Four RCTs (n=421) were included, of which 3 were of double-blind design .
Trial 1 (Jadad score 2; n=124).
Patients with mild-to-moderate acne were prescribed 5% water-based TTO gel or 5% water-based benzoyl peroxide lotion, both applied daily for 3 months. Lesions decreased with both treatments but inflamed lesions were significantly better with benzoyl peroxide compared with TTO; noninflamed lesions were comparable. Fewer patients experienced adverse events with TTO (44 versus 79%).
Trial 2 (Jadad score 3; n=120).
Patients with tinea pedis (proven by culture) were prescribed 10% TTO cream, 1% tolnaftate cream or placebo cream, all applied twice daily for 4 weeks. At the end of the treatment period, 30% of the TTO group, 85% of the tolnaftate group and 21% of the placebo group had negative cultures (non significant difference between TTO and placebo), and clinical improvement was experienced by 65, 58 and 41%, respectively (the difference between TTO and placebo was statistically significant). No adverse events were reported.
Trial 3 (Jadad score 5; n=117).
Patients with subungual onychomycosis received either 100% TTO or 1% clotrimazole twice daily for 6 months. At the end of trial, 18% of TTO-treated patients and 11% of control patients had negative cultures. Full or partial resolution of symptoms was experienced by 60 and 61% of patients, respectively. At 3-month follow-up, these figures had declined to 56 and 55%, respectively. None of these differences were statistically significant.
Trial 4 (Jadad score 4; n=60).
Patients received either 2% butenafine hydrochloride and 5% TTO cream or a cream of TTO only for toenail onychomycosis, applied thrice daily for 8 weeks. The overall cure rates (resolution of clinical symptoms, negative culture, and progressive growth of normal nail) at 9 months were 80% for the combined cream and 0% for controls. Four patients in the combined cream group experienced mild inflammation.