Burns Vol. 23, No. 4, pp.
349-351,1997
ELSEVIER
PII: SO305-4179(96)00130-l
Does tea tree oil have a place in the topical
treatment of burns?
J. Faoagali’, N. George’ and J. F. Leditschke”
‘Royal Brisbane Hospital, Herston, Queensland, Australia and ‘University of Queensland, Queensland, Australia
BurnaidTM is a sorbalene-based cream containing 40 m& of tea
tree oil and i mg/g of triclosan. This investigation was carried
out to determinethe effect of BurnaidrM, a commercial tea treeoil
preparation, against Enterococcus faecalis (ATCC29212),
Staphylococcus aureus (ATCC29213), Escherichia coli
(ATCC25922), and Pseudomonasaeruginosa (ATCC27853),
with the actizlity of the base product in the commercial prqara-
tion. The organisms were suspended in sterile saline (0.5 McFar-
land Standard) and inoculated onto horse blood agar (E. faecalis
and S. aureus)or Mueller-Hinton agar (E. coli and I?. aerugi-
nosa). One hundred microlitres of BurnaidJM unsterilized,
BurnaidrM sterilized and the base product (TinasolveTM) were
placed in duplicate in wells cut into the agar plates. Sterility and
inactivation cultures were also performed on the samples. None of
the samples zoere found to be contaminated with bacteria prior to
testing. Only S. aureus and E. coli showed zones of growth
inhibition around the BurnaidTM and TinasolveTM. Zones of
growth inhibition (22 mm) were similar for the active product
(BurnaidrM) and the base (TinasolverM). There was no activity
against E. faecalisor P. aeruginosa.In view of ourfindings and
literature indzcating the cytotoxicity of tea tree oil against human
fibroblasts and epithelial cells, it is recommended that this product
should not be used on burn wounds. 0 1997 Elsevier Science Ltd
for ISBI.
Key words: Tea tree oil, melaleuca oil, topical burns treatment,
BurnaidTM cream, antimicrobial activity.
Burns, Vol. 23, No. 4, 349-351,1997
Introduction
Tea tree oil (Meluleucu alternifoliu) is a native
Australian essential oil. It is a mixture of at least eight
different oils, and there have been several published
papers reporting mixed results from in vitro
antibiotic-sensitivity testing of the individual constit-
uents of tea tree oil as well as the whole product
against a range of micro-organisms. No standardized
testing method has been agreed and different testing
techniques have been required because of difficulties
in solublizing the test product.
0 1997 Elsevier Science Ltd for ISBI. All rights reserved
Printed in Great Britain
0305-4179/97 $17.00 + 0.00
Carson et al.’ reported tea tree oil to have
antibacterial efficacy against all 66 isolates of methi-
cillin-resistant Stuphylococcusuureus (MRSA) that they
tested. They used both disc diffusion and broth
microdilution methods.
Carson and Riley2 tested the antimicrobial efficacy
of eight components of tea tree oil and found that
l-terpinen-4-01 was active against all the organisms
tested (P. ueruginosu, Cundidu ulbicans, E. coli and S.
aureus). Rho-cymene showed no antimicrobial
activity. Linalool and the alpha-terpineols (alphater-
pinene, gamma terpinene, alphaterpineol and terpi-
nolene) were active against all organisms except P.
ueruginosa.
Carson and Riley2 used disc diffusion and broth
microdilution methods which both required modifi-
cations to enable the oils to be solubilized and the
broths clarified to enable reliable quantitative detec-
tion of bacterial growth or inhibition.
Raman et a1.3 used a TLC-bioautographic tech-
nique to demonstrate the antibacterial activity of
terpinen-4-01, alpha terpineol and alpha pinene
against S. uureus, S. epidermidis and Propionibucterium
ucnes.They failed to detect any antibacterial activity
in cineole.
Escherichiucoli* and oral bacteria5 were found to be
inhibited by tea tree oil but two reports investigating
antifungal activity were contradictory. Tong et a1.6
showed that tea tree oil had no mycological effect
but its regular application decreased scaling, inflam-
mation, itching and burning in patients presenting
with tinea pedis compared with a control group
treated with a placebo (P=O.O22). A double-blind
randomized control trial7 comparing topical 1 per
cent clotrimazole and 100 per cent tea tree oil for the
treatment of onychomycosis for 6 months showed
similar outcomes for culture and clinical assessment
(both less than 20 per cent) and partial or full resolu-
tion (61 and 6Oper cent, respectively).
With the increasing recognition and interest in the
use and application of natural products, there have
been requests from patients and manufacturers of
350
these products to use them in the topical therapy of
burns.
This study was set up to determine the in vitro
antibacterial effect of a commercial tea tree oil
preparation BurnaidTM against E. faeculis (ATCC-
29212), S. aurem (ATCC29213), E. coli (ATCC25922)
and P. aeruginosa(ATCC27853), and to compare these
results with those obtained using the base product
(TinasolverM) without additional tea tree oil.
Method
BurnaidTM burn first aid gel is a sorbalene-based
cream containing 40 mg/g of tea tree oil and 1 mg/g
of triclosan, an antistaphylococcal agent8.
Fifty grams Burnaidm cream (non-irradiated), 50 g
TinasolveTM cream (non-irradiated sorbalene base
plus 1 mg/g triclosan) and Burnaidm cream sterilized
with 25 kGy of gamma radiation were tested for
antibacterial activity against four control organisms,
E. fueculis (ATCC29212), S. uureus (ATCC29213), E. coli
(ATCC25922) and P. ueruginosa (ATCC27853). The
method used was a modification of that used by
Carson and Riley2. A suspension of each of the four
test organisms was prepared in sterile saline to a
turbidity of a 0.5 McFarland Standard.
Six 5 per cent horse blood agar plates were inocu-
lated with the suspension of E. fueculis and a further
six plates with the S. uureus suspension. Six Mueller-
Hinton plates were inoculated with the suspension of
E. coli and a further six with the P. ueruginosu
suspension.
Using a sterile Pasteur pipette, a well was cut in
the inoculated agar plates. The agar plug was then
removed with a sterile loop and discarded. One
hundred microlitres of the sterilized and unsterilized
BurnaidTM, and the TinasolveTM were inoculated in
duplicate onto each of the pre-inoculated plates. All
plates were incubated at 35°C in room air for 24 h
before they were examined for evidence of growth
inhibition around each well.
The diameter of the zones of growth inhibition
was recorded. All samples were also checked for
sterility by plating 10 ~1 of each sample into 5 per
cent horse blood agar and Columbia agar plates, and
incubating them at 35°C in room air for 2 days,
followed by 3 days at 28°C prior to examination. Ten
microlitres of each of the creams was also inoculated
into 25 ml of Brewers thioglycollate which was
incubated as above.
One microlitre each of the creams was mixed with
1 ml of inactivation solution, a nutrient broth
containing 5 per cent Tween 80, lecithin and 0.5 per
cent sodium thiosulfate. This mixture was vortexed
to obtain an even suspension (1-2 min). Ten micro-
litres was plated in duplicate onto 5 per cent horse
blood and Columbia agar plates. A further 10 ~1 of
each suspension was transferred to 25 ~1 of Brewers
thioglycollate broth. All samples were incubated as
above.
Bums: Vol. 23, No. 4,1997
Results
Sterility tests
No growth was detected in any of the samples plated
directly onto 5 per cent horse blood agar, the samples
placed in Columbia agar plates, or into Brewers
thioglycollate broth.
Antimicrobial activity
Zones of growth inhibition were present around only
S. aweus and E. coli. The zones of growth inhibition
around the BurnaidTM on the plates inoculated with
S. aweUs plates ranged from 20 to 22 mm. The zone
of inhibition around the TinasolveTM cream was
23 mm. The zones of growth inhibition around the
BurnaidTM containing wells in the plates inoculated
with E. coli ranged from 28 to 30 mm. There were no
zones of growth inhibition in any of the wells in the
plates inoculated with E. fueculis or P. aeruginosa.
Discussion
Both the y-irradiated and non-irradiated creams
showed no growth by direct plating or following the
use of inactivators.
BurnaidTM cream has been well documented as
having activity against S. uureus’-3and E. coli2. Some
of the constituents of tea tree oil (terpenol-4-01) have
antipseudomonal activity2, but this was not found in
the product we tested. No other researchers have
documented the lack of activity against E. fueculis.
The finding that the TinasolveTM cream has similar
activity against S. aureus and E. coli as the BurnaidTM
cream (tea tree oil) suggest that the tea tree oil is not
the active ingredient in the BurnaidTM. This may be
the triclosan which has documented antistaphylo-
coccal activity and some effect against E. coP.
We did not carry out any investigation into the
cytotoxicity of this product, but a recent report9
documents the toxic effect of tea tree oil on human
epithelial cells and fibroblasts in vitro. This report
showed that tea tree oil has a lesser toxicity than
other resin acid analogues studied which exerted
their cytolytic effect in proportion to the concentra-
tion and time of exposure.
This study also suggested that the antibacterial
effects of these products are actually associated with
their cytolytic activity.
Although tea tree oil has been demonstrated, in
vitro, to have a broad anti-Gram-negative and anti-
Gram-positive spectrum, use of the product on burns
should be limited because of the cytolytic effect on
epithelial cell and fibroblasts which accompanies this
antibacterial activity. There have also been reports of
contact allergy”,“, dermatitis’2’4 and poisoning’““.
The lack of activity of either the BurnaidTM or the
TinasolveTM cream against E. fueculis and P. ueruginosu,
two organisms commonly found in burn wounds,
must limit the potential usefulness of the product for
application to burn wounds.
Of even more concern is the recently described
cytotoxicity of tea tree oil. This may contribute to
decreased healing and increased scarring, two out-
Faoagali et al.: Does tea tree oil have a place in the topical
comes which need to be minimized in burn wound
care.
There is no data available on the effect of applica-
tion of 1 per cent triclosan to burns. The absorption
and cellular effects of this product both need to be
studied before its application can be recommended.
Conclusions
BurnaidTM burn first aid gel has been promoted as a
natural product for application to burns. We have
confirmed that it has activity only against E. coli and
S. uureus, and it has no activity against E. fueculisor P.
aeruginosa. ‘The active ingredient is most probably
triclosan.
Acknowledgements
The financial support of Rye Pharmacologicals to
carry out this project is gratefully acknowledged.
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Paper accepted 18 November 1996.
Correspondence should be addressed to: Dr J. Faoagali, Director
of Microbiology, Royal Brisbane Hospital, Herston Road,
Herston, Queensland4029,Australia.