Is there any benefit to ozone therapy?

Limited Benefits of Ozone Therapy in Clinical Practice

Based on current high-quality evidence, ozone therapy has very limited proven benefits and carries significant safety concerns, making it not recommended for most clinical applications.

Evidence on Ozone Therapy Applications

Potential Limited Applications

• Digital Ulcers in Systemic Sclerosis: One small RCT showed efficacy of oxygen-ozone therapy on ulcer healing and pain reduction, but the follow-up period was only 20 days 1. Blinded and placebo-controlled studies are still needed to validate these findings.

• Diabetic Foot Ulcers: While some research suggests potential benefits, the 2020 International Working Group on the Diabetic Foot (IWGDF) guidelines found that topical ozone therapy was not more effective than standard care for ulcer healing 1.

Safety Concerns

Ozone is recognized as a toxic gas with significant health risks:

• Respiratory Effects: Even at low concentrations (0.1 ppm), ozone can stimulate the upper respiratory tract and urinary tract 1
• Moderate Exposure (1.0-2.0 ppm): Can cause rhinitis, cough, nausea, retching, and asthma 1
• Higher Exposure (2-5 ppm): Brief inhalation (10-20 min) can cause breathing difficulties, bronchospasm, and retrosternal pain 1
• Severe Exposure: Inhalation for 4 hours at 10 ppm could cause death, while 50 ppm could be fatal within minutes 1

Material Damage

Ozone can cause significant damage to materials:

• Destroys molecular chain network structure of natural rubber products
• Causes oxidative degradation of plastic materials
• Generates potentially harmful byproducts when reacting with surface materials 1

Regulatory Limitations

Multiple regulatory agencies have established strict exposure limits:

• U.S. Environmental Protection Agency: 0.08 ppm for 8 hours
• Occupational Safety and Health Administration: 0.10 ppm for 8 hours
• Food and Drug Administration: 0.05 ppm for 8 hours 1

Clinical Considerations

Specific Applications with Limited Evidence

1. Water Disinfection: Ozone may be effective for inactivating pathogens in water systems, but generates potentially harmful byproducts 1

2. Surface Disinfection: While effective against some microorganisms, practical application is limited by safety concerns and material damage 1

3. Wound Healing: Evidence is inconsistent and of poor quality, with most high-quality studies showing no benefit over standard care 1

Conclusion

Despite some research suggesting potential applications in specific conditions like digital ulcers or diabetic foot ulcers, the overall evidence for ozone therapy remains weak, inconsistent, and often of poor methodological quality. The significant safety concerns, including respiratory toxicity and material damage, further limit its clinical utility.

Healthcare providers should be aware that ozone therapy carries substantial risks that likely outweigh any potential benefits for most clinical applications. Standard evidence-based treatments should be prioritized over ozone therapy until more robust evidence emerges.