Ozone in Dermatology – Between Science and Therapy

Ozone therapy is increasingly utilized in dermatology owing to its multimodal antimicrobial, anti-inflammatory, antioxidant, and regenerative properties; however, its clinical implementation remains heterogeneous and the quality of supporting evidence varies across indications. This review critically evaluates the mechanisms of action, clinical applications, safety profile, and future perspectives of ozone therapy in dermatological practice. A structured literature search of PubMed, Scopus, and Web of Science covering the period from January 2000 to December 2024 identified 60 eligible human studies, which were assessed according to study design and methodological quality. Biologically, ozone exerts its effects through controlled oxidative stimulation, leading to activation of the Nrf2/EpRE pathway, improvement of microcirculation, and promotion of immunomodulation, tissue oxygenation, and wound healing. Moderate-quality evidence supports the use of ozone as an adjunctive treatment for chronic ulcers and burns (evidence level B), while limited to moderate evidence suggests potential benefits in acne, atopic and seborrheic dermatitis, cutaneous infections, and psoriasis (evidence levels C–D). Aesthetic and regenerative applications remain largely experimental (evidence level D). When administered by trained professionals using appropriate protocols, ozone therapy demonstrates a generally favorable safety profile, with adverse events being infrequent and typically mild. Overall, ozone therapy shows meaningful therapeutic potential as an adjunctive modality in dermatology, particularly for chronic and treatment-resistant dermatoses; nevertheless, broader adoption will require standardized dosing and delivery protocols, high-quality randomized clinical trials, and robust long-term safety data, supported by continued technological advances and molecular research to enable more targeted, evidence-based integration into clinical practice.