48 EYE AREA CARE
the mean Ocular Surface Disease Index score decreased (p < 0.001, p < 0.001), tear breakup time increased (p < 0.002, p < 0.004). In Group 1, Demodex presence decreased from 42% to 27.8% (p < 0.0302); in Group 2 from 54.2% to 20.6% (p < 0.004). IL-1β and IL-6 decreased in group-2 (p < 0.002, p < 0.050, respectively). TNF-α decreased in both groups (p < 0.001, p < 0.001, respectively).
What makes TTO so effective? Researchers interested in identifying the active constituent in tea tree oil that is responsible for Demodex eradication conducted in vitro killing assays. They exposed Demodex folliculorum at up to 150 minutes to each of the known constituents to measure survival time. Terpinen-4-ol was the most potent ingredient followed by α-Terpineol, 1,8-Cineole and Sabinene. Terpinen-4-ol, the most abundant ingredient in TTO, was more potent than TTO at equivalent concentrations and its killing effect was even observable at a concentration of 1%.10
The researchers noted
that Terpinen-4-ol exhibited a significant synergistic effect with Terpinolene, but an antagonistic effect with α-Terpineol in killing mites (both p < 0.05). While the researchers determined that
the exclusive use of Terpinen-4-ol would be a suitable standalone treatment for demodicosis, there is significant evidence to suggest that parasites such as mites can develop resistance to single ingredients leading to resistance. In contrast, the complex nature of the chemical profile of essential oils such as tea tree oil prevents resistance from developing. Not surprisingly, a popular area of current scientific research is the investigation of essential oils as synergists alongside synthetic ingredients.
At risk populations Rosacea There is a statistically significant association between Demodex density and rosacea, a common facial dermatosis condition that causes redness in the skin.11
Pityriasis folliculorum has
been described as a dry type of rosacea with extensive proliferation of Demodex folliculorum. Acaricidal treatment is recommended for P. folliculorum with vascular symptoms/ erythematotelangiectatic rosacea (ETR) and follicular scales. Once the mites are eliminated, there is a decrease in subsequent inflammation and associated persistent erythema.12
SUMMARY: TEA TREE OIL EFFECTIVE CONCENTRATIONS VS CONTROL
■ 50% and 10% TTO wash, Gao 2005 (p < 0.01) ■ 7.5% TTO eyelash shampoo, Karakurt 2018 (p < 0.001) ■ 5% TTO Ointment, Gao 2012 (p < 0.01) ■ 3% (w/w)-TTO gel, Ergun 2020 (p < 0.001)
This highlights that only a very low
percentage of TTO is needed to effectively eradicate periocular Demodex.
There is a statistically significant association between Demodex density and rosacea. PERSONAL CARE September 2021
www.personalcaremagazine.com
Wearing of sunglasses is linked to Demodex infestation.
Eye/Sunglasses Wearing glasses has been linked to Demodex infestation (48.4% vs. 32.3%, p < 0.01) as has increased age of the sufferer.13
Eyelash extensions Eyelash extensions are a popular and a widely used cosmetic enhancement performed in beauty salons. Following exposure to substances used for adhesion and mechanical limitations of the false lashes adverse effects are often reported, including a variety of allergic reactions and damage to the ocular surface.14
Eyelash extension
procedures may cause ocular disorders, such as keratoconjunctivitis and allergic blepharitis.15
Pure tea tree oil – allergies and oxidation Essential oils should always be used with care and diluted prior to application. Studies where irritation has occurred have often found other factors to be implicated such as intentional oxidation and/or adulteration (impurities added to TTO to achieve low cost basis). An indicator of oxidation can be the
EYELASH EXTENSIONS PRODUCT APPLICATIONS
■ Eye Makeup Remover Oil ■ Eyelid Foaming Cleanser ■ Eyelash Wash ■ Eye Cleansing Wipes
Eyelash extensions are linked to a range of disorders.
presence of peroxide or p-cymene - the latter has been determined in studies to be a better indicator than peroxide. The ISO Standard lists the oxidative product, p-cymene, to be 0.5-8 however and oxidised oil can be as high as 19.2. Typical ‘fresh’ Australian Tea Tree Oil will be well below 5% p-cymene concentration.16 Interestingly, allergy patch tests are
commonly conducted with oxidised tea tree. The developers of such testing state that TTO from freshly opened TTO products elicits “no or weak reactions”, and therefore they recommend oxidised TTO to be used for patch testing.17
This form of testing is likely to result
in false positive results and lead to significant over reporting of TTO allergies and contact dermatitis. Naturally this testing format seems counterintuitive to manufacturers using fresh (not oxidised) and pure TTO in their products. Unfortunately, tea tree oil is the only essential oil that is deliberately oxidised for any regional or International Baseline Allergy Series. A study by Koo et. al. (2012), noted that 5
of 106 patients reported ocular irritation with TTO use, however most of these symptoms were caused by improper scrubbing and upon re-education on the scrubbing technique, the irritation resolved completely.18 A study by Maher (2018), reported that
one female patient developed contact dermatitis after applying the TTO foam over the entire upper lid. However, it was
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