OZONE
THERAPY IN THE DERMATOLOGY
In
the dermatology "the universality" of ozone therapy is explained by
physico-chemical properties of medical ozone and a wide range of its
therapeutic effects: bactericidal, viricidal, fungicidal, anti-inflammatory,
stimulating, immunomodulating. More often ozone therapy is used in a complex
with traditional methods to speed up the healing process, but it can also be
used as a monomethod. A treatment course of one nosological form includes
several methods of ozone therapy.
In
the dermatology the most frequently used methods are minor ozonated
autohaemotherapy in the treatment of allergodermia, acne, herpes; ozone
chambers in the treatment of varicose symptocomplex (as a variant - ozone caps
in the treatment of alopecia areata); intravenous infusions of ozonated saline
solution in the treatment of angiitis, severe forms of allergodermia, alopecia,
lichen planus; subcutaneous ozone injections in the treatment of alopecia, acne
disease, lipodystrophy.
One
of the central mechanisms of positive action of O3 in different diseases is
correction of hypoxic conditions by increasing deformability of the
erythrocytes, partial oxygen tension in arterial blood, by improving release of
oxygen by oxyhemoglobin.
Immunomodulating
effects of ozone therapy are related to an increase in the production of
cytokines. Of particular interest is the report of H. Kief (1993) about an
increase in the level of interleukin 2 and gamma-interferon through ozone
therapy provided to patients with allergosis (food allergy, bronchial asthma,
atopic dermatitis).
The
investigation into the effect of ozone therapy on the course of HIV-infection
was a starting point for studying the mechanism of immunocorrective properties
of O3. The results of the experiments "in vitro" have shown that
ozone is able to inactivate extracellular HIV in the organism's liquids and
suppress the growth of intracellular HIV in concentrations being safe for
cells. It has been established that the antiviral effect of ozone includes
destruction of virus particles, inactivation of reverse transcriptase and
disability of virus to adhere its receptor to target cells. The investigations
have shown that by conveying O3 through virus-containing liquid it comes to
complete inactivation of virus, chronically infected cells treated with ozone
lose their ability to initiate infection in case of joint cultivation with
intact sensitive cells. Thus, O3 is a promising method of inactivation of human
retroviruses in the organism's liquids and blood preparations.
The
experimental investigations conducted by Italian scientists V.Bocci and
L.Paulesu in 1990 established that ozone acts on monocytes and lymphocytes as
an inductor of cytokines towards the production of interferon and tumor necrosis
factor and apparently on many other immune functions as well. V.Bocci supposes
that these cytokines in turn can activate further lymphoid cells, lead to
immunostimulation without side effects. Of great importance are the data about
absence of carcinogenic and teratogenic effects of moderate ozone
concentrations. The use of high ozone concentrations for external applications
allows achieving a viricidal effect. Through interaction of microorganisms with
high ozone concentrations it comes to elimination of both bacteria and viruses
resulted from oxidative destruction of their capsulated membrane. Cleavage
products of DNA and RNA were found out through ozone by different authors.
Disturbances of physical properties of membranes occur due to changes in the
composition of their lipid fraction in case of excessive free-radical
oxidation. The mechanism of action of high ozone concentrations is of great
importance for practical medicine i.e. for treatment of trophic ulcers, burn
surfaces and infected wounds with ozone/oxygen gas mixtures.
Nowadays,
dermatovenereology and dermatocosmetology are the fields of medicine where
ozone therapy is widely used in the form of parenteral methods of introduction,
treatment of damaged areas with O2/O3 gas mixtures and ozonized external
remedies, in particular ozonized olive oil. High ozone concentrations are
indicated for bactericidal and mycocidal action, low ozone concentrations - for
inactivation of viruses and immunomodulating effects. The mechanisms of
sanogenesis of ozone therapy in atopic dermatitis are most well-investigated.
It has been shown that improvement of clinical picture is associated with
normalization of immune indices, activation of some enzymatic antioxidants
along with non-stimulation of lipid peroxidation, increase in the levels of
histaminopexia and serotoninopexia. Nowadays, ozone therapy of atopic
dermatitis is performed in the form of minor ozonated autohaemotherapy, rectal
insufflations of O2/O3 gas mixtures, intravenous infusions of ozonated saline
solution, major ozonated autohaemotherapy, applications with ozonized olive
oil. Thanks to similar etiology and pathogenesis ozone therapy is effective in
another allergodermia as well, in particular - eczema. The generally accepted
method of laboratory control over efficiency and safety of ozone therapy is
determination of lipid peroxidation products, spectrum of enzymatic
antioxidants, in particular superoxiddismutase and catalase of the erythrocytes
and integral index - total antioxidant plasma activity.
The
ability of ozone to inactivate viruses is used in the treatment of dermatosis
of viral etiology, in particular herpes, the method of choice is major ozonated
autohaemotherapy. J.Delgano et al. (1997) reported about efficiency of
subcutaneous injections of O2/O3 in the treatment of pemphigus.
The
use of ozone therapy in the treatment of viral diseases is especially actual in
the conditions of growing spread of HIV-infection. The important aspect
explaining a positive influence of ozone therapy in AIDS is the action of ozone
on causative agents of opportunistic infections (herpes, mycosis,
folliculitis). Besides, ozone can not only inactivate HIV, but also stimulate
immunocompetent cells through normalization in the level of T-helpers and
relationship Tx/Tc. The efficient antiviral effect of ozone is proved by
evidence about complete disappearance of pointed condylomas in women after
applications with ozone-containing drug products. Nowadays, ozonized olive oil
has a hygienic certificate and is a remedy for cosmetic care. Its production
requires lengthy perfusion of O2/O3 gas mixture with high ozone concentrations
through a column of olive oil. As a result of reaction between ozone and
unsaturated fatty acids it comes to formation of peroxides characterized by low
reactivity. While gaseous ozone exerts an instant bactericidal effect, the
effect of ozone-related oily products can last for many hours. Ozonized olive
oil has well-manifested fungicidal properties and can be efficiently used in
the treatment of onychomycosis caused by Tr. rubrum and yeast fungi.
Ozonized
olive oil is also used in the treatment of trophic ulcers, microbic eczema,
chronic ulcerous pyoderma, herpes. The use of ozonized olive oil in the
treatment of different pyodermas is proved by in vitro investigations of its
bactericidal activity.
The
high therapeutic efficiency of ozone therapy can be considered as a basis for
its successful use in dermatocosmetology. Nowadays, ozone therapy is used in
the treatment of acne, cicatricial changes, alopecia, for correction of age
related changes. Ozone therapy is most widely used in the form of subcutaneous
injections of O2/O3gas mixtures.
One
of variants for external application of O3 is balneotherapy that can be used in
both large dermatological clinics and SPA salons. Baths with ozonated mineral
water are indicated for disturbances of peripheral blood circulation,
varicosity, tropic ulcers, eczemas. Mineral water facilitates improvement of
diffuse processes in skin so that tissues, blood bed and lymphatic system
receive not only oxygen and ozone, but also mineral substances.
In
the treatment of acne minor ozonated autohaemotherapy is recommended for use.
Nowadays, ozone therapy is considered as a successful method of treatment for
acne rash of moderate stage of severity as well as acne conglobata. The
dynamics of indices of pro- and antioxidant systems through ozone therapy in
acne rash is well studied. In many cosmetological clinics priority is given to
cosmetic injections of O2/O3 gas mixtures into and around the elements of acne
rash that should not exclude the systemic methods of ozone therapy.
Besides,
nowadays ozone therapy is also used in cosmetological surgery. Subcutaneous
ozone injections at concentrations of about 10 mg/L during the operations of
liposuction and blepharoplasty provide a disinfectant, oxygenizing and healing
effect. At the pre-operative stage the patients can receive rectal
insufflations with O2/O3 gas mixture that facilitates detoxication of the
patient's organism and improvement of operation results. There are some reports
about the successful use of ozone therapy for correction of failures in the
field of injection cosmetology and lipoplasty.
There
are some reports about the efficiency of minor ozonated autohaemotherapy,
intravenous infusions of ozonated physiological saline and subcutaneous ozone
injections in the treatment of alopecia. In 106 patients with alopecia areata
it came to normalization of the initially decreased level of oxygen in the area
of alopecia proved by oxymetric method, oxygen deficit in hairs decreased
according to the data of gas analysis.
In
the treatment of different forms of scleroderma ozone therapy is used as a
component of complex treatment in the form of minor ozonated autohaemotherapy,
ozone chambers and ozone injections.
The
treatment of patients with local lipodystrophy and indurative hypodermatitis by
means of subcutaneous injections of O2/O3 gas mixture showed well-manifested
efficiency of ozone therapy in comparison with traditional methods. J.L.Cidon
(1977) believes that subcutaneous introduction of O2/O3 gas mixture is a
promising method of treatment for cellulites through exposure on degenerative
changed fatty tissue. A positive effect of ozone in cellulites and local lipodystrophy
can be explained by its influence on the metabolism of fatty tissue and
improvement of blood circulation in damaged areas. The Medozons Company
manufactures modified models of medical ozone generators with a multi-injector
for low-flow injections of O2/O3 gas mixtures at great volumes into problem
areas, this method received very positive reviews.
Of
great interest is correction of vascular defects by means of ozone. In the
foreign literature there are some reports about intravascular introduction of
O2/O3 gas mixture with high ozone concentrations that results in instant
coagulation of vascular wall, this method can be used in the treatment of
telangiectasia and "vascular stars". Our own observations have shown
a good perspective for ozone therapy in complicated forms of rosacea in the
form of ozone injections in the field of telangiectasia into the lumen of
vessel at ozone concentration of 10 mg/L in combination with subcutaneous ozone
injections at ozone concentration of 5 mg/L according to the method of
mesotherapy. A positive effect of this new method is characterized by regress
of telangiectasia, decrease in facial tissue swelling, regress of pustular
rash. We are now developing methods of mesotherapy with ozone for treatment of
different complicated forms of rosacea, including pustular, conglobated,
granulomatous as well rhinophyma and phymas of different localizations.
Pathogenetic links of pathogenesis of rosacea, namely vascular disturbances,
disorder of derma connective tissue shell, immune shifts give us a hope for
successful use of ozone therapy in the treatment of this pathology providing
serious competition to laser methods.
For
today the influence of ozone therapy on the pathology of connective tissue is
terra incognita. There are made first attempts of treatment of hypertrophic and
keloid scars by means of ozone injections, gathered a successful clinical
experience in the treatment of patients with collagenoses proved by positive
dynamics of immune indices, data of lipid peroxidation and antioxidant system,
improvement of metabolic indices of connective tissue (regulatory protein and
fibronectin) in the treatment of patients with atopic dermatitis. Of interest
is the investigation of proteolytic activity in the course of ozone therapy.
The effects of ozone allowing successfully using ozone in gerontocosmetology
are apparently connected with changes of collagenic fibers and certainly - with
improvement of oxygen release to tissues, activation of enzymatic antioxidants
(in particular catalase of the erythrocytes and superoxiddismutase) that
performs an important role in the inhibition of skin aging process.
