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The Practical Use of Topical Oxygen

By: Peter T. Pugliese, MD
Posted: August 22, 2008, from the September 2008 issue of Skin Inc. magazine.

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Oxygen reacts with the lipid layer in cellular membranes, usually forming hydroperoxides and a lot of other nasty-but-active germ-killing compounds. Net result: Oxygen breaks the bacterial cell envelope by lipid peroxidation. So basically, oxygen has effectively punched holes in the cell’s membrane, causing the bacteria’s nucleic acids and other critical compounds to exit the cell, thereby killing the bacteria. Besides this method, oxygen kills bacterial pathogens disrupting the system that creates the cell’s energy, as well as crippling the critical proteins’ manufacturing systems. See Figure 2.

Treating acne with oxygen. The current acne treatment regimen used should continue and the oxygen treatment should be adjusted according to the acne’s severity. In severe noncystic acne, use oxygen therapy three times a week for the first week.b During the second week, reduce to two treatments administered at least 2–4 days apart. On the third week and subsequent weeks, oxygen used once a week should produce good and lasting results. Have the client return in a month to check for comedones, both open and closed. As you are well aware, acne is a recurrent disease and those experiencing it should be followed up with regularly, often beyond the teen years. Acne and ignorance are the scourges of youth.

There are only two methods of oxygen application that I recommend and both use wet oxygen. The nebulizer format allows estheticians to use additional agents during the application, such as essential oils or plant extracts. The other form is oxygen generated in situ—that is, on the skin—and can be effectively used in a treatment lasting less than 10 minutes. Both of these systems are commercially available. Whatever system you use, make sure you understand it, and follow the directions of the supplier.


Of all the many diseases of obscure etiology, rosacea should rank near the top of the list. It is known that a lot of people have rosacea—an estimated 13–14 million in the United States.2 It occurs most frequently in people ranging from 30–50 years of age and is found primarily in fair-skinned people with northern European ancestry. Women, for some reason, are affected about two to three times more often than men.3 Rosacea is characterized by a persistent erythema of the face for a duration of at least three months. Diagnostic signs include flushing, papules, pustules, telangiectasias, edema, plaques, a dry appearance, ocular manifestations and phymatous changes. Symptoms include burning and stinging. A major finding is central facial flushing, often accompanied by burning or stinging. Patients generally have finely textured skin, although the face may appear rough and scaly, suggesting a low-grade dermatitis. Known triggers to flushing include emotional stress, alcohol, spicy foods, exercise, cold or hot weather, hot drinks, and hot baths and showers. Rosacea patients frequently have sensitive skin and may feel pain with many products, even when they are gently applied to the skin.

A present controversy is the concurrent existence of acne and rosacea. As a rule, no comedones are seen in rosacea. My personal opinion is that acne is a separate disease from rosacea. I base this on the fact that rosacea is characterized histopathologically with the appearance of perivascular infiltration. This would suggest some basic vascular pathology, which is to say, it covers a lot of area, but it presents a clue or starting point. Why do only men get rhinophyma with rosacea? Studies have shown possible associations between rosacea and the face mite Demodex folliculorum 4, 5 and Helicobacter pylori infection.6, 7, 8