Does Tea Tree Oil Truly Work for Nail Fungus and Dandruff?

Onychomycosis is a fungal infection of our nails, usually toenails, but sometimes fingernails, characterized by nail discoloration, deformity, detachment, thickening, crumbling, ridging. The above image is an example of what it can look like.

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Reported prevalence is estimated to be about 1 in 25 people, though it’s more common in older individuals: 1 in 5 over 60, and like half of 70-year-olds. Unfortunately, it’s really hard to treat, because the fungus can hide deep inside the nail, protected from the blood supply on one side or anything you want to put on topically on the other. So, recurrence after treatment is common due to residual fungus, even if you are able to beat it back.

Many of the oral systemic treatments can be toxic, and many topical applications require long treatment courses, which may limit patient compliance, especially in patients who want to use nail polish or something to cover it up. So, given all the problems with a lot of prescription anti-fungals, there has been renewed interest in natural remedies.

Well, if tea tree oil can affect athlete’s foot and dandruff fungus, what about nail fungus? Well, there was this study of a combination of the antifungal drug in Lotrimin cream with tea tree oil that seemed pretty effective— compared to nothing. But, what about compared to each other? Well, there was one head-to-head study comparing tea tree oil with a common antifungal drug, a double-blind, randomized controlled trial: twice-daily application of either the drug or pure tea tree oil on the nail for 6 months. Debridement was performed every few months, where some of the fungal mass is debulked, scraped, ground off. And, after 6 months, the drug only wiped the fungus out completely in about 1 in 10 cases, but looked better, with partial or full resolution of the appearance, in the majority of patients either from the doctor’s assessment or the patient’s. And, the tea tree oil did just as well. The two preparations were comparable in efficacy of cure, clinical assessment, and subjective improvement— even their cost was comparable.

So, for patients desiring a “natural” treatment for athlete’s foot or nail fungus, topical tea tree oil is a reasonable alternative to prescription or over-the-counter anti-fungals.

Speaking of natural treatments, how about a truly natural treatment. One potential reason for the poor long-term benefits of any therapy for nail fungus is that it may be only treating a manifestation of underlying disease, such as generalized immune suppression or peripheral micro- or macrovascular disease. Maybe fungal nail infections are just a manifestation of poor peripheral blood circulation that would normally allow your body’s natural defenses to keep the fungus from taking root in the first place. Evidently, there was a non-English language study of 400 patients that looked at the “relationship between blood circulation of the skin and the development of fungus disease”— that was the title—and “found a greater than 50% reduction in blood flow in patients with [athlete’s foot and nail fungus]… compared with patients without these disorders.”

So, if fungal nail infections are just a symptom of an underlying process, then treatment aimed at eradication of a pathogen may be unrealistic. No wonder it just grows right back. A more appropriate goal, then, may be to just give up and live with it. But wait! If it’s a circulation problem, why not try to instead improve the circulation. We’ve known since the 1950s that you can effectively switch peripheral artery circulation on and off like a light switch within days by switching people between a low fat plant-based diet and the more conventional diet that contributed to the problem in the first place.