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Adverse reactions have been noted with the use of tea tree oil. The number of cases of allergic contact dermatitis due to tea tree oil has been increasing. Khanna et al reported the case of allergic contact dermatitis to tea tree oil that presented with an extensive erythema multiforme-like id reaction in the December 2000 issue of the American Journal of Contact Dermatitis. In the March 2003 issue of Clinical and Experimental Dermatology, Perrett et al describe a patient in whom linear IgA disease appears to have been precipitated by a contact reaction to tea tree oil. Of greatest concern is the report by Mozelsio et al in the January-February 2003 issue of Allergy and Asthma Proceedings of a 38 year old man who experienced immediate flushing, pruritus, throat constriction, and lightheadedness after topical application of tea tree oil. The patient had a positive wheal and flare reaction on intradermal testing with tea tree oil. No specific IgG or IgE was detected. When my patients ask me what of think of alternative medicine, I quote the editorial by Fontanarosa and Lundberg from the November 11th, 1998 issue of JAMA, entitled "Alternative Medicine Meets Science". I agree with their assessment that there is no alternative medicine, just medicine. If novel uses for so-called natural substances such as the herbs discussed in this dialogue can be studied objectively by the same standards used for any new investigational new drug, and are proven to be efficacious with a tolerable side-effect profile, I would be delighted to endorse their use.

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