Efficacy and Safety of Melaleuca alternifolia (Tea Tree) Oil for Acne-A Systematic Review and Meta-Analysis

Acne vulgaris is a common chronic inflammatory skin disorder that begins in adolescents and often persists into adulthood, with substantial psychosocial impact. Tea tree oil (TTO) has been explored as a topical treatment for acne, but clinical evidence for its efficacy and safety remain limited and inconsistent. This systematic review and meta-analysis synthesizes available clinical data to evaluate TTO's therapeutic effects and safety profile in acne management. PubMed, Embase, and Web of Science were systematically searched for clinical studies published up to August 2025 that evaluated TTO for acne treatment. Study selection, data extraction, and risk-of-bias assessment were independently conducted by trained reviewers. Pooled estimates were calculated using fixed- or random-effects models according to heterogeneity, quantified using the I ² statistic. Seven studies comprising 445 patients were included. The use of TTO was associated with a reduction in acne severity compared with control groups (pooled odds ratio [pOR] = 0.74, 95% confidence intervals [CI]: 0.63-0.88). Adverse events were predominantly local and mild. An exploratory pooled analysis indicated a lower incidence of mild itching with TTO compared to the corresponding control treatments in the included studies (pOR = 0.09, 95% CI: 0.03-0.23), with similar trends observed for dryness, burning sensation, erythema, and scaling. Publication bias was not evident based on Egger's test and the trim-and-fill analysis, and overall risk of bias was assessed as low. Current evidence suggests that TTO is associated with a modest reduction in acne severity and generally acceptable short-term tolerability. Larger, high-quality trials with standardized formulations and long-term follow-up are needed to define its clinical role.