Comparing the Effects of Tea Tree Oil (Melaleuca Alternifolia) and Conventional Topical Dressing on Healing of Second-Degree Burn Wounds
Phase: EARLY_PHASE1
Conditions: Burn
Sponsor: Alexandria University

 
Comparing the Effects of Tea Tree Oil (Melaleuca alternifolia) and 
Conventional Topical Dressing on Healing of Second-Degree Burn Wounds" 
Heba Elsayed1† (PhD), Hoda Fathy2†(PhD), Mohamed Ahmed Seweed3(PhD), Thoraya 
Mohamed Abdelaziz1(PhD) 
Study protocol 
Ethical committee approval date:10/1/2021 
 
 

 
Introduction 
 
Burn is one of the most devastating injuries that have a catastrophic effect on 
people in terms of human life, suffering, disability, and financial loss. Burns are 
the third leading cause of accidental death in the United States; approximately5000 
people die each year from burns. Each year an estimated 2 million Americans 
experience burns severe enough to seek medical care (1,2). 
In Egypt, minimal studies discussed epidemiological records of burn, 
however it has been reported that burn cases were around 100.000 in 2018. 
Statistical records of the Burn Unit at the Main University Hospital; Alexandria, 
revealed that; 314 burn cases were admitted to unit in 2020 (3,4).  
 
Burns are caused by transfer of energy from a heat source to the body; which 
may be transferred through conduction or electromagnetic radiation. The depth of 
the injury depends on the temperature of the burning agent and the duration of 
contact with that agent. Burns are categorized as thermal (which include electrical 
burns), radiation, or chemical, in which tissue destruction results from coagulation, 
protein denaturation, or ionization of cellular contents.(5, 6) 
 
Wound healing is a complex process, involves optimizing patient local and 
systemic conditions in conjunction with an ideal wound healing environment. 
Many different products have been developed to influence this wound environment 
to provide a pathogen-free, protected, and moist area for healing to occur. Newer 
products are currently being used to replace or augment various substrates in the 
wound healing cascade; such as Silver, Negative Pressure Wound Devices, Skin 
Substitutes, Growth Factors and Biologic Wound Products, Hyperbaric Oxygen, 
and herbal therapy (6, 7). 
Burn hospital wound’s protocols vary, but the most common wound cleaning 
involves saline and povidone-iodine (Betadine). Wound is cleansed at each 
dressing change and is observed for signs of infection and rate of healing. This may 
be done in the hydrotherapy tub, shower, or at bedside (8, 9). 

Recent studies showed that alternative therapies are used as first aid 
treatment for burns as Aloe Vera, saliva and a tea tree oil impregnated dressing 
applied as first aid to a porcine deep dermal contact burn, results of it showed 
significantly decrease sub dermal temperature within the skin during the treatment 
period (10-12). 
Tea tree oil [TTO] (Melaleuca alternifolia) is a clear, colorless to pale 
yellow liquid, and is insoluble in water. It is lipophilic and works through 
penetrating the skin and mucous membranes. The active ingredients responsible for 
killing bacteria and fungi in TTO include terpinene-4-ol, alpha-terpineol and 
alphapinene, which inhibit cell respiration and disruption of cell membrane 
permeability with the resultant leakage of potassium (13, 14). 
 
Inherent in the previous statements, is the belief that there is a need to 
investigate whether TTO would be more cost effective, enhance rapid healing than 
the conventional topical agent. 
 
Aim of the study 
Compare the effect of two topical dressing techniques on the healing of 
second degree burn wounds; melaleuca alternifolia (tea tree oil) and conventional 
dressings. 
Operational definition 
Conventional dressing: 
       Sterile topical gauze dressing are impregnated with or laid over a topical 
antibiotic, silver sulphadiazine with adhesive tape to secure dressing.  
Materials and method 
 
Materials 
Design:  An experimental design will be utilized. 
Setting: The present study will be conducted at the burn unit, Alexandria Main 
University Hospital, Alexandria, Egypt. 
Subject: A convenient sample of 50 patients admitted to burn unit suffering from 
second-degree burns will be included in the present study.  
The fifty patients will be sequentially enrolled into two equal groups:- 
 The first group (25 patients) will be managed conventional dressings 
(control group). 

 The second group (25 patients) will be managed by local application tea tree oil 
(study group).  
Patient's inclusion criteria will include: 
 Adults of both genders (18-60 years), able and willing to cooperate and 
communicate. 
  Newly admitted to the study setting with recent 2nd degree burns whether 
superficial or deep ≤10%TSBA. 
 Free of associated illness that affect wound healing as DM, immune 
disorder, or associated injuries. 
 Free from pre-existing skin conditions such as eczema 
Tools: Two tools will used on this study: 
   Tool I: (Burn patient’s assessment sheet) 
This tool will mainly aim to assess burn parameters (as extent, depth, and 
cause of burn), criteria of wound healing (as wound color, appearance of burn 
wound, signs of infection and presence of exudates). It will be comprised of three 
parts. 
Part I: Patient Sociodemographic data: including: 
- Personal characteristics: as Patients' age, gender, level of education, 
occupation, date of burn, date of admission, date of discharge and habits.  
-  Patient history including past and present history. 
Part II: Laboratory studies: 
 Complete blood count. 
 Serum proteins. 
 Electrolytes. 
Part III: Burn parameters:  This part will include data regarding: Site of burn, 
extent, cause, and depth. 
Part IV: Type of wound dressing: Whether TTO or Conventional dressing. 
Tool II: (Burn wound follow up sheet) 
This tool will comprise two parts: 
      -Morphological changes of the wound: 
 This part will be used to assess burn wound healing, and determine signs of 
infection including signs of inflammation as wound color, presence of exudates 
(amount, color, and type), size, depth, edema, as well as frequency of dressing 
change. 
- Photographic pictures: 

Colored digital photographs will be taken three times to assess        
wound healing process (day of burn, each other day till healing and 
after one month) 
 
Method 
 
1. Written approval will be obtained from the hospital administrator and head of 
Burn Department, after explanation of the study aim.  
2. The study tools will be developed by the researcher after review of relevant 
literature.  
3. The developed tools will be submitted to 5 experts in the fields of plastic 
surgery &burn and Medical Surgical Nursing to test its content validity and 
necessary modification will be done accordingly.  
4.  Reliability of the tool will be tested. 
5. Ethical considerations: 
a. Patient's written informed consent will be obtained after explanation of the 
study aim.  
b. Confidentiality, privacy and right of withdrawal will be assured.  
c. Ethical committee approval will be obtained. 
6. Pilot study will be conducted on 5 patients for testing, clarity, feasibility and 
applicability of the developed tools and modification will be done. 
7. The study subjects meeting inclusion criteria and will be sequentially divided 
into two groups, the first group will receive conventional dressing (control 
group), and this dressing will be changed routinely once every other day. For 
the second group the wound will be dressed by TTO, which will be changed 
every other day till healing occurs. This frequency is advocated, since more 
frequent dressing change will interfere with granulation tissue formation. 
8. All burn wound will be washed gently with Saline, and all open blister and 
loose non-viable tissue will be removed from the burn, intact blisters will be 

left, and then the topical agents will be applied directly on wound. Burns 
involving body joints will be kept in functional position.  
9. Initial assessment of all patients will be done using tool I. Subsequent 
assessment will be done on 4th, 14th,21th of topical dressing agents use until the 
wound healing from both groups using tool II. 
10. Colored digital photographs will be taken-if possible- to assess wound healing 
process at the (day of burn, each other day till healing, after one month) 
11. Initial and ongoing assessment results for the conventional dressing, compared 
to TTO dressings, will be carried out using appropriate statistical methods. 
 
 
Statistical Analysis Plan (SAP):
 
 
Data will be analyzed using IBM SPSS software package version 23.0. The Shapiro-Wilk 
will be  used to verify the normality of distribution of variables; Comparisons between groups 
for categorical variables will be assessed using Chi-square test (Monte Carlo or Fisher Exact). 
Student t-test will be used to compare two groups for normally distributed quantitative variables, 
Mann Whitney test will be used to compare two groups for not normally distributed quantitative 
variables, Friedman Test for multiple comparisons between the different periods in each group. 
Significance of the obtained results will be judged at the 0.5% level. 
 
Results
 
 
The collected data will be analyzed, categorized and tabulated, the appropriate 
correlation and significant test will be done. 
 
 
 
 
Discussion 
 
 

Discussion of the obtained findings will be done based on the current related 
literature.  
 
 
 
 
Conclusions and Recommendations 
 
 
Conclusion and recommendation will be developed from the discussion.  
 
 
 
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