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

The Therapeutic Potential of Essential Oils in Managing Inflammatory Skin Conditions: A Scoping Review

Conventional therapy is commonly used for the treatment of inflammatory skin conditions, but undesirable effects, such as erythema, dryness, skin thinning, and resistance to treatment, may cause poor patient compliance. Therefore, patients may seek complementary treatment with herbal plant products including essential oils (EOs). This scoping review aims to generate a broad overview of the EOs used to treat inflammatory skin conditions, namely, acne vulgaris, dermatitis and eczema, psoriasis, and rosacea, in a clinical setting. The quality, efficacy, and safety of various EOs, as well as the way in which they are prepared, are reviewed, and the potential, as well as the limitations, of EOs for the treatment of inflammatory skin conditions are discussed. Twenty-nine eligible studies (case studies, uncontrolled clinical studies, and randomized clinical studies) on the applications of EOs for inflammatory skin conditions were retrieved from scientific electronic databases (PubMed, Embase, Scopus, and the Cochrane Library). As an initial result, tea tree (Melaleuca alternifolia) oil emerged as the most studied EO. The clinical studies with tea tree oil gel for acne treatment showed an efficacy with fewer adverse reactions compared to conventional treatments. The uncontrolled studies indicated the potential efficacy of ajwain (Trachyspermum ammi) oil, eucalyptus (Eucalyptus globulus) oil, and cedarwood (Cedrus libani) oil in the treatment of acne, but further research is required to reach conclusive evidence. The placebo-controlled studies revealed the positive effects of kānuka (Kunzea ericoides) oil and frankincense (Boswellia spp.) oil in the treatment of psoriasis and eczema. The quality verification of the EO products was inconsistent, with some studies lacking analyses and transparency. The quality limitations of some studies included a small sample size, a short duration, and the absence of a control group. This present review underscores the need for extended, well-designed clinical studies to further assess the efficacy and safety of EOs for treating inflammatory skin conditions with products of assured quality and to further elucidate the mechanisms of action involved.

Plants with cosmetic uses

The use of plants as a source of active principles for cosmetics has significantly increased in the last few years. Safety, compatibility with all types of skin, fewer side effects, and availability are among the advantages of herbal cosmetics above synthetic ingredients. The present review aims to explore the most important plants used in cosmetics. A literature search was carried out in several electronic databases with the following phrases: skincare and plants; cosmetics and plants; natural and cosmetics; and natural and skincare. Furthermore, more detailed filters such as clinical studies, meta-analyses, and systemic reviews were applied to positive results. Various plants and plant extracts currently used in skin care, scaring, whitening, and aging, as well as in sun protection, acne, eczema, and others, have been included in this review. The effectiveness of these plants is based mainly on preclinical research, and to a lesser extent on clinical studies. Some plant extracts or oils have been tested clinically, such as onions, aloe, and tea tree oil, more than other plant extracts. Despite many studies on natural products to improve dermal needs, proper clinical cosmeceutical trials are much fewer than expected. Therefore, more clinical trials are needed to evaluate appropriate efficacy. Furthermore, new formulation technologies might enhance the cosmeceutical benefits, but more work is warranted.

Emerging Insights into the Applicability of Essential Oils in the Management of Acne Vulgaris

The occurrence of pustules, comedones, nodules, and cysts defines acne vulgaris, a prevalent chronic inflammatory dermatological condition. In the past few decades, essential oils extracted from varied natural sources have acquired recognition due to their potential medicinal applications in acne therapy. However, there is not yet sufficient medical data to fully characterize this interaction. Multiple factors contribute to the development of acne vulgaris, including excessive sebaceous production, inflammatory processes, hyperkeratinization, and infection with Cutibacterium acnes. Essential oils, including oregano, lavender, lemon grass, myrtle, lemon, thyme, eucalyptus, rosemary, and tea tree, have been found to possess anti-inflammatory, antioxidant, and antimicrobial properties, which may target the multifactorial causes of acne. Analytical methods for determining antioxidant potential (i.e., total phenolic content, diphenyl-1-picrylhydrazyl free radical scavenging assay, reducing power assay, ferrous ion chelating activity, thiobarbituric acid reactive species assay, β-carotene bleaching assay, etc.) are essential for the evaluation of these essential oils, and their method optimization is crucial. Further studies could include the development of novel acne treatments incorporating essential oils and an assessment of their efficacy in large clinical trials. In addition, further research is necessary to ascertain the mechanisms of action of essential oils and their optimal doses and safety profiles for optimal implementation in the management of acne vulgaris.

Tea Tree Oil: Properties and the Therapeutic Approach to Acne-A Review

Acne vulgaris is an inflammatory dermatological pathology that affects mostly young people. However, it can also appear in adulthood, mainly in women. It has a high psychosocial impact, not only at the time of active lesions but also due to the consequences of lesions such as scarring and hyperpigmentation. Several factors are involved in the physiopathology of acne and the constant search for active ingredients is a reality, namely phytotherapeutic ingredients. Tea tree oil is an essential oil extracted from Melaleuca alternifolia (Maiden & Betch) Cheel with known antibacterial, anti-inflammatory, and antioxidant properties, making it a candidate for the treatment of acne. This review aims to describe the various properties of tea tree oil that make it a possible ingredient to use in the treatment of acne and to present several human studies that have evaluated the efficacy and safety of using tea tree oil in the treatment of acne. It can be concluded that tea tree oil has good antibacterial, anti-inflammatory, and antioxidant properties that result in a decrease in the number of inflammatory lesions, mainly papules, and pustules. However, given the diversity of study designs, it is not possible to draw concrete conclusions on the efficacy and safety of this oil in the treatment of acne.

Commercially Available Viola odorata Oil, Chemical Variability and Antimicrobial Activity

Viola odorata L. oil is frequently recommended in the aromatherapeutic literature for treating respiratory, urinary, and skin infections; however, antimicrobial evidence is lacking. In addition, in aromatherapy, combinations of essential oils are predominantly utilized with the goal of achieving therapeutic synergy, yet no studies investigating the interaction of essential oil combinations with V. odorata oil exists. This study thus aimed to address these gaps by investigating the antimicrobial activity of three Viola odorata oil samples, sourced from different suppliers, independently and in combination with 20 different commercial essential oils, against micro-organisms involved in respiratory, skin, and urinary tract infections associated with global resistance trends. These pathogens include several of the ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.) The chemical profile of the oils was determined using gas chromatography coupled with mass spectrometry. The minimum inhibitory concentrations (MIC) were determined using the broth micro-dilution method. The interactive profiles for the combinations were assessed by calculating the fractional inhibitory concentration index (ΣFIC). The main compounds varied across the three samples, and included phenethyl alcohol, isopropyl myristate, 2-nonynoic acid, methyl ester, α-terpineol, α-cetone, and benzyl acetate. The V. odorata oil samples displayed overall poor antimicrobial activity when tested alone; however, the antimicrobial activity of the combinations resulted in 55 synergistic interactions where the combination with Santalum austrocaledonicum resulted in the lowest MIC values as low as 0.13 mg/mL. The frequency of the synergistic interactions predominantly occurred against Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterococcus faecium with noteworthy MIC values ranging from 0.25-1.00 mg/mL. This study also reports on the variability of V. odorata oils sold commercially. While this warrants caution, the antimicrobial benefit in combination provides an impetus for further studies to investigate the therapeutic potential.

Moroccan medicinal plants traditionally used for the treatment of skin diseases: From ethnobotany to clinical trials

ETHNOPHARMACOLOGICAL RELEVANCE

Skin diseases are among the most common human health affections. A healthy skin promotes a healthy body that can be achieved through modern, allopathic and natural medicines. Therefore, medicinal plants can be a reliable therapy in treating skin diseases in humans through a diverse range of bioactive molecules they contain.

AIM OF THE STUDY

This review aims to provide for the first-time scientific evidence related to the dermatological properties of Morocco's medicinal plants and it aims to provide a baseline for the discovery of new drugs having activities against skin issues.

METHODS

This review involved an investigation with different search engines for Moroccan ethnobotanical surveys published between 1991 and 2021. The plants used to treat skin diseases have been determined. Information regarding pharmacological effects, phytochemical, and clinical trials related to the plants listed in this review was collected from different scientific databases like PubMed, Science Direct, Google Scholar, Web of Science and Scopus. The data were analyzed and summarized in the review.

RESULTS

A total of 401 plants belonging to 86 families mainly represented by Asteraceae, Lamiaceae, Fabaceae, and Apiaceae which have been documented to be in common use by Moroccans for managing skin diseases. Among those plants recorded, the most commonly used are Allium cepa L, Chamaeleon gummifer (L.) Cass and Salvia rosmarinus Schleid. Mill. Leaves were the most commonly used plant part, while powder and decoction were the most common method of traditional drug preparation. 107 of the 401 plants (27%) have undergone pharmacological validation. A total of 44 compounds isolated from 27 plants were investigated to treat different types of skin diseases, and 25 plants have been clinically studied for their activities against skin diseases.

CONCLUSION

The beneficial effects of using Moroccan medicinal plants to treat skin diseases, according to traditional practices, have been proven in numerous scientific studies. Therefore, other studies should focus on isolating and identifying specific bioactive compounds from plant extracts, revealing more valuable therapeutic properties. Furthermore, additional reliable clinical trials are needed to confirm their beneficial effect on patients with skin diseases.

The Role of Herbal Medicine in the Treatment of Acne Vulgaris: A Systematic Review of Clinical Trials

Over the past few decades, interest in medicinal plants and phytochemicals for the treatment of skin disorders, including acne vulgaris, has progressively increased. Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit, which mainly occurs in adolescents and young adults. The treatment focuses on the four main factors involved in its pathogenesis: increased sebum production, hyperkeratinization, overgrowth of Cutibacterium acnes, and inflammation. The treatment includes topical retinoids, benzoyl peroxide, antibiotics, and oral isotretinoin. In this regard, the use of herbal medicine as a complementary and alternative medicine is a promising strategy. The main objective of this study was to systematically evaluate the efficacy and safety of medicinal plants and phytochemicals in the treatment of acne vulgaris. Three scientific databases (PubMed, Web of Science, and Scopus) were searched from inception to January 2021. Clinical trials comparing herbal therapies with placebo or other medicines for the treatment of acne vulgaris were included and analyzed. Outcome measures of interest comprised acne lesions (inflammatory and noninflammatory), sebum production, acne severity, and quality of life. The risk of bias in the included randomized controlled trials (RCTs) was assessed using the Cochrane risk-of-bias tool. A total of 34 clinical trials involving 1753 participants met the inclusion criteria for this systematic review. Most trials showed that herbal medicine significantly reduces inflammatory and noninflammatory acne lesions and has a relevant effect on acne severity. Some medicinal plants revealed equal or higher efficacy to standard treatments. No significant difference between groups in sebum production and quality of life was observed and no severe adverse events were reported. This systematic review provides evidence that medicinal plants and phytochemicals are promising treatments for mild to moderate acne vulgaris. However, more quality of evidence and standardized methodologies are needed to support their effectiveness and safety claims.

Chemical and Biological Characterization of Melaleuca alternifolia Essential Oil

The essential oil of Melaleuca alternifolia, commonly known as tea tree oil, has many beneficial properties due to its bioactive compounds. The aim of this research was to characterize the tea tree essential oil (TTEO) from Slovakia and its biological properties, which are specific to the chemical composition of essential oil. Gas chromatography/mass spectroscopy revealed that terpinen-4-ol was dominant with a content of 40.3%. γ-Terpinene, 1,8-cineole, and p-cymene were identified in contents of 11.7%, 7.0%, and 6.2%, respectively. Antioxidant activity was determined at 41.6% radical inhibition, which was equivalent to 447 μg Trolox to 1 mL sample. Antimicrobial activity was observed by the disk diffusion method against Gram-positive (G⁺), Gram-negative (G^-) bacteria and against yeasts, where the best antimicrobial activity was against Enterococcus faecalis and Candida albicans with an inhibition zone of 10.67 mm. The minimum inhibitory concentration showed better susceptibility by G⁺ and G^- planktonic cells, while yeast species and biofilm-forming bacteria strains were more resistant. Antibiofilm activity was observed against Pseudomonas fluorescens and Salmonella enterica by MALDI-TOF, where degradation of the protein spectra after the addition of essential oil was obtained. Good biological properties of tea tree essential oil allow its use in the food industry or in medicine as an antioxidant and antimicrobial agent.

The relevance of nanotechnology, hepato-protective agents in reducing the toxicity and augmenting the bioavailability of isotretinoin

Acne Vulgaris is one of the most common chronic inflammatory skin disorders that affect majority of teen-agers worldwide. Isotretinoin (ITT) is the drug of choice in the management of acne, but, it suffers from serious side-effects including hepatotoxicity, and some psychological disturbances following its oral intake. The objective of this study was to develop and optimize ITT loaded nanoemulsions (ITT-SNEDDS) and to incorporate resveratrol (RSV)in optimum formulation to decrease ITT side effects The ITT solubility was first tested in various essential oils, surfactants, and co-surfactants to select the essential nanoemulsion ingredients. Mixture design was applied to study the effect of independent variables and their interactions on the selected dependent responses. The developed ITT-SNEDDS were characterized for their globule size and ex vivo permeation. The optimized batch was further loaded with RSV and evaluated for in vitro and ex vivo permeation and for in vivo hepatotoxicity. The developed ITT-SNEDDS exhibited globule size below 300 nm, up to 272.27 ± 7.12 mcg/cm².h and 61.27 ± 2.83% of steady-state flux (J_SS) and permeability % respectively. Optimum formulation consisted of 0.15 g oil mixture, 0.6 g of surfactant (Labrasol), and 0.250 g co-surfactant (Transcutol). Permeability studies confirmed the enhanced permeation percentage of ITT (40.77 ± 1.18%), and RSV (29.94 ± 2.02%) from optimized formulation, with enhanced steady-state flux (J_SS). In vivo studies demonstrated the superior hepatoprotective activity of optimized formulation compared to a different drug formulations and marketed product. Therefore, RVS loaded ITT-SNEDDS might be a successful strategy for acne management with improved action, and minimum side effects.

Complementary and alternative medicine treatments for common skin diseases: A systematic review and meta-analysis

Background

Complementary and alternative medicine (CAM) treatments are growing in popularity as alternative treatments for common skin conditions.

Objectives

To perform a systematic review and meta-analysis to determine the tolerability and treatment response to CAM treatments in acne, atopic dermatitis (AD), and psoriasis.

Methods

PubMed/Medline and Embase databases were searched to identify eligible studies measuring the effects of CAM in acne, AD, and psoriasis. Effect size with 95% confidence interval (CI) was estimated using the random-effect model.

Results

The search yielded 417 articles; 40 studies met the inclusion criteria. The quantitative results of CAM treatment showed a standard mean difference (SMD) of 3.78 (95% CI [−0.01, 7.57]) and 0.58 (95% CI [−6.99, 8.15]) in the acne total lesion count, a SMD of −0.70 (95% CI [−1.19, −0.21]) in the eczema area and severity index score and a SMD of 0.94 (95% CI [−0.83, 2.71]) in the scoring of atopic dermatitis score for AD, and a SMD of 3.04 (95% CI [−0.35, 6.43]) and 5.16 (95% CI [−0.52, 10.85]) in the Psoriasis Area Severity Index score for psoriasis.

Limitations

Differences between the study designs, sample sizes, outcome measures, and treatment durations limit the generalizability of data.

Conclusions

Based on our quantitative findings we conclude that there is insufficient evidence to support the efficacy and the recommendation of CAM for acne, AD, and psoriasis.

Evaluation of tea tree oil physicochemical features and its antimicrobial activity against Cutibacterium acnes (Propionibacterium acnes) ATCC 6919

Introducción.

El aceite del árbol de té es un aceite esencial reconocido por sus propiedades antimicrobianas.

Objetivos.

Evaluar la composición, características y efecto antimicrobiano del aceite al 2 % del árbol de té y su concentración inhibitoria mínima (CIM) contra Cutibacterium acnes (Propionibacterium acnes).

Materiales y métodos.

Se evaluó el quimiotipo en tres lotes diferentes de este aceite mediante cromatografía de gases, así como su actividad antimicrobiana en concentración al 2 % v/v y la CIM contra C. acnes mediante ensayo de difusión en agar (guía M11-A8 CLSI).

Resultados.

Los lotes evaluados presentaron los quimiotipos ajustados a la norma ISO 4730, lo que indicó la alta calidad del producto. Los lotes contenían de 30 a 40 % de terpinen-4-ol, compuesto que favorece la actividad antimicrobiana, la cual presentó en todos los lotes un efecto dependiente de la concentración contra C. acnes, con una inhibición del crecimiento microbiano en concentración al 2 % v/v en todas las pruebas. La concentración inhibitoria mínima fue de 0,25 % v/v. La actividad antimicrobiana del aceite del árbol de té contra este microorganismo ya ha sido reportada con una concentración inhibitoria mínima entre 0,05 y 1,25 % v/v, rango que cobija la obtenida en este estudio.

Conclusiones.

Los resultados evidenciaron la gran calidad de este producto y su capacidad como agente antibacteriano contra C. acnes. Se deben hacer estudios con otros aislamientos del microorganismo provenientes de pacientes con acné vulgar para confirmar su actividad general y la de cada uno de sus componentes.

Identifying and appraising patient-reported outcome measures on treatment satisfaction in acne: a systematic review

BACKGROUND

After dermatitis, acne is the next skin disease to contribute most to the burden of skin diseases worldwide. Recently, seven core outcome domains have been identified, which together form an Acne Core Outcome Set (ACORN). One of these was satisfaction with acne treatment.

OBJECTIVES

To identify studies that described the development of patient-reported outcome measures (PROMS), evaluated one or more measurement properties of a PROM, or evaluated the interpretability of a PROM in patients with acne regarding treatment satisfaction.

METHODS

The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) search strategy for identifying PROMS on acne treatment satisfaction was used. We searched PubMed, MEDLINE, Embase, LILACS, Web of Science, Cochrane Library, Emcare, PsycINFO and Academic Search premier (June 2020). Study selection, data extraction and assessment of methodological quality according to COSMIN guidance were carried out independently by two authors.

RESULTS

Only one study could be included, describing the development of a treatment satisfaction measure in patients with acne. The development was assessed as inadequate and data on measurement properties were lacking. Additionally, we found 188 studies reporting treatment satisfaction solely as an outcome, using a wide variety of methods, none of them standardized or validated.

CONCLUSIONS

We could not find a PROM on treatment satisfaction to recommend for a core outcome set in acne. There is an unmet need for a PROM on treatment satisfaction in acne that is robustly developed, designed and validated.

The sensitivity of Demodex canis (Acari: Demodicidae) to the essential oil of Melaleuca alternifolia - an in vitro study

The essential oil of the Melaleuca alternifolia (Maiden & Betche) (tea tree oil) has been effective in previous studies, in the treatment of infestation by Demodex mites in humans. The present study aimed at evaluating the in vitro acaricidal effect of this herbal medicine on Demodex canis. For the parasitological examination, samples were collected from a dog's skin and examined using optical microscopy. Only samples with intact mites and with evident movement of chelicerae and tarsi were selected. Twenty-one samples were tested with the oil, in seven different concentrations: 100%; 50%; 25%; 12.5%; 6.25%; 5.0% and 3.13%. Three samples were tested with the positive control amitraz, and three with the negative control neutral shampoo. The interval between the time the solution was added and the moment the movement of the last mite ceased defined the survival time in the sample. By comparing the times at different concentrations and controls, the results showed that the higher the concentration of the oil, the more quickly its lethal effect occurred, and that the survival times in the controls were longer than in the different concentrations of melaleuca oil.

Lactobacillus paraplantarum THG-G10 as a potential anti-acne agent with anti-bacterial and anti-inflammatory activities

Cutibacterium acnes (formerly Propionibacterium acnes) is the main bacterium targeted for the prevention and medical treatment of acne vulgaris. Lactic acid bacteria (LAB) are a group of microorganisms classified by their ability to produce lactic acid through fermentation. Although the activities of LAB have been studied, their potential anti-acne effects are not well known. Here, Lactobacillus paraplantarum THG-G10, which has anti-bacterial activity against C. acnes, was isolated from traditional Kimchi in Republic of Korea. The anti-acne effects of dried cell-free supernatant of L. paraplantarum THG-G10 (DC-G10) were evaluated by determining its anti-microbial and anti-inflammatory activities. Anti-microbial activity was examined by a broth dilution assay: 25 mg/ml of DC-G10 inhibited the growth of C. acnes KCTC 5012 and KACC 1194; salicylic acid and benzoyl peroxide for acne treatment inhibited the growth of C. acnes KCTC 5012 and KACC 11946 at concentrations of 1.25 and 7.5 mg/ml, respectively; and tea tree oil inhibited the growth of C. acnes KCTC 5012 but not the growth of C. acnes KACC 11946 at 50 mg/ml. Anti-inflammatory activity was evaluated by a nitric oxide (NO) assay: only DC-G10 and ascorbic acid reduced LPS-induced NO production in RAW 264.7 cells in a dose-dependent manner. In addition, the toxicities of erythromycin, salicylic acid, benzoyl peroxide, tea tree oil, and DC-G10 were examined in HaCaT cells and normal human dermal fibroblasts (NHDFs). In these cells, the cytotoxic effects of DC-G10 were weaker than the effects of erythromycin, benzoyl peroxide, and ascorbic acid. Furthermore, scanning electron microscopy revealed that DC-G10 induces deleterious morphological changes in the bacterial cell membrane. These results demonstrate that DC-G10 may be an effective and safe treatment for acne vulgaris.

Antimicrobial activity of certain natural-based plant oils against the antibiotic-resistant acne bacteria

The unceasing emerging of multidrug-resistant bacteria imposes a global foremost human health threat and discovery of new alternative remedies are necessity. The use of plant essential oil in the treatment of many pathogenic bacteria is promising. Acne vulgaris is the most common skin complaint that fears many people about their aesthetic appearance. In this work we investigated the antibacterial activity of some plant oils against acne-inducing bacteria. Three bacterial isolates were identified from Egypt, biochemically and by means of 16s rRNA gene typing, and were designated as Staphylococcus aureus EG-AE1, Staphylococcus epidermidis EG-AE2 and Cutibacterium acnes EG-AE1. Antibiotic susceptibility test showed resistance of the isolates to at least six antibiotics, yet they are still susceptible to the last resort Vancomycin. In vitro investigations of eleven Egyptian plant oils, identified tea tree and rosemary oils to exhibit antibacterial activity against the antibiotic-resistant acne isolates. Inhibition zones of 15 ± 0.5, 21.02 ± 0.73 and 20.85 ± 0.76 mm was detected when tea tree oil applied against the above-mentioned bacteria respectively, while inhibition zones of 12.5 ± 1.5, 15.18 ± 0.38 and 14.77 ± 0.35 mm were detected by rosemary oils. Tea tree and rosemary oils exhibited bacteriostatic and bactericidal activity against all the strains with MICs/MBCs ranging between 39-78 mg/L for tea tree oil and 39-156 mg/L for rosemary oil. All the isolates were killed after 4 and 6 h upon growing with 200 mg/L of tea tree and rosemary oils, respectively. Additionally, gas chromatography mass spectrometry (GC/MS) profiling identified and detected a variable number of antimicrobial compounds in both oils.

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.

Essential oils as topical anti-infective agents: A systematic review and meta-analysis

OBJECTIVE

This study summarized evidence on the efficacy and safety of essential oils (EOs) in the treatment of topical infections.

DESIGN AND SETTING

Systematic review of clinical trials conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline. Electronic databases of the Cochrane, PubMed, EMBASE, Web of Science, and Scopus were searched from inception to November 2018.

INTERVENTION

Essential oil of any type, standard treatment and placebo.

MAIN OUTCOME MEASURES

Outcomes of the study include total acne count, acne severity index, reduction in total acne surface area, number of non-inflammatory acne lesions and inflammatory acne lesions, microbial cure rate, microbial decolonization rate, and new microbial emergence.

RESULTS

Non-significant but higher proportion of MRSA was cleared in EOs group (69% [95%CI: 34%, 96%]) compared to routine care (45% [95%CI: 36%, 53%]). Essential oils significantly lowered level of new MRSA emergence (9% [95% CI: 5%, 14%], I² = 86.59%) compared to routine care (53% [95%CI: 30%, 75%], I² = 86.59%). Four of the five studies on acne treatment showed equal or superior efficacy of EOs and the remaining one showed inferior efficacy to a control. In treatment of topical fungal infections, efficacy of essential oils were non-inferior compared to a standard treatment but superior to a placebo.

CONCLUSION

Essential oils could be considered as alternative treatment for acne, decolonization of MRSA, and topical fungal infections, yet the low quality and heterogeneity among the studies calls for further studies.

Complementary and alternative therapy for pediatric acne: A review of botanical extracts, dietary interventions, and oral supplements

Many supplements and products containing botanical extracts are marketed to patients for the treatment of acne vulgaris. Additionally, increasing attention has been paid to the role of diet in acne vulgaris. Studies on this topic including pediatric patients are limited, with variable efficacy data. Despite these limitations, knowledge of alternative therapies in pediatric acne vulgaris is often expected from pediatric dermatologists. Here we review available data on the efficacy of complementary and alternative medicines for treatment of acne in pediatric patients, focusing on topical, oral, and dietary modifications.

Promising Antibacterial Effects of Silver Nanoparticle-Loaded Tea Tree Oil Nanoemulsion: a Synergistic Combination Against Resistance Threat

Highly resistant pathogens may be developed in patients with immune disorders after prolonged exposure to antibiotics, a growing threat worldwide. In order to overcome these problems, this study introduces a new class of engineered nanosystems comprising of tea tree oil nanoemulsion (TTO NE) loaded with Ag nanoparticles (NPs). Silver shows a strong toxicity towards a wide range of microorganisms. Also, TTO NE could be employed as a promising and safe antimicrobial agent for local therapies of bacterial infections. The nanosystem was prepared by low-energy method. Mean droplet size of the NE was found to be 17.7 nm. Results of the antibacterial assays showed promising ability of the designed nanosystem for eradication of Gram-positive and Gram-negative bacteria (95%). Also, it was shown that introducing colloidal Ag NPs to the TTO NE exerted a synergistic effect against Escherichia coli (FIC 0.48) while only an additive effect was observed against Staphylococcus aureus (FIC 0.75). The antibacterial effects of TTO NE+Ag NPs together with their compatibility with human cells can present them as a suitable candidate to fight against the antibacterial resistance threat.