inflammation. The main risk factors of this disease are Demodex folliculorum, living in the pilosebaceous units. AIMS: To evaluate the efficacy and safty of permethrin 2.5% in combination with tea tree oil (TTO) topical gel versus placebo on Demodex density (Dd) and clinical manifestation using standard skin surface biopsy (SSSB) in rosacea patients. PATIENT/METHODS: In this double-blind, randomized clinical trial, 47 papulopustular rosacea patients were enrolled, with 35 patients finishing the 12 weeks of treatment. Each patient used permethrin 2.5% with TTO on one side of the face and a placebo on the other, twice daily for 12 weeks. SSSB, photography and clinical rosacea scores according to National Rosacea Society, as well as adverse drug reaction (ADRs) were reported at the baseline, 2nd, 5th, 8th, and 12th weeks. RESULTS: A total of 47 patients were enrolled with papulopustular rosacea, and 35 patients finished the study. The effects of permethrin 2.5% with TTO gel on mite density were significant at week 5, 8, 12 (P value = .001). Clinical features and global assessments showed papules, pustules and nontransient erythema had improvement in drug group after 12 weeks (P values <.05). The improvement of burning and stinging and dry appearance was greater than the placebo gel (P value <.05). Itching in placebo group was significantly more than other group (P value = .002). CONCLUSION: Administration of permethrin 2.5% with TTO gel demonstrated good efficacy and safety in rosacea. This topical gel inhibited the inflammatory effects of rosacea and reduced Demodex mite.

Consumer exposure to certain ingredients of cosmetic products: The case for tea tree oil.

Reliable exposure data are essential to evaluate the safety of ingredients in cosmetics. The study reported here was carried out on behalf of the Australian Tea Tree Industry Association in order to support safety assessment of TTO in consumer cosmetic products. Data regarding the use of TTO-containing cosmetic products were collected through a web-survey among 2535 qualified users of validated TTO-containing cosmetics in 5 European countries. Data regarding the percentage of TTO present in the individual products (TTO-inclusion) were collected from the suppliers of those products. Beyond TTO exposure-measures there were several significant findings: One is a special "TTO-effect" for several categories of TTO-containing cosmetic products showing a positive correlation between consumers' strength of TTO-orientation and frequency of product use, combined with a negative correlation between frequency of product use and amount of product used per application. Another is significant differences regarding the intensity of product use between TTO-containing cosmetics and respective types of products in general. Thus it seems not to be appropriate to evaluate the toxicological safety of certain ingredients of cosmetic products from exposure data on "generic" types of cosmetic products.

Tea tree oil gel for mild to moderate acne; a 12 week uncontrolled, open-label phase II pilot study.

BACKGROUND: The efficacy, tolerability and acceptability of a tea tree oil gel (200 mg/g) and face wash (7 mg/g) were evaluated for the treatment of mild to moderate facial acne. METHODS: In this open-label, uncontrolled phase II pilot study, participants applied tea tree oil products to the face twice daily for 12 weeks and were assessed after 4, 8 and 12 weeks. Efficacy was determined from total numbers of facial acne lesions and the investigator global assessment (IGA) score. Tolerability was evaluated by the frequency of adverse events and the mean tolerability score determined at each visit. Product acceptability was assessed via a questionnaire at the end of the study period. RESULTS: Altogether 18 participants were enrolled, of whom 14 completed the study. Mean total lesion counts were 23.7 at baseline, 17.2 at 4, 15.1 at 8 and 10.7 at 12 weeks. Total lesion counts differed significantly over time by repeated measures anova (P < 0.0001). The mean IGA score was 2.4 at baseline, 2.2 at 4, 2.0 at 8 and 1.9 at 12 weeks, which also differed significantly over time (P = 0.0094). No serious adverse events occurred and minor local tolerability events were limited to peeling, dryness and scaling, all of which resolved without intervention. CONCLUSION: This study shows that the use of the tea tree oil products significantly improved mild to moderate acne and that the products were well tolerated.

Essential Oils, Part IV: Contact Allergy.

Nearly 80 essential oils (including 2 jasmine absolutes) have caused contact allergy. Fifty-five of these have been tested in consecutive patients suspected of contact dermatitis, and nine (laurel, turpentine, orange, tea tree, citronella, ylang-ylang, sandalwood, clove, and costus root) showed greater than 2% positive patch test reactions. Relevance data are generally missing or inadequate. Most reactions are caused by application of pure oils or high-concentration products. The clinical picture depends on the responsible product. Occupational contact dermatitis may occur in professionals performing massages. The (possible) allergens in essential oils are discussed. Several test allergens are available, but patients should preferably be tested with their own products. Co-reactivity with other essential oils and the fragrance mix is frequent, which may partly be explained by common ingredients. Patch test concentrations for essential oils are suggested.

Tea tree oil: contact allergy and chemical composition.

In this article, contact allergy to, and the chemical composition of, tea tree oil (TTO) are reviewed. This essential oil is a popular remedy for many skin diseases, and may be used as neat oil or be present in cosmetics, topical pharmaceuticals and household products. Of all essential oils, TTO has caused most (published) allergic reactions since the first cases were reported in 1991. In routine testing, prevalences of positive patch test reactions have ranged from 0.1% to 3.5%. Nearly 100 allergic patients have been described in case reports and case series. The major constituents of commercial TTO are terpinen-4-ol, γ-terpinene, 1,8-cineole, α-terpinene, α-terpineol, p-cymene, and α-pinene. Fresh TTO is a weak to moderate sensitizer, but oxidation increases its allergenic potency. The major sensitizers appear to be ascaridole, terpinolene, α-terpinene, 1,2,4-trihydroxymenthane, α-phellandrene, and limonene. The clinical picture of allergic contact dermatitis caused by TTO depends on the products used. Most reactions are caused by the application of pure oil; cosmetics are the culprits in a minority of cases. Patch testing may be performed with 5% oxidized TTO. Co-reactivity to turpentine oil is frequent, and there is an overrepresentation of reactions to fragrance mix I, Myroxylon pereirae, colophonium, and other essential oils.

Contact allergy to essential oils cannot always be predicted from allergy to fragrance markers in the baseline series.

BACKGROUND: Essential oils are fragrance substances that are labelled on cosmetic products by their INCI names, potentially confusing consumers. OBJECTIVES: To establish whether contact allergy to essential oils might be missed if not specifically tested for. METHODS: We tested 471 patients with 14 essential oils and 2104 patients with Melaleuca alternifolia oil between January 2008 and June 2014. All patients were tested with fragrance mix I, fragrance mix II, hydroxyisohexyl 3-cyclohexene carboxaldehyde, and Myroxylon pereirae. Three hundred and twenty-six patients were tested with hydroperoxides of limonene and linalool. RESULTS: Thirty-four patients had a +/++/+++ reaction to at least one essential oil. Eleven had no reaction to any of the six marker fragrance substances. Thus, 4 of 11 positive reactions to M. alternifolia oil, 2 of 7 reactions to Cymbopogon flexuosus oil, 1 of 5 reactions to Cananga odorata oil, 3 of 4 reactions to Santalum album oil and 2 of 3 reactions to Mentha piperita oil would have been missed without individual testing. CONCLUSION: A small number of patients who are allergic to essential oils could be missed if these are not specifically tested. Labelling by INCI names means that exposure may not be obvious. Careful inspection of so-called 'natural' products and targeted testing is recommended.

[Secondary effects of topical application of an essential oil. Allergic contact dermatitis due to tea tree oil]. / Efectos secundarios de la aplicación tópica de un aceite de esencial. Dermatitis alérgica de contacto a aceite de árbol de té.

BACKGROUND: Tea tree oil is an essential oil, whose use is increasing in our setting, due both to its supposed medicinal effects and to its aromatic properties. We describe our experience with allergic contact dermatitis following the application of this oil. MATERIAL AND METHODS: Five patients in the last 5 years (0.4% of all the patients studied in specialized consultation) reacted to a 5% concentration of tea tree oil in Vaseline. RESULTS: All the patients presented strong reactions, and in all cases these were considered relevant. Three of them also reacted to oxidized d-limonene, one of the components of tea tree oil, which is present in our standard series. CONCLUSIONS: Different cases have been described in the literature on allergic contact dermatitis due to tea tree oil, but until recently it was infrequent in our setting. With the increased popularity of alternative and natural therapies we have witnessed several cases of sensitization to this essential oil, which had been used to treat several supposedly "infectious" skin diseases, but which were very probably different forms of dermatitis.

Efectos secundarios de la aplicación tópica de un aceite de esencial. Dermatitis alérgica de contacto a aceite de árbol de té / Secondary effects of topical application of an essential oil. Allergic contact dermatitis due to tea tree oil

Fundamento: El aceite de árbol de té es un aceite esencial, cuyo uso está aumentando en nuestro medio, tanto por sus supuestos efectos medicinales, como por sus propiedades aromáticas. Se describe nuestra experiencia en dermatitis alérgica de contacto tras la aplicación de este aceite. Material y Métodos: Cinco pacientes en los últimos 5 años (0,4% de todos los pacientes estudiados en consulta especializada) reaccionaron a una concentración de 5% de aceite de árbol de té en vaselina. Resultados: Todos los pacientes presentaron reacciones fuertes, y en todos los casos éstas fueron consideradas relevantes. Tres de ellos reaccionaron también a d-limoneno oxidado, uno de los componentes del aceite de árbol de té, que está presente en nuestra serie estándar. Conclusiones: Se han descrito diversos casos en la literatura de dermatitis alérgica de contacto al aceite de árbol de té, pero hasta hace poco ha sido infrecuente en nuestro medio. Con el aumento de popularidad de terapias alternativas y naturales hemos sido testigos de varios casos de sensibilización a este aceite esencial, que había sido utilizado para tratar varias enfermedades de la piel supuestamente "infecciosas", pero que eran muy probablemente diferentes formas de dermatitis (AU)

Background: Tea tree oil is an essential oil, whose use is increasing in our setting, due both to its supposed medicinal effects and to its aromatic properties. We describe our experience with allergic contact dermatitis following the application of this oil. Material and methods: Five patients in the last 5 years (0.4% of all the patients studied in specialized consultation) reacted to a 5% concentration of tea tree oil in Vaseline. Results: All the patients presented strong reactions, and in all cases these were considered relevant. Three of them also reacted to oxidized d-limonene, one of the components of tea tree oil, which is present in our standard series. Conclusions: Different cases have been described in the literature on allergic contact dermatitis due to tea tree oil, but until recently it was infrequent in our setting. With the increased popularity of alternative and natural therapies we have witnessed several cases of sensitization to this essential oil, which had been used to treat several supposedly "infectious" skin diseases, but which were very probably different forms of dermatitis (AU)