Advice on Foot Care

An essential oil is extracted directly from a plant or a part of a plant and contains the concentrated properties of a plant extract. The oil will carry a distinctive scent, or essence, of the plant from which it is extracted. Essential oils are concentrated substances that may be composed of alcohols, hydrocarbons, aldehydes, ketones, phenols, esters or acids. Essential oils have been used for centuries across many cultures for medicinal purposes. Today they remain very popular worldwide.

TEA TREE OIL
Tea tree oil (Melaleuca alternifolia) is the most researched essential oil for foot conditions. This is likely due to the anti-microbial activity of it’s main chemical component, terpinen-4-ol. Tea tree oil is steam distilled from a small tree of the melaleuca family originally from Australia. Tea trees have needle-like leaves and yellow or purple flowers. There are many claims for the use of tea tree oil, including that it is anti-infectious, anti-inflammatory, anti-septic, antiviral, bactericidal, fungicidal and that it can act as an immunostimulant and a parasiticide. The literature is full of anecdotal reports of all of the these functions, but most of the clinical research associated with foot and skin conditions is centered around it’s anti-fungal activity.

There are many laboratory studies showing the effectiveness of tea tree oil and it’s main chemical components, especially terpinen-4-ol, against fungus (1, 2, 3). More importantly are the clinical trials using tea tree oil on tinea pedis (athlete’s foot) and onychomycosis (toenail fungus). One study compared the use of a popular topical anti-fungal medication, 1% clotrimazole solution, versus tea tree oil on toenail fungus for a period of 6 months. Although there was not a difference between the two groups at the end of the study, both groups reported a decrease in symptoms and improvement in appearance of the nails (4). Researchers from University of California at San Francisco studied 2% butenafine hydrochloride and 5% Melaleuca alternifolia oil incorporated in a cream. Sixty patients were randomized into the treatment group and placebo group. After 16 weeks, 80% of the group using the medicated cream reported a cure, but 10% reported some mild inflammation (5).

In another study, 104 patients were divided into three groups to compare the efficacy of 10% tea tree oil cream, 1% tolnaftate cream and a placebo cream for the treatment of tinea pedis. At the end of the therapy, significantly more patients using the tolnaftate cream had a negative culture than the tea tree oil cream or the placebo cream. There was no difference between the placebo group and the tea tree oil group in conversion to a negative fungal culture. But, both the tolnaftate group and tea tree oil cream group showed a significant decrease in symptoms (burning, iching and inflammation) as compared to the placebo group (6). The idea that tea tree oil can act as an anti-inflammatory is not new, but most of the reports have been anecdotal. A study from Australia evaluated tea tree oil application in histamine induced skin inflammation and found that 100% topically applied tea tree oil reduced inflammation 10 minutes after application, in comparison to the placebo (7). Another study from Australia evaluated the daily use of 25% and 50% tea tree oil solutions versus a placebo in the treatment of interdigital tinea pedis (fungus between the toes). After 4 weeks, there was a significant clinical improvement in both tea tree oil groups, compared with the placebo and a mycological cure rate in the tea tree oil group of 64% (8). In this study about 4% of the tea tree oil group developed moderate to severe dermatitis. This brings up the importance of understanding that even so called “natural” medications can have side effects. In a review of 2320 patients who were patch tested over 4 years, 41 (1.8%) had positive reactions to oxidized tea tree oil (9).

SUMMARY: There is enough clinical evidence to show that tea tree oil is effective in the treatment of both toenail fungus and athletes foot. But, it does not appear to be superior to prescription medications and is not without side effects (mainly dermatitis). It’s important to note that there is no standard for use regarding concentration and application. The research varies from 25% to 100% concentrations of tea tree oil and varies from creams to solutions. Hopefully more research in the future will help standardize it’s use. At this point, tea tree preparations are most likely best used as adjuncts for therapy and helpful for decreasing symptoms associated with fungus infections.

More on foot fungus
More on toenail fungus

REFERENCES
1. Terzi V, et al. In vitro antifungal activity of the tea tree (Melaleuca alternifolia) essential oil and its major components against plant pathogens. Lett Appl Microbiol. 2007 Jun;44(6):613-8.

2. Hammer KA, Carson CF, Riley TV . Antifungal activity of the components of Melaleuca alternifolia (tea tree) oil. J Appl Microbiol. 2003;95(4):853-60.

3. Inouye S, Uchida K, Yamaguchi H. In-vitro and in-vivo anti-Trichophyton activity of essential oils by vapour contact. Mycoses. 2001 May;44(3-4):99-107.

4. Buck DS, Nidorf DM, Addino JG. Comparison of two topical preparations for the treatment of onychomycosis: Melaleuca alternifolia (tea tree) oil and clotrimazole. J Fam Pract. 1994 Jun;38(6):601-5.

5. Syed TA et al. Treatment of toenail onychomycosis with 2% butenafine and 5% Melaleuca alternifolia (tea tree) oil in cream. Trop Med Int Health. 1999 Sep;4(9):630.

6. Tong MM et al. Tea tree oil in the treatment of tinea pedis. Australas J Dermatol. 1992;33(3):145-9.

7. Koh KJ et al. Tea tree oil reduces histamine-induced skin inflammation. Br J Dermatol. 2002 Dec;147(6):1212-7.

8. Satchell AC et al. Treatment of interdigital tinea pedis with 25% and 50% tea tree oil solution: a randomized, placebo-controlled, blinded study. Australas J Dermatol. 2002 Aug;43(3):175-8.

9. Rutherford T et al. Australas J Dermatol. Allergy to tea tree oil: retrospective review of 41 cases with positive patch tests over 4.5 years. 2007 May;48(2):83-7.

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