Aceites Ozonizados y Dermatitis Atópica

(Versión Completa en Inglés)

Atopic dermatitis (AD) is a chronic and recurrent inflammatory skin disease that involves pruritus ie. itching (usually intense) and damage to the skin barrier, with skin lesions ranging from mild erythema, to severe lichenification and erythroderma. It affects about 20% of children and 10% of adults worldwide and usually presents itself alongside other conditions such as sleep disorders, anxiety, social isolation and depression[i].
The microbiome of AD patients´ lesions are occupied by about 90% Staphylococcus aureus (S. aureus), which contributes to a greater frequency of attacks and poor prognosis/worsening of the disease[ii]. Colonization of S. aureus contributes to the activation of type 2 (Th2) helper lymphocytes, the dominant immune phenotype in this type of AD[iii].
Several studies have shown that a prevalence of S. aureus significantly increases the acute phase of AD and strongly correlates with the severity of the disease presentation, whilst another group of typical skin bacteria, which includes, Propionibacterium, Corynebacterium, and Malassezia [iv] are found in reduced numbers. The fact is that the data indicates that the diversity of the skin microbiome influences the severity and type of AD lesions[v].
Ozone therapy, which uses Ozone – a classic oxidant and antiseptic, has demonstrated clinical success in processes that require an antimicrobial effect, potentiation of antioxidant defenses, immunoregulation, epigenetic modification, biosynthesis, vasodilation and analgesic effect. Ozonated Oils have been used in the treatment of cutaneous inflammatory and infectious diseases, as they can quickly and effectively relieve various symptoms, such as itching and edema, thus mitigating the severity of the disease[vi].
In a comparative study carried out in 2019, a total of 12 AD patients between 6 and 28 years of age were pooled to verify the efficacy and safety of using ozonated oil on injured and uninjured atopic skin. This study found that about 7 out of 12 patients had a high ratio of S. aureaus in the cutaneous microbiome, the presence of Staphylococcus epidermis (S. epidermis) and Staphylococcus capitis (S. capitis) as well. Additionally, 8 of the patients displayed a history of asthmatic bronchitis and/or rhinitis.

Efficacy of ozone therapy in AD

Before the intervention, clinical manifestations of maculopapular lesion (rash), erosion and exudation were visible, especially in the areas of flexion of the limbs (inner area of the arms/elbow, knees, neck, armpits) where the skin is usually very dry.
After treatment, there was an attenuation (a reduction of effect) of inflammatory papules and edema. Observed in the samples with reflectance confocal microscopy (RCM). Thus, we understand that less infiltration of inflammatory cells occurred in the epidermis, compared to the samples before treatment.
Another way to verify the effectiveness of the treatment was by using modified[1] SCORAD and EASI scales that indicated a 22.15% decrease in symptoms after only three days of treatment. At the end of the treatment, symptoms decreased by about 48%, and we can therefore conclude that Ozone Therapy significantly mitigates AD lesions.

Diversity of the lesion microbiome vs severity

It was also verified that there is a direct relationship between the diversity of the microbiome and the severity of clinical manifestations, lesions and recurrence of AD, thus proving that the locations susceptible to greater damage/injury are those where there is less bacterial diversity.

Effect of Ozone Therapy on Skin Microecology

Ozone therapy has been applied in medicine as a strong oxidant that eliminates microorganisms and is used in over 50 pathological conditions, including skin diseases[vii].
Skin microbiome imbalance has a negative impact on inflammatory and immune responses in AD, contributing to its severity[viii].
The presence of S. aureus is associated with the exacerbation and recurrence of AD[ix] and S. aureus proliferation which can lead to the spread of P. acnes, (a common bacterium of the skin microbiome) through the production of virulence factors and causing endogenous epidermal proteolysis, alongside damage to the skin barrier[x].
Evidence shows that uninjured skin in AD patients has greater bacterial diversity and the application of ozonated oils can both restore balance and increase microbiome diversity.
Treatment with ozonated oils significantly decreases the proportion of Staphylococcus (which is excessively elevated) in the skin microbiome of patients with moderate to severe AD lesions[xi].
In addition to Ozone´s bactericidal properties, it also allows microbiological diversity restoration in AD lesions, with a decrease of around 75% in Staphylococcus strains, possible in just three days of treatment[xii].
As for other strains, such as the Acinetobacter, group, which are conditionally pathogenic, although their presence induces dendritic cell immune tolerance and inhibition of type 1 (Th1) T helper lymphocyte polarization, thus reducing the allergic reaction[xiii]. Other indications show that A. ropheus can stimulate the monocyte and keratinocyte production of interleukin 10 (IL-10) in order to modulate the Th1/Th2 cell differentiation ratio and, thereby, exert an anti-inflammatory effect[xiv].
Additionally, treatment with ozonated oils increases the proportion of Acinetobacter species, which has a direct effect on disease severity and Staphylococcus overgrowth.

Conclusion

Treatment of patients with atopic dermatitis that can include baths with ozonated products, the application of oils and creams (whether over the whole body as a prevention, or applied locally for acute) phase treatment) can rapidly improve symptoms, relieving itching and reducing inflammation, whilst simultaneously rebalancing the skin´s microbiome, allowing a reduction of severity-enhancing agents, such as Staphylococcus, increasing the diversity of the skin’s microecology, reducing the size and severity of active lesions and enhancing the healing of injured skin. This is why ozonated products are considered extremely useful in this disease and a new and sensible approach in clinical practice, allowing the use of more natural and hypoallergenic.

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[1] Dermatitis assessment scales/tools using a clinical score developed and validated by a group of experts on atopic dermatitis

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