Cutaneous fungal infections can be classified into infections that are limited to the stratum corneum, hair and nails and, infections that are seen deeper in the skin, involving the dermis and the subcutaneous tissues. Superficial mycoses include: tinea versicolor, tinea nigra, pityrosporum folliculitis, tinea corporis, tinea cruris, tinea barbae, tinea capitis, tinea pedis, and tinea unguium. Numerous genera are responsible for superficial mycoses including, but not limited to: Malassezia, Trichophyton, Microsporum and Epidermophyton. Diagnosis and treatment of these infections can pose a challenge. Topical antifungals may be ineffective if the organism exhibits resistance to the antifungal agent. Additionally, the topical antifungals themselves can cause allergic and irritant skin reactions. Oral agents are sometimes used when topical agents are not helpful and these agents are associated with a high incidence of systemic side effects. Many patients seek “alternative” approaches to traditional therapy to avoid these potential side effects. Worldwide, many plants are used to treat various bacterial and fungal infections. While some have been looked at in vitro, a minuscule percentage of these plants have been subjected to controlled clinical trials (Martin and Ernst 2004). Here we present primary and secondary considerations for treatment of fungal infections with plant derivatives, though it must be emphasized that much of the evidence in this section is fairly thin.

See Figs. 13.1 and 13.2

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See Tables 13.1 and 13.2.

Tea tree oil is an essential oil from the leaves of the Australian native tree, Melaleuca alternifolia. The indigenous people of Australia have used tea tree oil from crushed leaves as a traditional remedy for coughs and colds as well as to treat wounds and skin infections. Tea tree oil is commonly used as a topical antimicrobial agent. There have been a number of papers describing the antiseptic properties of tea tree oil, which has potential antibacterial activity through disruption of bacterial membranes (Carson et al. 2006). It is important to counsel patients that tea tree oil can be very irritating and a source of allergic contact dermatitis (Knight and Hausen 1994). Tea tree oil has been shown to have activity against dermatophytes in vitro (Hammer et al. 2002).

Coriander (Coriander sativum) is an annual herb in the family Apiaceae. Although coriander is the seed of the cilantro (Chinese parsley) plant, their flavors and properties are very different and they cannot be substituted for each other. Coriander has both culinary and medicinal applications. It is common in South Asian, Southeast Asian, Middle Eastern and Latin American cuisine, to name only a few. In addition to culinary uses, coriander has been touted as having many medicinal and pharmacological applications including: anti-microbial, anti-oxidant and anti-inflammatory properties (Sahib et al. 2013). Essential coriander oil has shown antibacterial activity towards many bacterial strains including Streptococcus pyogenes, and methicillin-resistant Staphylococcus aureus (MRSA) in vitro (Casett et al. 2012). In addition, in vitro studies also indicate that coriander essential oil shows promise in eradicating Candida (Freires et al. 2014).

The bitter orange (Citrus aurantium) is native to Southeast Asia. During the 10th and 11th centuries traders introduced the plant to the Mediterranean and the Spanish and the Portuguese brought the plant to the Americas in the fifteenth century. Globally it is widely cultivated. The bitter orange is an evergreen tree that can grow up to 10 m with long spines and very fragrant flowers. The entire plant is used for various purposes from culinary to medicinal to body care. From the flowers comes Neroli oil which is a popular oil used in fragrances. From the leaves and twigs comes Petitgrain essential oil, also used in aromatherapy and perfumery (DerMarderosian and Beutler 2012). The extracts from the plant have been looked at for their potential anti-inflammatory, antibacterial, anti-cholesterol and antifungal properties. Neroli oil, extracted from blossoms of the bitter orange tree has been shown, in vitro, to have antibacterial activity against Pseudomonas aeruginosa as well as strong antifungal activity when compared to Nystatin (Ammar et al. 2012).