# Topical ozone application for severe acne with serological evidence of prior varicella-zoster infection after unsuccessful antibiotic and corticosteroid treatment: a case report

## TL;DR

A 16-year-old girl with severe acne unresponsive to antibiotics and steroids showed rapid improvement using topical ozone treatments.

## Contribution

This case report introduces topical ozone application as a novel treatment for refractory acne fulminans.

## Key findings

- Topical ozone application led to rapid reduction of inflammation and purulent lesions.
- Conventional treatments failed to control the patient's condition and caused systemic complications.
- Ozonated water and ozonated olive oil showed clinical benefit in managing severe acne.

## Abstract

Acne fulminans is a rare and extreme form of inflammatory acne, which is characterized by the sudden onset of painful, ulcerative nodules and systemic symptoms such as fever, malaise, arthralgia, leukocytosis, and potential scarring.

We present the case of a 16-year-old white European (Polish) female patient with acne vulgaris that progressively worsened despite treatment with oral isotretinoin, estrogens, topical antibiotics, and corticosteroids. She subsequently developed systemic complications, including fever, malaise, severe musculoskeletal pain, and tachycardia, and was hospitalized, where she received corticosteroids, antibiotics, and isotretinoin; however, the inflammatory and purulent processes persisted. Following discharge, her condition further deteriorated, presenting as severe swelling, pustules, and inflammatory lesions. Upon consulting a different clinic, all previous medications were discontinued, and a treatment regimen involving topical ozone was initiated. This included washing with ozonated water (2.4 ppm) and applying ozonated olive oil (peroxide index 2300) twice daily. The therapy resulted in a rapid reduction of inflammation and purulent lesions, with significant improvement observed within days.

This case report suggests a potential benefit of combining ozonated water and ozonated oil as a novel therapeutic approach for refractory acne fulminans.

This case report describes the use of topical ozone application in the management of severe acne with apparent clinical benefit.Conventional treatments, including antibiotics, corticosteroids, and oral isotretinoin, did not control the patient’s condition and were associated with systemic complications.Topical application of ozonated water and ozonated olive oil was followed by rapid improvement in inflammation and purulent symptoms.This case provides preliminary observational evidence supporting the potential of ozone application as an adjunctive therapy in managing refractory acne, particularly when associated with viral factors or resistance to standard treatments.

This case report describes the use of topical ozone application in the management of severe acne with apparent clinical benefit.

Conventional treatments, including antibiotics, corticosteroids, and oral isotretinoin, did not control the patient’s condition and were associated with systemic complications.

Topical application of ozonated water and ozonated olive oil was followed by rapid improvement in inflammation and purulent symptoms.

This case provides preliminary observational evidence supporting the potential of ozone application as an adjunctive therapy in managing refractory acne, particularly when associated with viral factors or resistance to standard treatments.