Efficacy of local oxygen-ozone therapy for the treatment of digital ulcer refractory to medical therapy in systemic sclerosis: A randomized controlled study

Mod Rheumatol. 2022 Oct 15;32(6):1102-1107. doi: 10.1093/mr/roab117.


Background: This study aimed to investigate the efficacy of local oxygen-ozone therapy in systemic sclerosis (SSc) patients with digital ulcers (DUs) who were resistant to medical therapy and had impairment in activities of daily living.

Methods: Participants' demographic data, and clinical parameters were recorded. Twenty-five SSc patients with DUs were randomized to the ozone group (I) (n = 13) to receive medical treatment plus local oxygen-ozone therapy and the control group (II) (n = 12) to receive medical treatment only. Hand functions were assessed using the Health Assessment Questionnaire (HAQ) and the Modified Hand Mobility in Scleroderma (HAMISm) test. Clinical parameters, HAQ, and mHAMIS scores were re-evaluated in participants 4 weeks after the initiation of treatment.

Results: Demographic and clinical characteristics of the two groups showed no significant differences. At 4 weeks after the initial treatment, the efficacy rate was significantly higher in the ozone group than that in the control group (92% versus 42% P = 0.010). Clinical parameters, HAQ, and HAMISm scores were significantly improved in the treatment group compared to those in the control group (P < 0.05).

Conclusion: Local oxygen-ozone therapy was effective in the treatment of SSc patients with resistant DUs and improved clinical parameters and functional disability.

Keywords: Ozone; SSc; ulcers.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Activities of Daily Living
  • Fingers
  • Humans
  • Oxygen / therapeutic use
  • Ozone* / therapeutic use
  • Scleroderma, Localized*
  • Scleroderma, Systemic* / complications
  • Scleroderma, Systemic* / therapy
  • Skin Ulcer* / drug therapy
  • Skin Ulcer* / etiology
  • Ulcer


  • Oxygen
  • Ozone