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Melaleuca alternifolia (Maiden et Betche) Cheel Bastyr University, Department of Botanical Medicine This work may be copied and distributed for any non-commercial purpose as long as it is not  Highlights
Tea tree volatile oil is a potent antimicrobial.
Tea tree volatile oil is particularly used topically but can be used internally in small doses (- Tea tree is highly sustainable due to large-scale cultivation.
 Basic Clinical Information
. Part Used
Fresh leaf or steam-distilled volatile oil
. Taste
Very strong, slightly burning, characteristic of tea tree
. Principal Actions
Antimicrobial, strong (Carson, et al. )
. Major Indications
✎ Vaginitis, infectious (Pena ) Tea tree oil % ointment and % body wash more effective than % mupirocin ointment and triclosan body wash for eradicating methicillin-resistant Staphylococcus aureus (MRSA) carriage (Caelli,et al. ). Tea tree oil % cream and % body wash as effective as % nasal mupirocin, chlorhexidinegluconoate % soap, and % silver sulfadiazine cream at clearing MRSA colonization in hospitalizedpatients; mupirocin was more effective at clearing nasal carriage (Dryden, et al. ). Tea tree wasmore effective at clearing skin colonization than chlorhexidine and silver.
Tea tree oil (%) topically was as effective as benzoyl peroxide in treating patients with acne in a double-blind trial (Bassett, et al. ). Tea tree oil’s effects were slower in onset but there were feweradverse effects.
Several double-blind trials have shown that tea tree oil topically is as effective as standard drug treatments for people with tinea pedis or onychomycosis (Tong, et al. ; Buck, et al. ; Syed, etal. ).
. Major Constituents
Terpenoids
. Energetics
. Preparations and Dose
Steam-distilled volatile oil: Usually diluted % before application to the skin, though the skin of the
feet and toenails can usually withstand neat application. Interally, - drops of diluted oil (usually at
least %) are given every - h for acute conditions and three times a day for chronic conditions in
adults, modified for body size. Internal use in children is not recommended. For oral conditions, the
oil should be swished and then spit out.
Some studies have indicated that % volatile oil can still be effective topically and for oral rinses in some people. However, much higher doses may be necessary with extreme dilutions. One study inpeople with oral candidiasis used  of % oil solution four times per day (rinse and spit) ( Jandourek,et al. ).
. Interchangeability of Species
Little work has been done on other species in the genus with the exception of Melaleuca leucodendron
(cajeput). The steam-distilled volatile oil of this plant has a history of use as an antimicrobial and
rubefacient. Clinically it has had some demonstration of utility for people with furunculosis (Feinblatt
). In vitro it has been shown to inhibit histamine release from mast cells (Tsuruga, et al. ).
. Adverse Effects
✎ Contact dermatitis in sensitized patients ✎ Transient burning after application to the mucous membranes Patch testing the oil prior to widespread use can avoid application to sensitized patients. Apply a dot of neat oil to the inner forearm and cover with a bandaid. After  and  hours, check forinflammation. If inflammation appears, do not use neat oil on the skin. You could then patch test %or even more dilute oil if desired.
. Contraindications
✎ Topical application to dermatitis.
✎ Use caution in applying to burned skin.
Based on in vitro evidence that tea tree oil can be cytotoxic to fibroblasts and epithelial cells, and based on supposedly insufficiently powerful bacteriostatic activity, some recommend not applying teatree oil to burned skin (Faoagali, et al. ).
. Overdose
Internal overdose would be expected to primarily cause neurotoxicity, manifesting as confusion, ataxia,
arrhythmias, peripheral neuropathies, seizures, respiratory depression, and/or death depending on
the dose and patient factors. One -month-old who drank approximately  ml of tea tree oil devel-
oped ataxia and drowsiness but fully recovered (Del Beccaro ).
Excessive applications to the skin, or application of excessive concentrations to the skin of sensitive individuals, may cause contact dermatitis.
. Incompatibilities
Volatile oils are incompatible with water-based preparations due to immisicibility.
. Drug Interactions
As terpenoids are generally extensively metabolized by cytochrome P enzymes there is a theoret-
ical basis for many possible interactions with internal tea tree oil use. However, nothing has yet been
documented.
 Botanical Information
. Common Names
English Common Names
German Common Name: Teebaum
The word melaleuca is from the Greek for black and white. This may come from the common appearance of burned, blackened bark lower down on trees and the white, nonburned bark higher up.
. Botanical Description
Small to medium tree with white bark, often scorched by fire near the base. Produces inconspicuous
flower clusters notably primarily for their brightly colored, enlarged stamens (which are not attached
to the corolla). After flowering in the spring (Sept-Nov in Australia, occasionally at other times de-
pending on environmental conditions), it produces a woody seed capsule with many small seeds. The
pods only open in response to fire or death of the tree.
. Important Botanical Relatives
The genus Melaleuca is large with approximately  species.
Leptospermum scoparium (manuka), also native to Australia, is also frequently called tea tree. It is also in the Myrtaceae family and has an antimicrobial volatile oil.
Kunzea ericoides (kanuka) is another Myrtaceae family tree native to Australia with an antimicrobialvolatile oil.
Callistemon spp (bottlebrush) are botanically similar, except that the stamens are adnate to the tubularcorolla.
. Native Habitat and Current Range
Along edges of swamps or waterways in open forest, woodlands, or shrublands in northern New
South Wales. Tea tree has not spread outside of its native habitat. Unfortunately a close relative, M.
quinquenervia has escaped and become a serious pest in the Everglades of Florida.
. Ecological Status
No threat due to widespread habitat, planting for ornamentation, and cultivation.
. Cultivation
Widespread and easily done in its native habitat with the exception of many years required to get
an adult tree producing a lot of leaves. Generally the trees are propagated by cuttings to maintain
particular trees, or else seeds to start new ones. Seeds are collected by warming  month or older
pods for - days until they burst open. Seeds are often germinated by floating them in water. Should
be watered regularly but not daily. Prefer total sun. Respond fine to light pruning.
. Wildcrafting
Unclear how widespread this still is, given that there are now many plantations growing the plant for
oil production.
 Advanced Clinical Information
. Additional Actions
✎ Antiherpetic (Schnitzler, et al. ) ✎ Antihistamine (Koh, et al. ) ✎ Interferes with bacterial adhesion (Takarada, et al. ).
. Additional Indications
✎ Dandruff✎ Halitosis✎ Scabies✎ Burns (with caution)✎ Wounds (with caution)✎ Oropharyngeal candidiasis, thrush A systematic review found only four clinical trials of tea tree oil and concluded there is no conclu- sive information the efficacy of this product (Ernst and Huntley ).
A % tea tree oil shampoo was effective for people with dandruff compared to placebo in a single- blind trial (Satchell, et al. ).
A % tea tree oil oral solution was effective for fluconazole-resistant thrush in HIV+ patients in a single-blind trial ( Jandourek, et al. ).
. Constituents
✎ terpinen--ol✎ gamma-terpinene✎ alpha-terpinene✎ p-cymene✎ terpinolene✎ alpha-terpineole✎ alpha-pinene✎ ,-cineole In vitro, terpinen--ol is a more potent antimicrobial than tea tree volatile oil (Cox, et al. ).
This suggests that other components of tea tree oil interfere with terpinen--ol (an oxygenated ter-pene), particularly gamma-terpinene and p-cymene (both non-oxygenated). Part of the problem ap-peared to be because non-oxygenated terpenes decreased the water solubility of terpinen--ol.
. Pharmacokinetics
Tea tree terpenoids absorbed systemically are excreted through the lungs and the kidneys, and thus
tend to be most useful for problems in those organs.
. Similar Herbs (By Action)
Other antimicrobial volatile oils.
. Classic Formulations
None identified.
 Other Viewpoints
. Discussions in Historical Texts
None identified.
. Ethnobotany
Unknown if used in traditional Aboriginal medicine.
 References
Bassett IB, Pannowitz DL, Barnetson RS () ”A comparative study of tea-tree oil versus benzoylper-oxide in the treatment of acne” Med J Austral :- Buck DS, Nidorf DM, Addino JG () ”Comparison of two topical preparations for the treatment ofonychomycosis: Melaleuca alternifolia (tea tree) oil and clotrimazole” J Fam Pract :- Caelli M, Porteous J, Carson CF, et al. () ”Tea tree oil as an alternative topical decolonizationagent for methicillin-resistant Staphylococcus aureus” J Hosp Infect :- Carson CF, Riley TV () ”Antimicrobial activity of the major components of the essential oil ofMelaleuca alternifolia” J Appl Bacteriol :- Del Beccaro MA () ”Melaleuca oil poisoning in a -month-old” Vet Hum Toxicol ():- Dryden MS, Dailly S, Crouch M () A randomized, controlled trial of tea tree topical preparationsversus a standard topical regimen for the clearance of MRSA colonization J Hosp Infection :- Cox SD, Mann CM, Markham JL () Interactions between components of the essential oil ofMelaleuca alternifolia J Appl Microbiol : - Ernst E, Huntley A () Tea tree oil: A systematic review of randomized clinical trials Forsch Komple-mentarmed Klass Naturheilkd ():- Faoagali J, George N, Leditschke JF () ”Does tea tree oil have a place in the topical treatment ofburns?” Burns :- Feinblatt HM () ”Cajeput-type oil for the treatment of furunculosis” J Natl Med Assoc : Jandourek A, Vaishampayan JK, Vazquez JA () ”Efficacy of melaleuca oral solution for the treat-ment of fluconazole refractory oral candidiasis in AIDS patients” AIDS :- Koh KJ, Pearce AL, Marshman G, Finlay-Jones JJ, Hart PH () Tea tree oil reduces histamine-induced skin inflammation Br J Dermatol ():- Pena EO () ”Melaleuca alternifolia oil. Uses for trichomonal vaginitis and other vaginal infections”Obstet Gynecol :- Satchell AC, Saurajen A, Bell C, et al. () Treatment of dandruff with % tea tree oil shampoo J AmAcad Dermatol :- Schnitzler P, Schon K, Reichling J () Antiviral activity of Australian tea tree oil and eucalyptus oilagainst herpes simplex virus in cell culture Pharmazie :- Syed TA, Qureshi ZA, Ali SM, et al. () ”Treatment of toenail onychomycosis with % butenafineand % Melaleuca alternifolia (tea tree) oil in cream” Trop Med Int Health :- Takarada K, Kimizuka R, Takahashi N, et al. () A comparison of the antibacterial efficacies ofessential oils against oral pathogens Oral Microbiol Immunol :- Tong MM, Altman PM, Barnetson RS () ”Tea tree oil in the treatment of tinea pedis” Austral JDermatol :- Tsuruga T, et al. () ”Biologically active constituents of Melaleuca leucodencron: Inhibitors of inducedhistamine release from rat mast cells” Chem Pharm Bull (Tokyo) :-

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