Home' Australian Pharmacist : Australian Pharmacist December 2012 Contents Australian Pharmacist December 2012 I ©Pharmaceutical Society of Australia Ltd. 967
Continuing Professional Development
1. Most commercial products for
topical use contain what percent of
tea tree oil?
2. Tea tree oil, an essential oil, has
the potential to cause sensitivity
reactions in patients due to:
a) the heterogeneous nature of the oil,
since it consists of a mixture of terpene
hydrocarbons and tertiary alcohols.
b) oxidative degradation resulting in the
formation of oxidation products.
c) storage of the product at temperatures
less than 25 ºC and protection from
d) exposure of patients to lower
concentrations of TTO, especially
during initial use.
e) the slower onset of action compared
to benzoyl peroxide.
3. Aminomethyl propanol is included
in the TTO acne gel for its ________
4. The emulsifying agent(s) in TTO
acne gel, which is an oil-in-water
a) Carbomer 940 and aminomethyl
b) Propylene glycol.
c) Cremophor RH 40.
d) Polysorbate 80 and cremophor RH 40.
e) Cremophor RH 40.
exposure to halogens and to industrial
oils such as those used by mechanics).
Working in a hot, humid environment
can also aggravate acne.20
• Endocrine factors should be considered
in female patients, since acne can be
one of the signs of androgenisation in
women, although most women with
acne have entirely normal hormone
profiles. Association with hirsutism,
obesity and menstrual irregularity should
trigger investigation. Polycystic ovary
syndrome is also particularly common.20
• Acne has been shown to negatively
impact on a young person's quality of
life. The emotional and social impact
of acne does not necessarily correlate
with acne severity and pharmacists
should be cognisant of the emotional,
psychological and social impact on
• Patients should be referred if showing
signs of moderate to severe acne.
• Since sensitivity reactions have been
reported, testing a small patch of skin
is recommended prior to use. Irritant
reactions are often concentration
dependant and are not reliant on
previous exposure to the irritating
agent.7 Irritant reactions may usually
be avoided through the use of lower
concentrations of the API in the product
initially7 (e.g. 1% of tea tree oil as in
Figure 1, whereas most commercial
products contain 5%), with subsequent
increase in concentration. Patients may
also apply the gel once daily initially,
increasing to twice daily applications.4
• Directions for use
• Wash your hands well with soap and
water before opening any packaging.
• Before applying, wash affected area with
mild soap or soap substitute and warm
water, rinse and gently pat dry.3
• Apply enough to cover affected areas
and rub in gently. Avoid contact with
eyes, lips and other sensitive areas.3 Wash
your hands after application.
• Store the preparation in a cool place
(below 25 °C), protected from light and
away from children and pets.
1. Russell JJ. Topical therapy for acne. Am Fam Physician
2. Baxi S. OTC products for the treatment of acne. US Pharm
3. Australian Medicines Handbook. 13th edn. Adelaide: AMH;
4. Thomsen PS, Jensen TM, Hammer KA, et al. Survey of the
antimicrobial activity of commercially available Australian tea
tree (Melaleuca alternifolia) essential oil products in vitro. J
Altern Complement Med 2011;17(9):835--41.
5. Carson CF, Hammer KA, Riley TV. Melaleuca alternifolia (Tea
Tree) oil: a review of antimicrobial and other medicinal
properties. Clin Microbiol Rev 2006;19(1):50--62.
6. Reuter J, Merfort I, Schempp CM. Botanicals in dermatology: an
evidence-based review. Am J Clin Dermatol 2010;11(4):247--67.
7. Hammer KA, Carson CF, Riley TV, et al. A review of the toxicity
of Melaleuca alternifolia (tea tree) oil. Food Chem Toxicol
8. Bassett IB, Pannowitz DL, Barnetson RS. A comparative study of
tea-tree oil versus benzoylperoxide in the treatment of acne.
Med J Aust 1990;153(8):455--8.
9. Enshaieh S, Jooya A, Siadat AH, et al. The efficacy of 5%
topical tea tree oil gel in mild to moderate acne vulgaris: a
randomized, double-blind placebo-controlled study. Indian J
Dermatol Venereol Leprol 2007;73(1):22--5.
10. Allen LVJ. Tea Tree Oil Acne Gel. IJPC 2011;15(2):165.
11. Martindale: The complete drug reference (electronic resource).
London: Pharmaceutical Press; 2012.
12. Australian Tea Tree Industry Association (ATTIA Ltd). At: www.
13. Hausen BM. Evaluation of the main contact allergens in
oxidized tea tree oil. Dermatitis 2004;15(4):213--4.
14. Hausen BM, Reichling J, Harkenthal M. Degradation products
of monoterpenes are the sensitizing agents in tea tree oil. Am J
Contact Dermat 1999;10(2):68--77.
15. Rutherford T, Nixon R, Tam M, et al. Allergy to tea tree oil:
retrospective review of 41 cases with positive patch tests over
4.5 years. Australas J Dermatol 2007;48(2):83--7.
16. Rowe RC, Sheskey PJ, Quinn ME. Handbook of pharmaceutical
excipients. 6th edn. London: Pharmaceutical Press; 2009.
17. Pharmaceutical Society of Australia. Professional Practice
Standards, Version 4: Compounding. 2010. At: www.psa.org.au/
18. Australian Pharmaceutical Formulary and Handbook. 22nd
edn. Canberra: PSA; 2012.
19. MIMS Australia: MIMS Online. 2012.
20. Therapeutic Guidelines: eTG Complete. North Melbourne:
Therapeutic Guidelines; 2012.
Key learning points
• Tea tree oil may be beneficial to
treat acne, especially in patients
exhibiting sensitivity reactions to
• Pharmacists will be able to provide
advice on the suitability of various
ingredients within compounded
products for the treatment of acne.
• Pharmacists are able to counsel
patients on the appropriate
storage of these products, based
on included ingredients, in order
to ensure the quality of the
SOLUTIONS THROUGH COMPOUNDING
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