Dermatology
The Potential of HBOT in Treating Dermatological Conditions
Introduction
Hyperbaric oxygen therapy (HBOT), in which the patient breathes a mix of gases (usually with a higher percentage of oxygen) in a pressurised chamber, is approved for several dermatological conditions, including burns and radiotherapy-induced dermatitis, and may benefit patients with other skin disorders. HBOT results in increased oxygen delivery to tissues and has anti-inflammatory and tissue regenerative properties. Although HBOT is not currently approved for the treatment of many skin conditions, a variety of dermatological issues have been treated off-label or in clinical trials, in particular, psoriasis and atopic dermatitis. Given that dermatological conditions may involve inflammation, hypoxia, immune dysregulation, and barrier dysfunction, HBOT may offer a novel adjunctive approach for their management.
During HBOT at OxyGeneration, clients breathe 94% – 98% oxygen in a chamber in which the pressure (2 ATA) is around twice that of normal atmospheric pressure for >60 minutes (with 10 minutes to compress and 10 minutes to decompress) for multiple sessions.
Hyperbaric Oxygen Therapy (HBOT) consists of breathing oxygen at a pressure higher than local atmospheric pressure for multiple sessions for the treatment or prevention of specific diseases. As per the European Code of Good Practice (Kot et al.), there is a general consensus that the term HBOT can only be applied when the partial pressure of oxygen in breathing mixture exceeds 1.5 absolute atmosphere (ATA) for a minimum period of 60 minutes (excluding compression and decompression). The pathogenesis of many dermatological conditions, such as psoriasis and dermatitis, is characterised by immune dysregulation, impaired skin barrier function, and localised tissue hypoxia, and HBOT may counteract these processes by enhancing oxygen delivery to tissues (Cannelotto et al., 2024).
Enhanced tissue oxygenation: Enhanced oxygen delivery during HBOT may aid dermatological conditions by promoting tissue repair, reducing inflammation, and combating infection. This is especially significant in inflamed or oedematous skin, such as psoriatic plaques, where abnormal vasculature, epidermal thickening, and hyperproliferative keratinocytes may trigger hypoxia-inducible factors, propagating inflammation and tissue damage (Rosenberger et al., 2007).
Anti-inflammatory effects: HBOT modulates inflammation by downregulating pro-inflammatory cytokines, such as TNF-α, while upregulating anti-inflammatory cytokines (Capó et al., 2023; De Wolde et al., 2021). This cytokine shift may alleviate the chronic inflammation seen in psoriasis and dermatitis lesions (Zwoliński et al., 2025). HBOT may also reduce mast cell degranulation, potentially easing pruritus and erythema, which are common in dermatitis (Kim et al., 2014).
Modulation of oxidative stress: Although associated with increased oxygen levels, HBOT reduces oxidative stress in chronic inflammatory conditions through the induction of antioxidant enzymes (Schottlender et al., 2021). Dermatological conditions such as psoriasis are associated with elevated levels of reactive oxygen species and impaired redox balance (Pleńkowska et al., 2020) and thus, the antioxidant effects of HBOT may contribute to disease control.
Angiogenesis: Skin conditions such as dermatitis, psoriasis, and chronic wounds are associated with abnormal angiogenesis (Lee et al., 2021). HBOT stimulates angiogenesis through the induction of VEGF, enhancing capillary growth and blood flow to affected tissues (Buckley & Cooper, 2023).
Fibroblast activity: In chronic wounds, HBOT promotes fibroblast proliferation and collagen synthesis (Thackham et al., 2008; Bhutani & Verma, 2010), potentially facilitating the repair and barrier function of skin.
Antimicrobial activity: Secondary infection with Staphylococcus aureus or other organisms is a frequent complication of dermatological conditions (Salle et al., 2024). HBOT exerts bacteriostatic and bactericidal effects against aerobic and anaerobic bacteria (Chmelař et al., 2024), potentially alleviating infections of the skin.
Benefits to Patients of HBOT for Dermatological Conditions
HBOT is generally well tolerated, and serious side effects are rare (Camporesi, 2014; Zhang et al., 2023). Reported side effects are typically mild and reversible, including middle ear barotrauma and transient myopia. Serious complications, such as oxygen toxicity seizures or pulmonary barotrauma, are rare. There is a range of potential benefits for patients with dermatological conditions that may improve their symptoms and quality of life:
Reduction in disease severity and symptom burden: Patients undergoing HBOT often report improvements in erythema, oedema, pruritus, and skin integrity (Mews et al., 2021).
Accelerated healing: HBOT promotes the skin-healing process (Niezgoda et al., 1997) via improved oxygen delivery, reduced inflammation, and enhanced angiogenesis (Bhutani & Vishwanath, 2012).
Improved healing of secondary infections or ulcerations: Complicated dermatitis, such as in cases with lichenification, excoriations, or secondary infection, may progress to ulceration or chronic wounds. HBOT accelerates healing of ulcers by promoting angiogenesis, resolving infection, and reducing oedema (Thackham et al., 2008), and may benefit patients with recalcitrant dermatological conditions.
Pain relief: HBOT can reduce the pain caused by thermal burns (Chen et al., 2018), and potentially other skin conditions, by reducing inflammation, promoting tissue repair, and attenuating central sensitisation (Rasmussen et al., 2015).
Reduction of scarring: HBOT may reduce scarring by promoting collagen synthesis and reducing inflammation (Khan et al., 2023), which may be beneficial for some dermatological conditions or after surgical treatments.
Clinical Evidence of HBOT for Dermatological Conditions
While robust, large-scale randomised controlled trials (RCTs) specifically assessing HBOT for psoriasis, dermatitis, and other dermatological conditions are limited, existing studies and case reports provide preliminary support for its efficacy (Piotrowska et al., 2021; Simman et al., 2022; Parnis et al., 2024; Zwoliński et al., 2025). Protocols vary but generally involve exposure to near-100% oxygen at pressures ranging from 2.0 to 3.0 ATA for 30–120 minutes and 1–43 sessions (Jeter & Wong, 2021).
Psoriasis: One case report of two patients treated with HBOT (2.8 ATA, 60 mins, 6 or 15 sessions) for psoriasis showed marked improvements in symptoms, suggesting a protective role against psoriasis (Butler et al., 2009).
Dermatitis: Several clinical trials have indicated that HBOT may be beneficial for patients with dermatitis. In a trial of 10 patients with severe atopic dermatitis treated with HBOT (100% O2, 2.5 ATA, 60 mins, 10 sessions), all patients showed clinical improvements and had decreased IgE and complement C3 levels (Olszański et al., 2024). A study on children with atopic dermatitis showed a reduction in the extent and intensity of skin lesions, redness, swelling, oozing/crusting, scratch marks, and skin lichenification after HBOT (100% O2, 2.5 ATA, 60 mins, 30 daily sessions), as well as a reduction in serum IgE levels (Mews et al., 2021). Following therapy, patients also reported less intense itching and improved sleep quality, suggesting a quality-of-life benefit. In another study, 25 patients with radiation-induced dermatitis were treated with HBOT (100% O2, 1.5 ATA, 30 mins, 21 sessions). Although there were no statistically significant differences in the endpoints, including incidence of radiodermatitis and skin-rating profiles, there were trends towards lower skin-related discomfort and improved patient-reported outcomes in the HBOT group (Lee et al., 2025).
Healing of burns: Numerous studies, clinical reports, and meta-analyses support the use of HBOT (typically 100% O2, 2 ATA, 90 mins, >10 sessions) as an adjunctive treatment for thermal burn injuries (Villanueva et al., 2004; Alyafi et al., 2021; Weitgasser et al., 2021). HBOT is recognised by the US FDA, the European Committee on Hyperbaric Medicine (ECHM) (Mathieu et al., 2017), and the Undersea and Hyperbaric Medical Society (UHMS, 2024) for the treatment of thermal burns. More details about the use of HBOT for burns can be found here.
Non-healing wounds: The clinical efficacy of HBOT in treating non-healing wounds, such as ulcers, is supported by many studies, clinical trials, and meta-analyses (see, for example, Nagarsheth et al. (2024) and Zhang et al. (2025)). HBOT is recognised by the US FDA as a treatment for non-healing and diabetic lower extremity wounds, as well as by Diabetes Ireland, ECHM, and UHMS. More details about the use of HBOT for non-healing wounds can be found here.
Cosmetic procedure complications: HBOT has also been used after common cosmetic procedures to improve recovery times or promote the resolution of complications. For example, after phenol chemical peels, HBOT led to faster recovery, with reduced severity of adverse events, such as erythema, scaling, and pruritus (Wiser et al., 2018). HBOT has also been used to limit the damage following injection of cosmetic fillers (Tsai et al., 2014; Henderson et al., 2018; Hong et al., 2019). Tsai et al. (2014) treated four patients with complications following filler rhinoplasty with HBOT (100% O2, 2–2.5 ATA, 80–120 mins, 2–8 sessions), and the treatment was satisfactory in three out of four cases. Henderson et al. (2018) reported a case of a woman who had severe complications, including artery occlusion, after using a self-injected dermal filler and reported an acceptable cosmetic outcome following HBOT (100% O2, 2–3 ATA, 90 mins, six sessions). Another case report (Hong et al., 2019) described a patient with severe necrosis of the nose, philtrum, and upper lip due to retrograde arterial occlusion after nasolabial fold filler injection with hyaluronic acid. The authors concluded that HBOT (100% O2, 2–2.8 ATA, 110–135 mins, 43 sessions) reduced necrosis. However, it should be noted that none of the studies regarding HBOT for damage related to injectable fillers included a control group.
Conclusion
Hyperbaric oxygen therapy holds promise as an adjunctive treatment in the management of dermatological issues. By enhancing tissue oxygenation, reducing inflammation, supporting skin repair, and mitigating infection, HBOT potentially addresses multiple pathogenic mechanisms that underlie dermatitis and other skin issues. Preliminary clinical studies and case reports suggest symptom relief and accelerated healing in selected patients, particularly those with refractory disease or complications, such as infection or ulceration. Importantly, HBOT offers a non-pharmacological approach with a favourable safety profile, expanding therapeutic options for patients.
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