Allergy to tea tree oil: retrospective review of 41 cases with positive patch tests over 4.5 years

Tea tree oil use is increasing, with considerable interest in it being a 'natural' antimicrobial. It is found in many commercially available skin and hair care products in Australia. We retrospectively reviewed our patch test data at the Skin and Cancer Foundation Victoria over a 4.5-year period and identified 41 cases of positive reactions to oxidized tea tree oil of 2320 people patch-tested, giving a prevalence of 1.8%. The tea tree oil reaction was deemed relevant to the presenting dermatitis in 17 of 41 (41%) patients. Of those with positive reactions, 27 of 41 (66%) recalled prior use of tea tree oil and eight of 41 (20%) specified prior application of neat (100%) tea tree oil. Tea tree oil allergic contact dermatitis is under-reported in the literature but is sufficiently common in Australia to warrant inclusion of tea tree oil, at a concentration of 10% in petrolatum, in standard patch-test series. Given tea tree oil from freshly opened tea tree oil products elicits no or weak reactions, oxidized tea tree oil should be used for patch testing.