Ozone Treatment for Skin and Dermatology

At a Glance:

1. Skin conditions typically involve many factors, such as the gut, gut flora, toxicity, immune system, infections, skin flora, nutritional status, and even stress
2. Conventional treatments typically focus on the skin’s appearance, sometimes at the expense of overall health. Ozone therapy addresses immune functions, skin flora, and other factors that may underlie the skin issue. In addition, topical ozone therapy can stimulate the healing process and collagen production. 
3. Ozone oil may be effective for eczema, acne, skin ulcers, and other types of skin infections. 
4. Ozone-oxygen gas injections under the skin may improve skin healing and the appearance of cellulite and stretch marks.
5. Systemic ozone treatments and gut ozone treatments may deliver some skin benefits.

Recent research suggests that skin conditions involve more than the skin or your hygiene. Your skin reflects the health of your entire body, especially your gut health and flora, immune system, and toxicity levels. For example, the gut-skin axis explains how various changes in the gut flora and their communication with the skin can contribute to skin conditions [1]. This also explains how various systemic ozone therapies, such as IV or rectal insufflation, can improve skin health. 

Conventional dermatology addresses symptoms, such as by killing bacteria or suppressing skin immune responses just to clear the skin. However, the underlying dysfunctions, such as inflammation, dysbiosis, or toxicity, often remain. As a result, symptoms can return after stopping treatments or manifest elsewhere in the body. In many cases, the side effects can thin or sensitize the skin, or affect overall long-term health. 

In contrast, oxygen-ozone therapy in the skin works by [2]:

• Inhibiting inflammation (NF-kB)
• Jump-starting your skin’s antioxidant response 
• Stimulating a type of balancing immune cells called regulatory T cells, while reducing autoimmune response or excess chronic inflammation [3]
• Stimulating the skin's regenerative pathways and growth factors
• Improving the composition of skin flora
• Improving the composition of the gut flora (rectal insufflation, drinking ozone water, and ozone oil ingestion) [4]
• Treating infections 
• Stimulating mitochondrial functions
• Delivering oxygen to the skin and wound areas that lack blood flow

There is a time and place for both approaches, and neither is 100% effective. This article aims to provide information to help you make informed decisions. 

Note: diabetic complications and ulcers will be primarily discussed in our ozone therapy for diabetes article. 

What Are Ozone Skin Treatments?

Topical (skin) ozone treatments involve using therapeutic (low) concentrations of ozone or an ozone-treated medium to improve skin health. These include the topical application of ozone-oxygen gas, ozonated oil, ozonated water, and ozone injections [5]. 

Ozone sauna 

An ozone sauna combines the therapeutic benefits of steam, heat, and ozone therapy to enhance overall skin health and well-being. In this treatment, ozone gas is introduced into a steam sauna, which should be sealed to prevent ozone gas inhalation. 

The ozone gas doesn’t cross the skin barrier. However, the gas reacts with fats and other molecules in the skin, creating ozonides and other byproducts. The smaller ozonides and byproducts such as 4-hydroxynonenal (4-HNE) can be absorbed into the bloodstream, delivering some skin and whole-body effects [6, 7]. At low, therapeutic doses, 4-HNE activates Nrf2 in skin cells [8].

Application Techniques:

• Steam Infusion: The ozone sauna generates steam, heating the skin and opening its pores, which facilitates the absorption of ozonides and other ozonated byproducts.
• Ozone Introduction: Ozone-oxygen gas is infused into the sauna chamber, where it delivers antimicrobial benefits and creates ozonides in the skin.

Application Uses:

• Detoxification: Ozone saunas help detoxify the body by promoting sweating and eliminating toxins through the skin.
• Skin Health: May improve skin conditions and rejuvenation 
• Circulation: Ozone saunas enhance blood circulation, improving oxygen delivery to tissues 

By combining the benefits of steam and ozone, ozone saunas offer a comprehensive approach to skincare, aiding in detoxification, improving skin conditions, and promoting general well-being.

Ozone bagging

Ozone limb bagging is a targeted ozone therapy technique used to treat localized skin conditions and infections in the limbs. This method involves enclosing the affected limb in a plastic bag, and then filling the bag with ozone gas.

Application Techniques:

• Sealed Environment: The limb is placed in a plastic bag that is sealed to prevent ozone leakage.
• Ozone Infusion: Ozone-oxygen gas is pumped into the bag, ensuring the limb is fully exposed to the gas.
• Duration: The limb remains in the bag for a specified period, typically around 20-30 minutes, to maximize the therapeutic effects.

Application Uses:

• Wound Healing: Effective for chronic wounds, diabetic ulcers, and bedsores. It promotes faster healing and reduces infection
• Infections: Treats localized skin infections by utilizing ozone's potent antimicrobial properties
• Inflammatory Conditions: Reduces inflammation in conditions such as eczema and psoriasis, promoting skin regeneration and relief

Ozone limb bagging provides a focused approach to treating various skin issues on the limbs, leveraging ozone’s powerful antimicrobial and healing properties.

Topical ozone oil application

Topical ozone oil and ozone oil-based cream deliver ozonides and their byproducts to the skin [9, 10]. 

The ozonation process saturates culinary oil with ozone in a temperature-controlled reactor for up to 10 days. This creates an oil product that can disinfect and stimulate beneficial physiologic processes. At low therapeutic doses, the ozonated byproducts [2]:

• Activate antioxidant responses (Nrf2) 
• Inhibit inflammation (Nf-kB)
• Stimulate a type of balancing immune cells called regulatory T cells [3]
• Activate growth factors and regenerative pathways in the skin

The net effect is the re-balancing of inflammation without suppressing the immune system or thinning out the skin aside from the first few days.

Ozone creams may be a suspension of oil in water or other emollient to help moisturize the skin. They may improve the absorption of the ozone oil into the skin. These treatments are applied directly to affected areas, offering a non-invasive and effective option for improving skin health and addressing persistent dermatological issues.

Applications:

• Wound Healing: Ozone oil and cream can be used to treat chronic wounds, diabetic ulcers, and bedsores, accelerating healing and preventing infection.
• Skin Infections: These products are effective against common skin infections, including those caused by Staphylococcus aureus and other resistant bacteria.
• Inflammatory Skin Conditions: Ozone treatments can help manage conditions such as eczema and psoriasis by reducing inflammation and promoting skin repair.

By utilizing the therapeutic properties of ozone in oil and cream form, these topical applications provide a versatile and potent solution for a range of skin issues, enhancing overall skin health and accelerating the healing process.

Ozone water

Ozone water is a solution where ozone (O₃) is dissolved in water, creating a powerful antimicrobial agent used for various dermatological applications. The ozonation process involves passing ozone gas through water, which results in a solution that can effectively kill bacteria, viruses, and fungi [9, 11].

Application Techniques:

• Topical Wash: Ozone water can be used as a rinse or wash for wounds, ulcers, and other infected areas. It disinfects the tissues and promotes healing by reducing microbial load and inflammation.
• Compresses: Soaked in ozone water, compresses can be applied to the skin to treat specific lesions or infections, providing localized antimicrobial effects.
• Baths: For more extensive skin conditions, ozone water baths can be used to treat larger body areas, improving skin health and hygiene.

Application Uses:

• Wound Care: Ozone water is particularly effective in managing chronic wounds, diabetic ulcers, and bedsores by preventing infection and promoting faster healing.
• Infections: It is used to treat various skin infections, including those caused by antibiotic-resistant bacteria.
• Skin Conditions: Ozone water helps in managing inflammatory skin conditions like eczema and psoriasis, reducing inflammation and promoting skin repair.

By harnessing ozone’s disinfectant and healing properties, ozone water provides a versatile and effective treatment option for a wide range of dermatological issues, enhancing overall skin health and accelerating the recovery process.

Ozone facial

Ozone facials are a rejuvenating skin treatment that utilizes ozone’s antioxidant and healing properties to improve skin health and appearance. This technique involves applying ozonated oils or using ozone steam to deliver ozone directly to the facial skin [12, 13].

Application Techniques:

• Ozone Steam: Ozone is infused into steam, which is then directed onto the face. 
• Ozonated Oils: Ozonated olive or sunflower oil is massaged into the skin.

Application Uses:

• Acne Treatment: Ozone facials help reduce acne by killing bacteria and reducing inflammation.
• Anti-aging: Ozone’s antioxidant properties reduce wrinkles and improve skin elasticity, promoting a youthful appearance.
• Skin Detoxification: Ozone facials cleanse the skin by removing toxins and impurities, leading to a clearer complexion.

Ozone facials offer a non-invasive, effective method to enhance skin health, address acne, and reduce signs of aging, providing a comprehensive approach to skincare.

Ozone resurfacing or exfoliation

Ozone resurfacing, or exfoliation, is a skin treatment that combines ozone’s oxidative properties to remove the skin’s top layers. This method removes dead skin cells and stimulates the production of new, healthy cells, improving the skin's texture and appearance.

Application Techniques:

• Ozone Peels: Ozonated solutions are applied to the skin to exfoliate and remove dead cells and the skin’s outer layer.
• Ozone Microdermabrasion: Uses ozonated crystals or other instruments to gently exfoliate the skin.

Application Uses:

• Skin Rejuvenation: Enhances skin texture, reduces fine lines, and promotes a youthful glow.
• Acne Scars: Helps in reducing the appearance of acne scars and hyperpigmentation.
• Sun Damage: Repairs and rejuvenates sun-damaged skin, improving overall complexion.

Ozone resurfacing/exfoliation offers a powerful method to rejuvenate the skin, addressing various skin concerns and promoting a healthier, more vibrant complexion.

Ozone injection under the skin

Ozone injection under the skin, also known as subcutaneous ozone therapy, involves injecting ozone gas directly into the subcutaneous tissue to harness its therapeutic properties [14]. The ozone gas may also be mixed with another modality, such as platelet-rich plasma.

Application Techniques:

• Subcutaneous Injection: Ozone gas is injected into the tissue just beneath the skin using a fine needle. The injection targets specific areas of concern, such as inflamed or infected tissues.

Application Uses:

• Pain Management: Reduces pain and inflammation in conditions such as arthritis and joint pain [15].
• Skin Healing: Promotes healing of wounds, scars, and other skin conditions by enhancing oxygen delivery and stimulating tissue regeneration [5].
• Anti-inflammatory: Helps reduce local inflammation and boosts the body's natural healing processes.

Ozone injection under the skin provides a targeted and effective method to treat various conditions, leveraging ozone’s powerful therapeutic effects to promote healing and reduce inflammation.

Systemic Ozone Treatments that May Help the Skin

Ozone autohemotherapy

Ozone autohemotherapy is a systemic treatment whereby a patient’s blood is exposed to ozone and then reinfused into their body. This method harnesses ozone’s immune-modulating and healing properties to enhance overall health [9].

Application Techniques:

• Blood Extraction: A small amount of blood is drawn from the patient.
• Ozonation: The blood is mixed with a specific concentration of ozone-oxygen gas.
• Reinfusion: The ozonated blood is infused into the patient’s bloodstream.

Application Uses:

• Immune Modulation: Enhances the body’s immune response, making it effective for autoimmune diseases and infections.
• Anti-inflammatory Effects: Reduces inflammation throughout the body, so is beneficial for chronic inflammatory conditions.
• Improved Circulation: Promotes better blood flow and oxygen delivery to tissues, aiding in overall health and recovery.

Ozone autohemotherapy offers a comprehensive approach to improving systemic health by utilizing ozone’s therapeutic benefits through the patient's own blood.

Ozone rectal insufflation

Rectal insufflation is a systemic treatment whereby ozone-oxygen gas is delivered through the rectum. Oxygen and ozone reactants are then absorbed through the gut wall into the bloodstream, delivering some systemic benefits. Studies and case reports have shown benefits outside the gut, including some skin and autoimmune conditions. Rectal insufflation may also help kill gut infections in the large intestine or promote a healthy gut flora, which is important for healthy skin [5].

How Does Ozone Therapy Help with Each Skin Condition?

Eczema

Eczema, or atopic dermatitis (AD), is a chronic inflammatory skin condition characterized by itchy, red, and swollen skin. 

Eczema has multiple contributing causes including genetics, allergies, inflammation, gut dysbiosis, and mental-emotional factors. Conventional medicine considers it to have no cure, but manages it with immunosuppressants such as steroids and cytokine blockers.

In some cases, the skin bacteria Staphylococcus aureus (S. aureus) can worsen symptoms and trigger flare-ups. 

Ozone therapy and topical ozone oil help with eczema by leveraging ozone’s bactericidal and immune-balancing properties. 

A randomized split-side clinical trial evaluated the effects of topical ozone therapy on microbiome diversity in eczema lesions. The study involved patients with moderate to severe bilateral eczema lesions. One side of each patient was treated with ozone hydrotherapy followed by ozonated oil, while the control group was treated with tap water and the same non-ozonated culinary oil. 

Treatment with ozone hydrotherapy and ozonated oil resulted in higher micro-ecological diversity after ozone treatment (p < 0.05), and a marginal reduction in the S. aureus proportion after ozone treatment (p = 0.07). The eczema severity was also significantly reduced compared to the control group. The study concluded that topical ozone therapy is highly effective for treating eczema by altering the skin flora, normalizing inflammation, reducing harmful bacteria, and promoting a healthier skin environment [16].

Acne

Acne is a common skin disorder where the hair follicles become clogged with dead skin cells and natural fats found in the skin. Many factors contribute to acne, including:

• Inflammation
• Certain species of skin bacteria such as Propionibacterium acnes (P. acnes) and Cutibacterium acnes [17]
• Poor blood sugar control, high insulin, or insulin resistance in up to 81% of acne patients (even without diabetes) [17]
• Hormones, especially high androgens [18]
• Gut dysbiosis and intestinal permeability [19]

Conventional treatments focus on skin appearance using drugs such as with topical benzoyl peroxide and retin-A, which irritate the skin and may increase sun sensitivity. In some cases, the doctor may also prescribe oral antibiotics, hormonal birth control, and Accutane, which can have long-term negative health impacts.

In contrast, topical ozone treatments can improve the skin flora, reduce inflammation, and stimulate healing, which may reduce the appearance of scars. Systemic ozone therapies and ingesting ozone oil capsules can work on the gut flora and lining, while temporarily improving blood sugar control.

There is limited clinical evidence of ozone therapy for general acne, however. One study found topical ozone gas on the skin to be ineffective against P. acnes [20]. The effect of ozone therapy on acne could be individual, since every case is different.

A case study involving a 34-year-old male with chronic severe acne explored the efficacy of ozone therapy. The patient had previously failed to respond to antibiotics and steroids and experienced significant pain and psychological distress. Over a year, the patient underwent multiple ozone treatments, including topical ozonated oil, full-body bag topical ozone, intralesional ozone, and minor autohemotherapy. 

The results were promising, with the patient reporting:

• A reduction in the number and severity of lesions
• Decreased pain
• Reduced lesion drainage
• Improved life outlook
• Decreased alcohol intake

This case demonstrates that ozone therapy can be a safe and effective treatment option for severe, debilitating acne, providing significant relief and improving the patient's quality of life [21].

Ringworm

Ringworm, or tinea, is a common fungal infection affecting the skin, causing red, itchy, circular rashes. Traditional treatments include antifungal creams and medications, but ozone therapy offers an alternative due to its potent antifungal, immune-stimulating, and regenerative properties.

A randomized, blinded study evaluated the efficacy of ozonated water and oil on 60 patients with tinea pedis (athlete's foot). The control group received naftifine hydrochloride and ketoconazole cream (antifungal), while the ozone group received ozonated water baths and ozonated oil applications daily for four weeks. 

Clinical and laboratory data were collected at the end of the 1st, 2nd, and 4th weeks. Results showed that at the end of the treatment, one patient in the ozone group and six in the control group tested positive for the infection, with no significant difference in clinical signs and symptoms scores between the groups at any time. No side effects were observed. The study concluded that the combination of ozonated water and oil is effective and safe for treating tinea pedis [22].

Skin ulcers

Skin ulcers, particularly chronic and infected wounds, pose a significant challenge in medical treatment as antibiotic therapy tends not to be effective.

Ozone therapy offers a promising solution for enhancing the healing process of such ulcers.

A case report detailed the successful treatment of a 52-year-old woman with a chronic ulcer on her right lower leg, resulting from previous orthopedic surgery. The comprehensive treatment included pharmacotherapy, compression therapy, and 30 sessions of local ozone therapy. 

The ulcer healed completely, and the patient's pain decreased significantly (from 9.0 to 0.5 on the visual analog scale). Additionally, the patient's quality of life improved markedly, as measured by the EuroQol scale (from 10 to 90 points). This case demonstrates that local ozone therapy can significantly enhance the healing of chronic wounds, alleviate pain, and improve overall quality of life [23].

Skin cancer

Ozone therapy addresses many features of cancer, such as [24] 

• Low oxygen use due to the Warburg effect reducing mitochondrial function. As a result, many cancer cells find oxygen toxic.
• Inflammation
• Suppressed or evaded immune system that allows the cancer cells to grow

Most of the research on ozone therapy for skin cancer is in the preclinical stage or done in a test tube. One study delivered ozone oil into melanoma skin cells with a delivery system that penetrates the cells. It found that ozone oil is toxic to melanoma [25]. Another study applied 50 gammas of ozone gas to melanoma cells in the test tube, and found reduced inflammation [26]. We still need more clinical studies or studies in a whole animal to confirm its effectiveness.

Ozone therapy also supports the healing following skin cancer surgery, particularly in enhancing the success of grafts and flaps used in reconstructive procedures. Its regenerative and antimicrobial properties can significantly improve postoperative outcomes, reducing complications and promoting faster tissue regeneration.

A study examined the effectiveness of ozone therapy in enhancing the healing of grafts and flaps used in surgical reconstruction after skin cancer removal. Patients received ozone therapy tailored to individual needs. Postoperative monitoring focused on wound closure, tissue viability, and healing progression. 

Results indicated that ozone therapy, combined with standard postoperative protocols, achieved a 100% recovery rate in several challenging cases. Patients reported high satisfaction levels, and the approach proved cost-effective. The study concluded that incorporating ozone therapy into skin cancer surgery reconstruction significantly improves patient outcomes, both functionally and aesthetically [27].

Wound healing

Ozone therapy has demonstrated significant benefits in promoting wound healing due to its antimicrobial and tissue-regenerative properties [28].

Topical application of ozonated oils enhances the healing process by treating infections, reducing inflammation, and promoting tissue repairs.

An animal study evaluated the effects of topical ozonated olive oil on acute cutaneous wound healing in guinea pigs. Full-thickness skin wounds were created on the backs of guinea pigs, which were then treated with ozonated olive oil (ozone group), pure olive oil (oil group), or no treatment (control group). 

The ozone group showed significantly smaller wound sizes and residual wound areas compared to the oil group on days 5 and 7 (P<0.05 and P<0.01, respectively). Histological analysis revealed increased collagen fiber intensity and fibroblast numbers in the ozone group. 

Immunohistochemical staining indicated upregulation of PDGF, TGF-beta, and VEGF in the ozone group, suggesting enhanced wound repair mechanisms. Topical ozonated olive oil accelerates wound healing by increasing growth factors and enhancing collagen production [29].

Skin autoimmune conditions

Ozone therapy can address autoimmune skin conditions by balancing the immune system and improving tissue oxygenation. 

Psoriasis

Psoriasis is a chronic autoimmune skin condition characterized by the abnormal growth and reduced differentiation of a type of skin cells called keratinocytes. Differentiation is when a cell stops growing in numbers and becomes a specialized cell. 

Ozone therapy modulates the disease’s underlying mechanisms, such as autoimmunity and growth genes.

A cell and clinical study investigated the effects of ozone therapy on psoriasis, focusing on its impact on keratinocyte behavior and autoimmune markers. The study found that ozone oil treatment reduced the production of keratin 6 (KRT6), IL-17, and IL-22 proteins, which are associated with keratinocyte growth within psoriasis lesions. 

In both psoriasis patients and mice models, ozone therapy reduced keratinocyte proliferation while enhancing Tp63-mediated transcription of KRT10, promoting keratinocyte differentiation.

The study concluded that ozonated oil could be an efficient and safe treatment for psoriasis by promoting the differentiation of keratinocytes to improve the condition [30].

Scleroderma 

Scleroderma, also known as systemic sclerosis (SSc), is a chronic autoimmune disease characterized by hardening and tightening of the skin and connective tissues. This condition often leads to complications such as fingertip ulcers (digital ulcers or DUs), which are resistant to conventional treatments and impair daily activities. 

Ozone therapy, with its anti-inflammatory and vasodilatory properties, shows promise in treating scleroderma-related complications.

A randomized controlled trial investigated the efficacy of local oxygen-ozone therapy in twenty-five SSc patients with resistant digital ulcers. Patients were randomized into two groups: one received medical treatment plus local ozone therapy (ozone group, n = 13), and the other received only medical treatment (control group, n = 12). Hand functions were assessed using the Health Assessment Questionnaire (HAQ) and the Modified Hand Mobility in Scleroderma (HAMISm) test. 

After 4 weeks, the ozone group showed a significantly higher efficacy rate (92% vs. 42%, p = 0.01) and improvements in clinical parameters, HAQ, and HAMISm scores compared to the control group (P < 0.05). The study concluded that local oxygen-ozone therapy effectively treats resistant digital ulcers in SSc patients, improving clinical outcomes and functional disability [31].

Raynaud's 

Raynaud's phenomenon is a condition characterized by episodes of reduced blood flow to the extremities, typically triggered by cold or stress. This results in color changes, numbness, and pain in the affected areas [32]. 

Ozone therapy may help with Raynaud’s by modulating immune function and improving blood flow.

A case study focused on a systemic sclerosis (SSc) patient who experienced significant improvement in Raynaud's phenomenon through ozone autohemotherapy. 

The patient showed a clear reduction in Raynaud's episodes and resolution of hand edema (swelling). Evaluation of the capillaries revealed rapid and sustained improvements in microcirculation. Ozone therapy, which functions as an oxygen donor, immunomodulator, and inducer of antioxidant enzymes, was effective in treating Raynaud's symptoms and enhancing microcirculation. 

Ozone therapy could be a valuable complementary treatment for patients unresponsive to conventional therapies or experiencing adverse drug reactions. Further studies are needed to confirm these findings in larger populations [33].

Ozone Anti-aging and Aesthetic Benefits for Skin

Improves skin elasticity and increases collagen

By stimulating the skin's natural healing processes, ozone enhances collagen synthesis. Collagen is an essential protein for maintaining firm and youthful skin.

An animal study examined the effects of ozonated Aloe vera oil on wound healing in Sprague-Dawley rats, focusing on collagen thickness and fibroblast numbers. Collagen thickness and the number of fibroblasts were significantly higher in the treatment (ozone) group compared to the control group on days 3 and 7, as shown by Masson's trichrome staining and microscopic evaluation (p = 0.001). The study concluded that ozonated Aloe vera oil effectively enhances collagen production and fibroblast activity, accelerating wound healing [34].

Normalizes antioxidant response

Ozone therapy helps normalize the antioxidant response by inducing moderate oxidative stress, which activates nuclear factor-erythroid 2-related factor 2 (Nrf2) [35]. 

Nrf2 then stimulates the transcription of antioxidant response elements (ARE), leading to the production of various antioxidant enzymes, including:

• Superoxide dismutase (SOD)
• Glutathione peroxidase (GPx)
• Catalase (CAT) 

These enzymes play a critical role in:

• Protecting cells from oxidative damage and inflammation
• Reversing chronic oxidative stress
• Maintaining cellular health

Promotes healthy skin flora

Ozone therapy can significantly improve skin flora by leveraging its antimicrobial properties. By reducing harmful bacteria and promoting a balanced microbial environment, ozone therapy enhances overall skin health. This is particularly beneficial for conditions like acne, where bacterial colonization plays a critical role.

A cell study examined the efficacy of High Frequency (HF) ozone therapy on skin flora and Propionibacterium acnes (P. acnes) in vitro, utilizing a commercial device. HF therapy was found to significantly reduce bacterial and fungal species, including a marked decrease in P. acnes colonies compared to controls. 

The study provided a mechanistic basis for HF therapy as a complementary acne treatment, although further in vivo studies are necessary to assess clinical effects. The results suggest that HF therapy, by producing ozone, can beneficially impact skin health by altering microbial flora  [36].

Balances skin immune response

Ozone therapy enhances the skin's immune response by modulating inflammatory pathways and promoting the production of immune-regulating proteins. 

This therapy can help manage chronic inflammatory skin conditions, such as psoriasis, by reducing excessive immune activity and fostering a balanced immune environment.

A combination study explored the impact of ozone therapy on psoriasis in twenty patients. After receiving 13.5% ozonated oil, tissue samples were analyzed. 

Ozone therapy decreased the levels of KRT6, IL-17, and IL-22 proteins within psoriasis lesions while increasing KRT10 and Tp63 proteins. Ozone treatment also down-regulated KRT6 and up-regulated KRT10 mRNA and protein expression in IL-22 treated keratinocytes.

The study concluded that ozonated oil could be an effective and safe treatment for psoriasis by promoting keratinocyte differentiation and improving immune response, thereby alleviating psoriasis symptoms [30].

Tightens crepey or sagging skin and wrinkles

Ozone therapy has shown potential in addressing signs of aging such as crepey, sagging, or wrinkly skin. This therapy leverages ozone’s antioxidant and regenerative properties  to enhance skin health and appearance.

Ozone can work to promote:

• Collagen Stimulation: Ozone therapy promotes the production of collagen and elastin, essential proteins for skin elasticity and firmness [2].
• Improved Circulation: Enhances blood flow to the skin, providing essential nutrients and oxygen, which help in skin rejuvenation [14].
• Antioxidant Effects: Reduces oxidative stress, which is a major contributor to skin aging.

Application modalities may include:

• Topical Ozonated Oils: Applying ozonated oils can stimulate collagen production and reduce uneven skin appearance
• Ozone Saunas: Ozone saunas can improve overall skin tone by enhancing circulation and promoting detoxification.
• Ozone Injections: Subcutaneous ozone injections target specific areas to reduce wrinkles and improve skin firmness.

By stimulating collagen production, improving circulation, and reducing oxidative stress, ozone therapy can effectively combat signs of aging, leading to smoother, firmer, and more youthful-looking skin.

Improves the appearance of cellulite and stretch marks

Ozone therapy can theoretically be used to treat cellulite and stretch marks. The therapeutic actions of ozone align well with the clinical manifestations of these conditions, which involve oxidative stress and inflammation in the affected adipose tissue [37].

Ozone may help through:

1. Reduction of Oxidative Stress: Ozone activates the Nrf2 pathway, which regulates the body's antioxidant response, reducing local and systemic oxidative stress.
2. Anti-inflammatory Effects: It decreases the production of pro-inflammatory cytokines and mediators, which are often elevated in cellulite.
3. Lipid Oxidation: Ozone causes lipid oxidation in the fatty acids of adipocyte membranes, destroying fat cells under the skin
4. Enhanced Microcirculation: Improves blood flow and eliminates stagnant interstitial fluids, reducing chronic cellulitis swelling
5. Increased Skin Elasticity: Ozone boosts skin tone and elasticity, important for treating flaccid cellulite.

Various protocols suggest using ozone therapy concentrations up to 10 μg/ml, combined with local ozone injections and rectal insufflation. 

Additional techniques, such as gluteal macro-vents (suction cups) and electrotherapeutic resources (radiofrequency, ultrasound, etc.), can enhance treatment outcomes [37].

Table source [37]

Side Effects of Ozone Skin Treatments

Temporary irritation or redness

One common side effect of ozone therapy is temporary irritation or redness at the application site. 

This occurs due to ozone’s oxidative nature, which can cause mild inflammation as it interacts with the skin's surface. The redness and irritation are generally short-lived and subside within a few hours to a day. 

This reaction is a result of the skin's response to the oxidative stress induced by ozone, similar to how the skin reacts to other treatments that stimulate healing and regeneration processes. 

It is usually a mild and manageable side effect, indicating the skin's engagement with the therapeutic process.

Accidental inhalation

Accidental inhalation of ozone can lead to respiratory irritation and discomfort. Ozone is a strong oxidant and can cause inflammation of the airways, leading to symptoms such as [38]:

• Coughing
• Throat irritation
• Shortness of breath
• Chest pain

In some cases, ozone inhalation can exacerbate existing respiratory conditions like asthma or chronic obstructive pulmonary disease (COPD). Prolonged or high-level exposure can result in more severe respiratory issues, necessitating medical attention.

It is crucial to ensure proper ventilation and safety measures when using ozone therapy to avoid inhalation.

Other Potential Side Effects of Ozone Therapy

In addition to temporary skin irritation and redness, and respiratory issues from accidental inhalation, ozone therapy can have other side effects. These include:

• Skin Sensitivity: Temporarily increased sensitivity to sunlight or cosmetic products.
• Allergic Reactions: Rare but possible, causing rashes or hives.
• Pain or Discomfort: Mild pain or discomfort at the injection or application site.
• Infection Risk: If not properly administered, there is a potential risk of infection from non-sterile equipment.

Disclaimer

Ozone therapy for skin treatments should always be conducted under the supervision of a qualified health professional. Due to ozone’s potent oxidative properties, improper use can lead to adverse effects such as skin irritation, respiratory issues, and other complications. 

It’s a good idea to consult an ozone-trained physician to ensure the correct dosage, application method, and safety protocols are followed to minimize risks and maximize therapeutic benefits.

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13 Ozone Facial Treatment https://www.biohealthspa.com/services/wellness/ozone-facial-treatment

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15 Feng, X. and Beiping, L. (2017) Therapeutic Efficacy Of Ozone Injection Into The Knee For The Osteoarthritis Patient Along With Oral Celecoxib And Glucosamine. J. Clin. Diagn. Res. 11, UC01–UC03 

16 Zeng, J., Dou, J., Gao, L., Xiang, Y., Huang, J., Ding, S., et al. (2020) Topical Ozone Therapy Restores Microbiome Diversity In Atopic Dermatitis. Int. Immunopharmacol. 80, 106191 

17 Hasrat, N. H. and Al-Yassen, A. Q. (2023) The Relationship Between Acne Vulgaris and Insulin Resistance. Cureus 15, e34241 

18 Bagatin, E., Freitas, T. H. P. de, Rivitti-Machado, M. C., Machado, M. C. R., Ribeiro, B. M., Nunes, S., et al. (2019) Adult Female Acne: A Guide To Clinical Practice. An. Bras. Dermatol. 94, 62–75 

19 Sánchez-Pellicer, P., Navarro-Moratalla, L., Núñez-Delegido, E., Ruzafa-Costas, B., Agüera-Santos, J. and Navarro-López, V. (2022) Acne, Microbiome, and Probiotics: The Gut-Skin Axis. Microorganisms 10 

20 Gloor, M. and Lipphardt, B. A. (1976) Studies On Ozone Therapy Of Acne Vulgaris. Z. Hautkr. 51, 97–101

21 Davis, V. G. (2018) Clinical Improvement of Severe Chronic Acne Conglobata. Case Report. Revista Española de Ozonoterapia

22 Lu, J., Guo, M., Ligui, H., Wu, K., Xiang, Y., Huang, J., et al. (2018) Efficacy Of Combination Of Ozonated Water With Oil For Treatment Of Tinea Pedis. Zhong Nan Da Xue Xue Bao Yi Xue Ban 43, 147–151 

23 Pasek, J., Stanek, A., Szyluk, K. and Cieślar, G. (2022) Ozone Therapy in the Comprehensive Treatment of Leg Ulcers: Case Report. Adv. Skin Wound Care 35, 1–5 

24 Barba, I., Carrillo-Bosch, L. and Seoane, J. (2024) Targeting the Warburg Effect in Cancer: Where Do We Stand? Int. J. Mol. Sci. 25 

25 Fahmy, S. A., Ramzy, A., Sawy, A. M., Nabil, M., Gad, M. Z., El-Shazly, M., et al. (2022) Ozonated Olive Oil: Enhanced Cutaneous Delivery via Niosomal Nanovesicles for Melanoma Treatment. Antioxidants (Basel) 11 

26 Simonetti, V., Franzini, M., Iaffaioli, R. V., Pandolfi, S., Valdenassi, L. and Quagliariello, V. (2018) Anti-Inflammatory Effects of Ozone In Human Melanoma Cells And Its Modulation of Tumour Microenvironment. International Journal of Advanced Research 6, 1196-1203 

27 Feltrim, E., Portes, G. M., Costa, A. M. A., Abadia, F. A., de Morais, I. A., Neto, J. G. F., et al. (2024) Optimizing Healing: Evaluating Ozone Therapy’s Impact On Skin Cancer Surgery Reconstruction At The Amazon Head And Neck Surgery Center. EJC Skin Cancer, Elsevier BV 2, 100062 

28 Borges, G. Á., Elias, S. T., da Silva, S. M. M., Magalhães, P. O., Macedo, S. B., Ribeiro, A. P. D., et al. (2017) In Vitro Evaluation of Wound Healing and Antimicrobial Potential of Ozone Therapy. J. Craniomaxillofac. Surg. 45, 364–370 

29 Kim, H. S., Noh, S. U., Han, Y. W., Kim, K. M., Kang, H., Kim, H. O., et al. (2009) Therapeutic Effects Of Topical Application Of Ozone On Acute Cutaneous Wound Healing. J. Korean Med. Sci. 24, 368–374 

30 Gao, L., Dou, J., Zhang, B., Zeng, J., Cheng, Q., Lei, L., et al. (2020) Ozone Therapy Promotes The Differentiation Of Basal Keratinocytes Via Increasing Tp63-Mediated Transcription Of KRT10 To Improve Psoriasis. J. Cell. Mol. Med. 24, 4819–4829 

31 Kaymaz, S., Karasu, U., Alkan, H., Ulutaş, F., Albayrak Yaşar, C., Dündar Ök, Z., et al. (2022) Efficacy Of Local Oxygen-Ozone Therapy For The Treatment Of Digital Ulcer Refractory To Medical Therapy In Systemic Sclerosis: A Randomized Controlled Study. Mod. Rheumatol. 32, 1102–1107 

32 Haque, A. and Hughes, M. (2020) Raynaud’s Phenomenon. Clin. Med.  20, 580–587 

33 Galluccio, F. (2022) Rapid and Sustained Effect of Ozone Major Autohemotherapy for Raynaud and Hand Edema in Systemic Sclerosis Patient: A Case Report. Cureus 14, e31831 

34 Taqwim Hidayat, A., Thohar Arifin, M., Nur, M., Muniroh, M. and Susilaningsih, N. (2021) Ozonated Aloe Vera Oil Effective Increased the Number of Fibroblasts and Collagen Thickening in the Healing Response of Full-Thickness Skin Defects. Int. J. Inflam. 2021, 6654343 

35 Sagai, M. and Bocci, V. (2011) Mechanisms Of Action Involved In Ozone Therapy: Is Healing Induced Via A Mild Oxidative Stress? Med. Gas Res. 1, 29 

36 Frommherz, L., Reinholz, M., Gürtler, A., Stadler, P.-C., Kaemmerer, T., French, L., et al. (2022) High-Frequency Devices Effect In Vitro: Promissing Approach In The Treatment Of Acne Vulgaris? An. Bras. Dermatol. 97, 729–734 

37 Borges, F. dos S., Meyer, P. F., Jahara, R. S., de Morais Carreiro, E., Antonuzzo, P. A., Picariello, F., et al. (2021) Fundamentals Of The Use Of Ozone Therapy In The Treatment Of Aesthetic Disorders: A Review. J. Biosci. Med., Scientific Research Publishing, Inc. 09, 40–70 

38 Martínez-Lazcano, J. C., González-Guevara, E., del Carmen Rubio, M., Franco-Pérez, J., Custodio, V., Hernández-Cerón, M., et al. (2013) The Effects Of Ozone Exposure And Associated Injury Mechanisms On The Central Nervous System. Rev. Neurosci. 24, 337–352