Why is Tea Tree Oil Still the Underdog of Acne Treatments?

Tea tree oil, an extract of a tree native to Australia, has been used by Aborigines as an antiseptic and antifungal for centuries. In recent years, scientific research has shown it to be an effective treatment for acne.

Despite the evidence, though, it remains as the underdog of acne treatments and unlikely to get the respect it deserves.

Studies show tea tree oil as effective as benzoyl peroxide and topical antibiotics

A recent article in the International Journal of Antimicrobial Agents reviewed scientific studies on the effectiveness of tea tree oil against acne. The authors looked at a series of scientific studies that were performed between 2005 and 2014. The studies showed that products containing TTO reduced acne lesions anywhere from 23.7% to 62.1%.

Taken together, these studies present strong evidence that tea tree oil’s effects are comparable to other commonly used anti-acne treatments, such as benzoyl peroxide and antibiotics. Though the authors claimed that some of the studies don’t meet the current methodological standards for a “rigorous, clinical acne study,” the majority of the data showed consistently positive results.

Many over the counter products have too little tea tree oil

The study authors looked at various anti-acne products containing TTO. They concluded:

Tea tree oil may be included as the active therapeutic agent or at lower levels that are unlikely to have therapeutic benefit but instead serve to increase the appeal or marketability of the product.

The authors concluded that a solution containing 5% or greater tea tree oil applied twice daily for several weeks would be enough to have an impact.

Side effects

TTO is fairly well tolerated but can cause some side effects. The studies that tracked side effects showed that TTO can cause some skin irritation and similar side effects than other acne treatments, including:

  • Itching
  • Burning
  • Sticking
  • Redness
  • Dryness

Studies that compared TTO to benzoyl peroxide or antibiotics showed side effects were milder and less frequent in the group using TTO.

In a nutshell: TTO can cause mild skin irritation.

How TTO works

Acne medications work by addressing one or more of the proximal causes of acne:

  • Bacteria (bacteria that colonize blocked pores turn small blackheads into painful pimples)
  • Inflammation
  • Excessive keratin production (keratin is a protein that binds skin cells together. Too much keratin prevents skin cells from separating, and big lumps of dead skin cells clog the pores)
  • Excessive sebum production

Studies have shown that TTO addresses 2 of the 4 proximal causes of acne. It effectively kills acne-causing bacteria. TTO also has anti-inflammatory effect in the skin.

Unlike vitamin C and green tea it’s not an antioxidant, rather it inhibits the production of pro-inflammatory cytokines in the skin. You could think of pro-inflammatory cytokines as fire alarm in the skin. The skin cells release them in response to injury. And if pro-inflammatory cytokines are the fire alarm then the immune system is the fire brigade. It responds to the cytokines and clears damaged cells. Alas, this causes further inflammation in the area.

This is a long way of saying that you’ll get much better results when you combine TTO with treatments that address the other proximal causes of acne. These include topical antioxidants and ‘peeling agents’ that open blocked pores (like salicylic acid and retinol).

Conclusion

Tea tree oil is one of the better researched natural treatments for acne. Studies show it can be as effective many commonly-used prescription treatments for acne, and yet causes fewer side-effects. Despite this, doctors still treat it as the underdog of acne treatments.

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About Me

Hi, I am Acne Einstein(a.k.a. Seppo Puusa). I'm a bit of a science nerd who is also passionate about health. I enjoy digging through medical journals for acne treatment gems I can share here. You can read more about my journey through acne and how I eventually ended up creating this.

References

27 thoughts on “Why is Tea Tree Oil Still the Underdog of Acne Treatments?

  1. Have you ever heard about earthing? And if yes whay is your opinion about it? I saw one study about it but i’m sceptical…

    • It’s useless alt-med nonsense. There are crappy alt-med journals that publish studies on all sorts of nonsense. So a ‘study’ doesn’t really prove anything yet. We also have to think about biological plausibility, as in, does this fit into what we already know about how the human body functions. Earthing fails completely on this front. And until the proponents can muster more convincing evidence to show ‘earthing’ does anything, I see no point to waste intellectual energy investigating it.

      • Nice yeah that also were my thoughts i just wanted to be sure that its useless..so thankx
        But another question i just read the book “why stomach acid is good for you” because my mother had a reflux. And after researching a bit on the net i foind out that acne sufferer do have lower levels ov zinc selwnium chrom,…
        Cpuld this be because of the low stomach acid (i also read that 40percent of acne sufferer do have not enough stomach acid )
        What is your opionion on that.. and whats your rec.on how to produce more. Do you think slowly stressfree eating will do the job ?
        Thank you

        • Yes, there have been a few studies that show acne patients have lower levels of zinc, selenium and some other minerals. I suspect that’s because acne patients generally have more ‘oxidative stress’ (basically inflammation) and those minerals are used in the antioxidant pathways.

          There are some older papers that showed acne patients have lower levels of stomach acid, but nobody has looked into this recently. It’s not very surprising as low stomach acid is linked to gut issues, which are more prevalent in acne patients.

          I can’t really say how to increase stomach acid levels. Taking HCL supplements should work, and I recall reading that managing stress would also help.

  2. Yesterday i have been to a holistic dermatologist and the things she recommended me sounded really good.. she gave me a food face wash, a bpo cream for night and I should choose between a green tea cream or a vitamin b3 cream. So my question here:
    What do you thinj is more beneficial?
    She said that i should not worry not too much about diet just replacing a few carbs with fat and protein like eggs fish coconut and avoiding sugar milk..
    And at the end of the “meeting” she said ishould look up the information a page called “acneeinstein”.. 😀 really funny to hear that from a derm 😀

    • Solid advice, especially the part about reading “acneeinstein”.. lol

      No studies have compared the effectiveness of B3 and green tea, so I can’t say. I can say that the evidence for B3 is of higher quality than the studies done on green tea creams. But that doesn’t mean B3 would be more effective. I would say choose something that’s more convenient, cheaper, easier to find, etc for you. You can’t go wrong with either B3 or green tea cream.

      • Hey seppo since drinking greentea and applying green tea my skin got more better. But i do have a few questions..
        My neighbour is a holistic doctor and she said i should do a saliva hormone testing what do you think of it?
        And second whats your opinion on the crushing syndrome and do you think it does affect many people with acne?
        So thankful for your information.. :))

        • First, I would take anything a ‘holistic’ doctor says with a huge grain of salt. Quite often they have fairly serious anti-science tendencies. Some might offer really good advice, but you never know which ones offer good advice and which ones are utter quacks.

          I don’t know how accurate saliva hormone testing is. I was under the impression that it’s not that accurate, but wikipedia page on saliva testing suggests it could be useful.

          I don’t know anything about Cushing syndrome and would rather not speculate on areas I have no clue about.

  3. Hi Seppo,

    Speaking of natural topical treatments, while investigating the paleo diet more, I came across a line of acne products by a company called Primal Life Organics. Stefani Ruper, who I know you’re quite familiar with, is a fan, as is Liz Wolfe. The owner is a nurse who became interested in the skin while working with burn patients, and the products use a wide variety of oils (including tea tree) and clays and contain no water, alcohol, or preservatives. Have you looked into this line at all? If so, what are your thoughts?

    Thanks!

    • Honestly speaking? I got a headache from reading their site. It’s blatant fear-mongering against ‘chemicals’ and trying to make ‘mainstream’ skincare products to seem more dangerous than they actually are. This page is a good example of the fear-mongering:

      https://www.primallifeorganics.com/pages/how-safe-is-lab-made-vs-nature-made

      They complain that so-called synthetic vitamin A somehow imbalances the skin because it’s isolated from the holistic compound (whatever that means). What she utterly fails to understand is that, regardless of the source, the skin will break down and convert vitamin A into those ‘evil synthetic forms’ she warns you against. The ‘carrot form’ of vitamin A, actually a vitamin A precursor, is converted in the skin thusly: carotene > retinol esters > retinol > retinaldehyde > retinoic acid. Retinoic acid is the ‘synthetic’ form of vitamin A you’ll find in many prescription creams (tretinoids), and the evil chemical she warns you against.

      Retinoic acid is the biologically active form of vitamin A. The preceding forms only work because the skin converts them to retinoic acid. Of course this conversion is slow and quite ineffective. So it’s unlikely that any carotene applied to the skin ever gets converted to retinoic acid. They may act as antioxidants, but that’s about it.

      She displays her ignorance further by indirectly claiming that rosehip seed oil is safe because it’s ‘food source’. What she probably doesn’t know is that rosehip oil contains all-trans retinoic acid (tretinoid). The same ‘evil synthetic chemical’ she’s so against. https://en.wikipedia.org/wiki/Rose_hip_seed_oil

      Pretty much every paragraph on that page is wrong. Synthetic vitamin A forms are not unstable. Natural forms are far more unstable and degrade easily, one of the reasons so little of them gets converted into retinoic acid. Vitamin A creams aren’t designed to ‘burn’ the skin. That’s just utter nonsense. They accelerate separation of dead skin cells and reduce excessive keratin production (2 reasons why skin pores in acne-prone skin get clogged). Exactly the same effect rosehip oil has on the skin.

      Ironically, the paleo skincare products are full of essential oils, which are among the most irritating substances put into skincare products. Usually far more irritating and dangerous than the ‘chemicals’ these people rail against. For example, she uses neem in many of her products, but need is a known and common contact allergen.

      Another issue with these supposedly all-natural blends is that there’s almost no way to asses how effective they are. There’s very little research to on various essential oils and plant extracts.

      Sorry if this came off as a rant. As you can probably tell, these people press my buttons. Why can’t they just say they are selling all-natural, organic skin care? Why do they have to muddy the waters with scientifically-ignorant and factually challenged tirades against evil chemicals and poisonous skincare products.

      • Hah, I saw Neem oil for sale with the beauty products in an Indian grocery and I thought to myself, what a misuse of a perfectly good pesticide….

  4. Hi Seppo,

    I have seen you mention the B3 cream a few times. Can you recommend a brand or two that you like? It’s so hard to wade through the BS companies say about their products.

    Thanks, TM

    • Not really. Just pick something where B3 is at the beginning of the ingredients list. It needs about 4% concentration to be effective. So it should appear in the first 3 lines of the ingredients label.

  5. TTO doesn’t do much for my acne as a spot treatment. However, a few drops on my feet before putting on socks completely helps with the sweaty socks smell when I remove my shoes and socks after track in field training.

    Also, benzoyl peroxide doesn’t do much for my acne either. Ah, spot treatments hate me.

    But I agree. TTO is wicked stuff and helps disinfect popped zits. whooo

    • Sounds like your skin is a bit like mine. It doesn’t really matter what I put on my skin. If I eat something that aggravates my gut, I get acne regardless of what I put on my skin.

  6. The reason i ask is becuase i got one very cheap from my neighbour and i got the results and it “turned out” that i have very low testosterone in my saliva.. 😀
    and its recommended to talk to a holistic doctor or so. but to me this sounds like a huge scam and i cant really believe that my testo is low. i do workout 3 times a week stress is low vitamin d levels are perfect libido is also good, only the thing that i dont have a beard does make it plausible but i think its more due genetics! 😀

    • I read a few papers on this and it seems that saliva hormone testing can be reasonably reliable, but only when done correctly. It seems there are a lot of pitfalls that can render saliva hormone test results unreliable. It can be reliable if the person collecting and analyzing the sample really knows what they are doing. If they don’t know, then the results are useless.

      And yeah, this is another reason I tell people to be wary of holistic and natural health practitioners. They frequently use dubious diagnostic tests to ‘find out’ there’s something wrong with you and then proceed to sell consultations and supplements to fix the problem. Say what you want of normal doctors, but they have to abide by fairly strict code of ethics and standards of care. And could lose their license if they violate those. No such things exist for holistic and natural healers. Doctors also don’t sell the drugs from their office whereas most alternative practitioners also sell you the supplements they prescribe.

  7. I used tea tree items for my acne and hair. I love it, I am allergic to salicylic acid and benzoyl peroxide. So I cannot use most OTC items. But tea tree items are great. No adverse reactions, no drying out, no swelling like the SA or BP. If you are sensitive to those, definitely try tea tree items.

  8. I am also allergic to benzoyl peroxide, it leaves my skin irritated (red and itchy) so I do not like using the acne treatment serum. I do however have tea tree oil but do not know the best way to go about using it. I was hoping to use it to replace the acne treatment serum. I have read that people put it in scrubs but I am looking for an actual acne treatment. Any thoughts on usage?

  9. hey Seppo! first of all, many thanks for the tonne of information you post on your website!
    A question on green tea is: I seem not to tolerate it very well… some time ago I have a cup of tea at work and made me extremely sick – I was feeling really dizzy and took hours to go away and basically freaked me out.
    I would like to drink some for the acne benefits but how can I avoid feeling sick? Is it maybe the caffeine in it?

    • If you have such a strong reaction to green tea then you obviously shouldn’t drink it. It’s not required in order to get clear. You can try rooibos tea instead. It doesn’t have any caffeine.

  10. Love your blog! Thanks a lot for sharing all useful info. I stumbled upon this blog trying to finding the way out from my dry skin that now becomes acne-dry skin. I am from south east Asia which the climate is more humid n hot(never had any pimples issue there). It has been a month since I’m in korea and it is winter over here now. My pimples starts tragically n drastically. I tried several products but i can feel the tightness in my skin. I went to body shop earlier today n they recommend me to use their vit E cleanser as it is for dry skin but i dont buy haha he didnt convinced me with facts n figures but now i will! 🙂 i should try some innisfree tea tree cream as well..

    • I think you just need a bit heavier moisturizer. Climate and ambient humidity affect the skin a lot. I have the opposite problem. I’m from Finland but live in hot and humid Thailand. My skin gets ridiculously oily here.

  11. Hello! Your blog is really interesting.

    I have been drinking diluted apple cider vinegar the 3 weeks and I noticed that for once, I have clear skin. And it’s quite the novelty since I have never been pimple free since I was in the fourth grade. There is always that one zit no matter what. So I did a little Googling and found your blog. In one of your posts, you wrote that there is no sufficient evidence that ACV helps in clearing up acne.
    So I thought, maybe it wasn’t the apple cider but the virgin coconut oil that I have also recently been applying (on a whim) in the evenings. Sure enough, I found your post about VCO being a good product for acne. Now I’m not sure about the proper way to do it since I only leave it overnight and wash my face in the mornings. But I did notice that my skin got significantly less rough (because of the moisturizing properties, as you mentioned).
    My question being, is it okay to use VCO with an exfoliant containing tretinoin and hydroquinone? I was planning to use the exfoliant in the mornings and VCO in the evenings.
    About this specific article though, I would also like to ask if it is safe to use tea tree oil just by itself topically.

    • Yes, it’s OK to use coconut oil with an exfoliant – though some exfoliants make your skin sensitive to sunlight, so I recommend you use them in the evening. You need to dilute TTO (and any other essential oil) before applying on the skin. They are very irritating when used at 100% concentration.

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