Traditional medicine has made use of many different plant extracts for treatment of fungal infections and some of these have been tested for in vitro antifungal activity. This systematic review evaluated antifungal herbal preparations that have been tested in CCTs. Four electronic databases were searched for CCTs of antifungal herbal medicines. Data were extracted in a standardised manner by two independent reviewers and were reviewed narratively. Seven clinical trials met the inclusion criteria. Melaleuca alternifolia (tea tree) oil preparations were tested in four RCTs and some positive outcomes were attributed to the intervention in all trials. Solanum spp. (two trials) and Citrus aurantium (bitter orange) oil preparations (one trial) were compared with conventional treatments. In all cases encouraging results were reported. There are few CCTs of herbal antifungal medicines. The most thoroughly clinically tested is M. alternifolia oil, which holds some promise. All herbal remedies require further investigation in rigorous clinical trials.