Comparison of the efficacy of tea tree (Melaleuca alternifolia) oil with other current pharmacological management in human demodicosis: A Systematic Review

Abstract

Various treatments are found to be moderately effective in managing Demodex-related diseases except tea tree oil (TTO) and terpinen-4-ol (T4O), which showed superior miticidal and anti-inflammatory effects in numerous clinical studies. Their possible effects include lowering mite counts, relieving Demodex-related symptoms, and modulating the immune system. This review summarizes the current clinical topical and oral treatments in human demodicosis, their possible mechanisms of action, side-effects and resistance in treating this condition. TTO (especially T4O) is found to be the most effective followed by metronidazole, ivermectin and permethrin in managing the disease. This is because TTO has anti-parasitic, anti-bacterial, anti-fungal, anti-inflammatory and wound-healing effects. Furthermore, nanoTTO can even release its contents into fungus and Pseudomonas biofilms. Combinations of different treatments are occasionally needed for refractory cases, especially for individuals with underlying genetic predisposal or are immuno-compromised. Although the current treatments show efficacy in controlling the Demodex mite population and the related symptoms, further research needs to be focused on the efficacy and drug delivery technology in order to develop alternative treatments with better side-effects profiles, less toxicity, lower risk of resistance and are more cost-effective.

Efficacy of Topical Ivermectin 1% in the Treatment of Demodex Blepharitis

“…Oral ivermectin treatment may result in moderate-to-severe adverse reactions, although most adverse reactions are transient and mild. [23][24][25] On the other hand, the side effects of topical ivermectin are mostly mild, including irritation, allergic dermatitis, and redness. 25,26 In this study, topical application of ivermectin 1% cream improved clinical signs and symptoms without moderate-to-severe side effects from the medication in Demodex blepharitis.…”

<em>Demodex</em>: The worst enemies are the ones that used to be friends

“… 54 , 65 Tea tree oil are also found to be effective in Demodicosis, possible effects include lowering Demodex mite counts, relieving clinical symptoms, and modulating the immune system. 66 Topical ivermectin 1%, showed excellent clinical improvement and none of the patients were still positive for demodex SSSB after 16 weeks of treatment. 67 Topical metronidazole 2% have been recommended for demodicosis blepharitis and conjunctivitis.…”

Varied presentations of ocular demodicosis in a rural population

“…Tea tree oil (TTO-terpinen-4-ol)with concentrations ranging from 5% twice a day to 50% weekly-is highly effective in its treatment followed by medications like metronidazole, ivermectin and permethrin. 4 TTO application should be supplemented with warm saline compression and lid scrubs. 5 Our cases presented after other therapeutic modalities were tried elsewhere, and we could achieve rapid resolution of the condition once the diagnosis was established.…”

“…A simple microscopic examination of eyelash samples can help us diagnose and thereafter provide specific treatment. Tea tree oil (TTO-terpinen-4-ol)— with concentrations ranging from 5% twice a day to 50% weekly—is highly effective in its treatment followed by medications like metronidazole, ivermectin and permethrin 4. TTO application should be supplemented with warm saline compression and lid scrubs 5.…”