Benzoyl Peroxide vs. Tea Tree Oil for Acne

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A 5% tea-tree oil gel is pitted head-to-head against the leading over-the-counter treatment for pimples.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

“Acne…remains one of the commonest diseases to afflict humanity.” If you do online surveys, tea tree oil appears to be “the second most commonly used topical treatment” after benzoyl peroxide. Though crowdsourcing may be “a novel research method for evaluation of acne treatments,” before getting too enamored with popular wisdom, you should know there’s stuff like this circulating on the internet—the facial application of urine as a home remedy for acne.

“[U]rine therapy advocates cite historical use as proof of its therapeutic potential…as a ‘free cure’ for many systemic diseases,” apparently forgetting all the godawful, crazy skeletons crowding the closets of medical history. “While recycling what the body intentionally removes may seem counterintuitive to good health,” what about Premarin? The best argument this author could come up with for putting urine on your face is that hey—women, after all, swallow pills made from pregnant horse pee. I’m not exactly following the logic there.

Of course, there’s drugs for acne. There are always drugs, though, along with drugs come drug side-effects. Antibiotics that suppress the bacteria that cause acne “are the standard treatment for acne, but are becoming less effective, [presumably] because of the emergence of antibiotic-resistant strains.” The prevalence of resistant strains has apparently grown rapidly, such that antibiotics for acne are no longer recommended just by themselves, with re-evaluations advised every six to eight weeks.

Well, the bacteria do seem to be susceptible to tea tree oil in a petri dish, but these kinds of studies were performed with free-floating bacteria, whereas in pimples, the bacteria form what’s called a biofilm, which makes them generally “more difficult to eradicate.” The bacteria forms like a glue that plugs up the follicle. So, petri dish studies can only tell you so much.

Even if tea tree oil couldn’t kill off the bugs, though, it has been shown to suppress skin inflammation. Like if you inflame people’s skin with an allergen and then try to calm it down, tea tree oil did a decent job, compared to an over-the-counter ointment, or a moderate potency prescription steroid cream. So potentially, tea tree oil could help with acne via an antibacterial mechanism, or from an anti-inflammatory standpoint. But you don’t know until you put it to the test.

A 20% tea tree oil gel applied twice a day, and a beautiful drop in acne lesions after one…two…three…months. About 24 pimples down to about 11. They conclude that the study showed that tea tree oil could “significantly improve…mild to moderate acne.” But, who can tell me the study’s fatal flaw?

Right, there was no control group. How do we know they wouldn’t have healed even faster without it? In this “systematic review of randomized clinical trials” on tea tree oil, their “most striking finding” is that they could hardly find any. Given “the widespread use” of tea tree oil, “this is both disappointing and important to note.” But finally, a randomized, double-blind, placebo-controlled trial of a 5% topical tea tree oil gel in mild-to-moderate acne.

After six weeks in the tea tree oil group, a 40% drop in whiteheads and blackheads, a 40% drop in red and tender acne bumps, and a 47% drop in pus-filled pimples, compared to comparatively little change in the control group. Overall, in terms of total lesion count, the tea tree oil gel was three and a half times “more effective than placebo,”—three and a half times more effective than essentially doing nothing. But most teens don’t do nothing for their pimples. How does tea tree oil compare to the gold standard, benzoyl peroxide? We’ll find out…right now!

Benzoyl peroxide is by far the most popular over-the-counter acne therapy despite its side effects. It can be irritating, causing redness, dryness, peeling, stinging, or burning. However, the prescription option, “the long-term use of [topical or oral] antibiotics, is discouraged due to the development [and spread of antibiotic] resistance. As a result, [attention has turned to] non-antibiotic products such as tea tree oil.”

The benzoyl peroxide did cause more side effects—dryness, itching, stinging, redness, burning— but it worked better too, cutting the number of inflamed pimples by two-thirds within three months, versus only by half in the tea tree oil group, though the most recent study found them to be more comparable.

Putting all the studies together, and tea tree oil products not only beat out placebo but approximate more standard regimens like benzoyl peroxide or topical antibiotics, suggesting tea tree oil products may be “an appropriate option for treating mild-to-moderate acne.”

Please consider volunteering to help out on the site.

Image credit: amy_lv via Adobe Stock images. Image has been modified.

Motion graphics by Avocado Video.

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

“Acne…remains one of the commonest diseases to afflict humanity.” If you do online surveys, tea tree oil appears to be “the second most commonly used topical treatment” after benzoyl peroxide. Though crowdsourcing may be “a novel research method for evaluation of acne treatments,” before getting too enamored with popular wisdom, you should know there’s stuff like this circulating on the internet—the facial application of urine as a home remedy for acne.

“[U]rine therapy advocates cite historical use as proof of its therapeutic potential…as a ‘free cure’ for many systemic diseases,” apparently forgetting all the godawful, crazy skeletons crowding the closets of medical history. “While recycling what the body intentionally removes may seem counterintuitive to good health,” what about Premarin? The best argument this author could come up with for putting urine on your face is that hey—women, after all, swallow pills made from pregnant horse pee. I’m not exactly following the logic there.

Of course, there’s drugs for acne. There are always drugs, though, along with drugs come drug side-effects. Antibiotics that suppress the bacteria that cause acne “are the standard treatment for acne, but are becoming less effective, [presumably] because of the emergence of antibiotic-resistant strains.” The prevalence of resistant strains has apparently grown rapidly, such that antibiotics for acne are no longer recommended just by themselves, with re-evaluations advised every six to eight weeks.

Well, the bacteria do seem to be susceptible to tea tree oil in a petri dish, but these kinds of studies were performed with free-floating bacteria, whereas in pimples, the bacteria form what’s called a biofilm, which makes them generally “more difficult to eradicate.” The bacteria forms like a glue that plugs up the follicle. So, petri dish studies can only tell you so much.

Even if tea tree oil couldn’t kill off the bugs, though, it has been shown to suppress skin inflammation. Like if you inflame people’s skin with an allergen and then try to calm it down, tea tree oil did a decent job, compared to an over-the-counter ointment, or a moderate potency prescription steroid cream. So potentially, tea tree oil could help with acne via an antibacterial mechanism, or from an anti-inflammatory standpoint. But you don’t know until you put it to the test.

A 20% tea tree oil gel applied twice a day, and a beautiful drop in acne lesions after one…two…three…months. About 24 pimples down to about 11. They conclude that the study showed that tea tree oil could “significantly improve…mild to moderate acne.” But, who can tell me the study’s fatal flaw?

Right, there was no control group. How do we know they wouldn’t have healed even faster without it? In this “systematic review of randomized clinical trials” on tea tree oil, their “most striking finding” is that they could hardly find any. Given “the widespread use” of tea tree oil, “this is both disappointing and important to note.” But finally, a randomized, double-blind, placebo-controlled trial of a 5% topical tea tree oil gel in mild-to-moderate acne.

After six weeks in the tea tree oil group, a 40% drop in whiteheads and blackheads, a 40% drop in red and tender acne bumps, and a 47% drop in pus-filled pimples, compared to comparatively little change in the control group. Overall, in terms of total lesion count, the tea tree oil gel was three and a half times “more effective than placebo,”—three and a half times more effective than essentially doing nothing. But most teens don’t do nothing for their pimples. How does tea tree oil compare to the gold standard, benzoyl peroxide? We’ll find out…right now!

Benzoyl peroxide is by far the most popular over-the-counter acne therapy despite its side effects. It can be irritating, causing redness, dryness, peeling, stinging, or burning. However, the prescription option, “the long-term use of [topical or oral] antibiotics, is discouraged due to the development [and spread of antibiotic] resistance. As a result, [attention has turned to] non-antibiotic products such as tea tree oil.”

The benzoyl peroxide did cause more side effects—dryness, itching, stinging, redness, burning— but it worked better too, cutting the number of inflamed pimples by two-thirds within three months, versus only by half in the tea tree oil group, though the most recent study found them to be more comparable.

Putting all the studies together, and tea tree oil products not only beat out placebo but approximate more standard regimens like benzoyl peroxide or topical antibiotics, suggesting tea tree oil products may be “an appropriate option for treating mild-to-moderate acne.”

Please consider volunteering to help out on the site.

Image credit: amy_lv via Adobe Stock images. Image has been modified.

Motion graphics by Avocado Video.

Doctor's Note

This is but one of the extended series of videos I have on tea tree oil. Here are the other ones I have up so far:

What else can we do for acne? Here are some of my faves:

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