Ozone Therapy in Dermatology: Mechanisms and Clinical Applications

Background

Ozone gas and ozonated preparations have been used in dermatology for decades, largely on the strength of anecdotal reports and small case series rather than systematic scientific study. Ozone (O3) is a highly reactive form of oxygen that can act on the skin either directly - as a gas or dissolved in water - or via ozonated oils, in which ozone is bubbled through a vegetable oil to create longer-lasting active compounds. Researchers Jinrong Zeng and Jianyun Lu set out to draw together the scattered laboratory and clinical evidence on how ozone actually works against skin disease, and to identify where the gaps in that evidence remain.

Study design

This is a narrative literature review, not a new clinical trial or laboratory experiment. The authors synthesised findings from existing cell-based (in vitro), animal, and human clinical studies published on ozone therapy in dermatology. They organised the evidence around three ways ozone is delivered in skin practice - ozone hydrotherapy (ozonated water applied to the skin), ozonated oil (typically ozonated olive or sunflower oil applied topically), and ozone autohemotherapy (where a small volume of the patient's own blood is treated with ozone outside the body and then reinfused) - and considered how each is used across infectious, allergic, and wound-related skin conditions.

Findings

The review groups ozone's reported effects on skin into four categories: antimicrobial action against a range of gram-positive and gram-negative bacteria, viruses and fungi; immunoregulation, meaning changes to the activity of immune cells and signalling molecules; antioxidant defence, in which controlled ozone exposure appears to trigger the body's own protective enzyme systems; and epigenetic modification, referring to changes in how genes are expressed rather than changes to the genes themselves. Ozonated oil and ozone hydrotherapy were most commonly reported in the context of infections, allergic skin reactions, scaly erythema-type disorders, and wound healing, while autohemotherapy was described mainly as a systemic adjunct. Notably, the authors were explicit that "the exact mechanisms of ozone-therapy still remain unclear" - a gap in the underlying evidence rather than a settled result.

What the authors concluded

Zeng and Lu concluded that ozone shows biological activity relevant to several skin conditions, and that its several proposed mechanisms make it a plausible complementary option in dermatology. Their tone was cautious rather than declarative: they stated that additional evidence is needed before ozone can be considered a fully validated treatment for the skin conditions discussed.

Limitations of this study

As a narrative review rather than a systematic review, the paper does not describe a pre-registered search protocol, formal quality scoring of the studies it draws on, or a quantitative pooling (meta-analysis) of results, so its conclusions reflect the authors' synthesis rather than a standardised appraisal. Much of the underlying evidence it cites comes from in vitro and animal work rather than well-controlled human trials, and the three ozone delivery methods discussed vary considerably in dose, concentration, and duration between the studies referenced, making direct comparisons difficult. The authors themselves note that the precise mechanisms remain unclear, and the review does not report new safety or dosing data of its own.