Summary

Candida is a diverse pathogen with over 100 species existing in nature. The incidence of Candida Albicans is rising and is reportedly now eight times more common than ten years ago, with some researchers attributing this to antibiotic overuse. With traditional medical treatment, the number of anti-Candida drugs is limited, and many have important side effects.

This infection most frequently affects women, and in its most common form is a mild vaginal irritation. Social embarrassment, and the preference of many women NOT to see their GP, encourages the use of powerful OTC drugs that in many cases amount to using a “sledgehammer to crack a nut”.

There are a number of alternative cures being sold, usually as dietary supplements. The evidence to support the effectiveness of these treatments is limited, and the only trial results available comes from a source linked to the manufacturer.

Aromatherapy treatments for Candida Albicans are believed to be effective, but the published results are old and need updating.

Aromatherapy Treatments

Research into the effectiveness of essential oils in the treatment of Candida has been ongoing for over forty years. One of the earliest useful studies was that published by Pena⁽⁷⁾ in 1962.

The Essential Oil Resource Database has 139 entries regarding Candida. Many of these relate to pharmacological studies of the properties of an essential oil, performed in vitro and at full concentration, and are of little use in deciding upon possible treatment strategies.

The most common anecdotal evidence involves the use of Tea Tree oil, either individually or in a blend, and this evidence is supported by published data and observations.

Tea Tree Oil (Melaleuca Alternifolia)

A 1995 study by Carson and Riley⁽⁸⁾ investigated the effectiveness of various components of Tea Tree oil. The major components of tea tree oil investigated were 1,8-cineole, terpinen-4-ol, p-cymene, linalol, a-terpinene, g-terpinene, a-terpineol and terpinolene. The test organisms included Staphylococcus aureus, Clostridium perfringens, Escherichia coli, Mycobacterium smegmatis, Bacteroides fragilis, Pseudomonas aeruginosa, Serratia marcescens and Candida albicans. Minimal antimicrobial activity was exhibited by g-terpinene and p-cymene. Five microorganisms were resistant to 1,8-cineole, whilst linalol, terpinolene and a-terpineol were active against all except Ps. aeruginosa. Terpinen-4-ol inhibited all the microorganisms with a minimum inhibitory concentration range of 0.06, 0.25 and 0.25 v/v % for E.coli, Staph. aureus and C. albicans respectively.

Cutaneous Candidiasis

There have been very few Randomised Controlled Trials (RCTs) involving the use of essential oils in the treatment of Candida. One is a 1994 study⁽⁹⁾ by Buck, Nidorf and Addino. This double blind, randomised multicentre trial used 117 patients that were randomly divided into two treatment groups. The efficacy of 1% clotrimazole or 100% essential oil of Melaleuca Alternifolia were compared by applying them directly to infected toenails twice daily in their respective treatment group. After six months, both patient groups showed similar improvements in clinical assessment, nail appearance and symptomatology. Both preparations were comparable in both efficacy and cost and were similar in effect to many other available treatments.

An earlier 1985 study by Belaiche⁽¹¹) concluded that Tea Tree oil proved to be highly efficacious against all of the infections examined, although cases of acne were improved but not cured. Melaleuca Alternifolia essential oil was applied topically to the infection sites twice daily in an undiluted form. For nail infections, treatment was recommended for three months. Cases of intertrigo took six weeks to two months to resolve whilst impetigo lesions disappeared within 10-15 days.

Oropharyngeal Candidiasis (OPC)

A 1998 single centre, open-label clinical trial by Jandourek, Vaishampayan and Vazquez⁽¹⁰⁾, 13 patients with fluconazole-refractory OPC were treated with Melaleuca oral solution (Breath-Away, Melaleuca Inc.). This is a non-prescription mouthwash derived from Melaleuca Alternifolia essential oil. For two weeks, 15ml of the solution was swilled and held in the mouth for 30-60 seconds four times daily and then expelled. Rinsing was not permitted for at least 30 minutes. Treatment was continued for a further two weeks with patients who showed clinical improvement but had not shown a complete clinical response. Clinical evaluations were performed on four separate occasions, noting the severity of soreness, burning, erythema and the extend of the lesions. During the initial two weeks, no patients were cured and six were unchanged. However after 28 days of therapy, there was a positive clinical response in eight patients; two were cured and six were improved. Two weeks after the last treatment, both cured patients remained relapse-free. Eight patients noted a mild to moderate burning sensation when the solution contacted the mucosa, but this complaint lessened with improvement of the OPC. Nine patients had significant decreases in the oral candida population after the treatment regime. The use of Melaleuca oral solution gave a greater than 65% efficacy and thus appeared to be an effective alternative treatment for fluconazole-refractory oropharyngeal candidiasis in immunocompromised patients

Vulvovaginal Candidiasis (VVC)

According to Pena⁽⁷⁾, the objective of the clinical trial was to investigate the effect of tea tree oil in the treatment of vaginal infections in a total of 130 cases. A combination of essential oil tampons (each left for 24 hours) and daily douches of the diluted oil at 0.4% proved to be highly effective. The number of vaginal douches per patient averaged 42. Results were compared with a control group of fifty were no better than those patients treated with Melaleuca Alternifolia. In ten cases of chronic endocervicitis, a cure was achieved by four weekly treatments of washing the vagina with 20% tea tree oil and the insertion of a tampon soaked in 20% tea tree for 24 hours. Cases of moniliasis (Candida albicans) were treated with the same concentration. The clinical evidence supported laboratory tests which showed that M. alternifolia oil had penetrating antibacterial and antifungal action, and had dissolved pus and debris.

The 1985 study by Belaiche⁽¹¹⁾ also reviewed VVC, and in that trial twenty-eight patients with vaginitis caused by Candida albicans were treated with pessaries containing 200 mg of Melaleuca alternifolia essential oil, once each evening for 90 days. This mode of application meant that the oil acted topically on the candida, was rapidly absorbed by tributary veins and the pelvic lymphatics enabling a true recovery of the pelvic area, and bypassed the hepatic filter. Only one patient had irritation and stopped the treatment after one week. Of the others, twenty one (75%) were clinically and microbiologically healed after thirty days of treatment, four showed a moderate amelioration of discharge and three were symptomless but with candida still present.

References

Extracted from "Candida Albicans, A Review Of Conventional And Alternative Treatments Compared To Aromatherapy Treatments With Tea Tree Oil" Craig Vassie, Dec 2003