Medical Benefits of DMSO (Dimethyl Sulfoxide)
DMSO has limited FDA-approved medical benefits, primarily for interstitial cystitis, but shows potential in several off-label applications including as a penetration enhancer for other medications, for pain management, and in chemotherapy extravasation treatment. 1
FDA-Approved Use
- Interstitial cystitis: DMSO 50% aqueous solution (RIMSO-50®) is the only FDA-approved indication for intravesical instillation to provide symptomatic relief in patients with interstitial cystitis 1
- Not approved for bacterial infections of the urinary tract 1
Chemotherapy Extravasation Treatment
- Topical DMSO is recommended as a treatment option for extravasations occurring during anthracyclines, mitomycin C, or platin salts infusion [III, B] 2
- Important considerations:
- DMSO 99% can cause local erythema which may affect correct evaluation of tissue damage
- Some countries only have DMSO at 50% concentration available 2
Pain Management Applications
- DMSO has free-radical scavenging properties and penetrates tissue when applied topically, making it an effective vehicle for other pain medications 3
- DMSO can block conduction in peripheral nerve C fibers (pain-transmitting fibers), which may explain its analgesic properties 4
- Even low concentrations (5-7%) slow C fiber conduction
- Concentrations of 9% or higher can completely block C fiber conduction
- Higher concentrations (15%+) produce almost immediate nerve blockade
Dermatological Applications
Shows promise in off-label treatment of various skin conditions 5:
- Basal cell carcinoma
- Pressure ulcers
- Scleroderma
- Herpes simplex
- Cutaneous fungal infections
- Amyloidosis
In photodynamic therapy (PDT), DMSO has been used as a penetration enhancer:
Inflammatory Conditions
- Used in treating various inflammatory conditions of the lower genitourinary tract 6:
- Interstitial cystitis
- Radiation cystitis
- Chronic prostatitis
- Chronic female trigonitis
Pharmacological Properties
- At low concentrations, DMSO exhibits multiple beneficial properties 5:
- Anti-inflammatory
- Analgesic
- Diuretic
- Vasodilator
- Anti-platelet aggregation
- Radio-protective
- Muscle-relaxing
- Hydroxyl free radical scavenger (may explain benefits in skin rejuvenation and recovery from thermal injury)
Safety Considerations and Adverse Effects
Most common adverse reactions 7, 8:
- Gastrointestinal discomfort
- Skin reactions (rash, pruritus)
- Local erythema, especially at higher concentrations
- Characteristic garlic-like breath odor
Safety considerations:
- Most reactions are transient and mild
- Clear dose-relationship with adverse effects
- Generally safe in small doses
- Starting with lower concentrations (around 50%) is recommended to minimize skin irritation 3
- Safety of DMSO in combination with other drugs has not been fully established; neurotoxic interactions with sulindac have been reported 8
Practical Applications
As a penetration enhancer for other medications:
Concentration considerations:
- Higher concentrations increase both efficacy and side effects
- Most adverse effects can be minimized by using more dilute solutions 8
DMSO remains a compound with significant potential beyond its limited FDA approval, particularly as a penetration enhancer and for pain management. However, more rigorous clinical trials are needed to fully establish its efficacy for many of its off-label uses.