Systematic Review of DMSO: Efficacy, Safety, Applications, and Medical Insights (2025)

Dimethyl sulfoxide (DMSO), with the chemical formula (CH₃)₂SO, is a colorless, polar aprotic solvent that is miscible with water and a wide range of organic solvents. It has a high boiling point (189°C) and a relatively low melting point (19°C), and is known for its ability to penetrate biological membranes, including skin, without causing damage. DMSO is produced industrially from dimethyl sulfide, a byproduct of paper manufacturing, via oxidation. Historically, it was first synthesized in 1866 by Russian chemist Alexander Zaytsev, but its modern applications as a solvent emerged in the mid-20th century. In medicine, DMSO gained attention in the 1960s for its membrane-penetrating properties, leading to its use as a vehicle for drug delivery, anti-inflammatory agent, and cryoprotectant.

It is FDA-approved only for the symptomatic relief of interstitial cystitis (IC), also known as bladder pain syndrome (BPS), but has been explored off-label for various conditions.

This systematic review synthesizes evidence on DMSO's uses, efficacy, safety, and applications, drawing from existing reviews, clinical studies, and general overviews.

Methods

To conduct this review, web searches were performed using queries such as "systematic review dimethyl sulfoxide," "systematic review DMSO efficacy safety," and "dimethyl sulfoxide uses applications review site:pubmed.ncbi.nlm.nih.gov," retrieving up to 20 results per query from reliable sources like PubMed, PMC, and scientific journals. Key full-text articles and overviews were further browsed for detailed summaries, focusing on methods, results, efficacy, safety, and conclusions. Inclusion criteria prioritized systematic reviews, meta-analyses, randomized controlled trials (RCTs), and cohort studies on human applications, excluding case reports and animal studies unless relevant to context. Data synthesis involved categorizing findings by application (e.g., medical, veterinary, other), efficacy outcomes, adverse effects, and overall conclusions. Risk of bias was noted where reported in source reviews, such as using tools like the Newcastle-Ottawa Scale or Cochrane Handbook.

Results

Medical Uses and Efficacy

DMSO has been investigated for multiple medical applications, primarily as a topical or intravesical agent, cryoprotectant, and drug solvent. Key findings from systematic reviews and studies are summarized below.

Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS)

DMSO is the only FDA-approved treatment for IC/BPS, administered intravesically (directly into the bladder). A meta-analysis of 5 RCTs and 9 single-arm or cohort studies involving 554 patients found that intravesical DMSO significantly improved symptoms, including pain reduction and increased bladder capacity.

Efficacy was moderate and durable in some cases, with one Japanese study confirming tolerability and symptom relief in hydrodistention-resistant IC.

Historical studies show mixed results, but overall, DMSO provides symptomatic relief in inflammatory genitourinary disorders.

Osteoarthritis (OA) and Musculoskeletal Disorders

As a nutritional supplement, DMSO (often compared to methylsulfonylmethane [MSM]) has been evaluated for OA pain relief. A systematic review of 6 studies (681 patients for DMSO, 168 for MSM) found that 2 of 4 DMSO trials and both MSM trials showed significant pain improvement compared to placebo or comparators, particularly for mild-to-moderate knee OA.4 sources

However, methodological flaws (e.g., unblinding due to DMSO's odor) limit definitive conclusions. Topical DMSO provides temporary pain relief in arthritis and connective tissue injuries.

Wound Healing and Anti-Inflammatory Effects

Topical DMSO acts as an anti-inflammatory and analgesic, promoting wound healing. A systematic review concluded it is effective for decubitus ulcers and reduces inflammation, with positive effects on healing rates.

Daily application decreased pressure ulcer incidence in susceptible patients. It also shows promise in basal cell carcinoma, scleroderma, and cutaneous infections.

Cryopreservation and Stem Cell Therapy

DMSO is widely used as a cryoprotectant for hematopoietic stem cells (HSCs) and mesenchymal stromal cells (MSCs), preventing ice crystal damage during freezing.

A review of controlled studies noted infusional toxicities but supported lower concentrations to maintain cell viability and engraftment.

Other Medical Applications

• Amyloidosis: Oral DMSO is effective for systemic amyloid A amyloidosis, particularly gastrointestinal involvement in early stages.

• Immunomodulation: DMSO exhibits immune-enhancing and anti-inflammatory effects in innate immunity.

• Antiviral: It blocks herpes simplex virus replication and has been used topically with idoxuridine.

• Post-Surgical: Topical DMSO reduces nipple-areolar congestion after breast surgery.

• Drug Delivery: Used as a solvent in embolization and transdermal systems.

Non-Medical Applications

DMSO serves as a solvent in chemical reactions, biochemistry (e.g., PCR, cell differentiation), and microelectronics (e.g., photoresist stripping). It is also used in drug discovery for solubility in testing. In mining, it aids gold dissolution when combined with halides.

DMSO Safety and Adverse Effects

DMSO has low systemic toxicity (LD50 oral rat: 14,500 mg/kg), but can enhance absorption of other substances, potentially amplifying drug effects or toxicities. A systematic review of 109 studies identified mostly mild, transient adverse reactions:

• Category: Gastrointestinal

  • Common Effects: Nausea, vomiting, halitosis, abdominal cramps, diarrhea

  • Frequency (Range): Nausea: 2–41%; Halitosis: 0–100%

  • Severity: Mild, transient

• Category: Dermatological

  • Common Effects: Erythema, itching, burning

  • Frequency (Range): Erythema: 3–95%; Burning: 0–100%

  • Severity: Mild, common with topical use

• Category: Cardiovascular/Respiratory

  • Common Effects: Hypotension, bradycardia, dyspnea

  • Frequency (Range): Hypotension: 1–14%; Dyspnea: 0–10%

  • Severity: More severe with IV use; rare

• Category: Neurological

  • Common Effects: Headache, rare seizures/encephalopathy

  • Frequency (Range): Headache: 1–50%

  • Severity: Mostly mild

• Category: Other

  • Common Effects: Fever, chills, hyponatremia

  • Frequency (Range): Fever: 2–19%

  • Severity: Transient

Reactions show a dose-response relationship, with fewer issues at lower doses. Serious events (e.g., asystole, neurotoxicity) are rare but noted in high-dose contexts like stem cell infusions. DMSO can interfere with lab assays and cause garlic-like odor/taste.

Discussion and Conclusion

DMSO demonstrates efficacy in approved (IC/BPS) and off-label uses (e.g., OA pain, wound healing, cryopreservation), with evidence from Randomised Controlled Trials (RCTs) and reviews supporting symptom relief and anti-inflammatory effects.3 sources

However, limitations include methodological issues in studies, lack of long-term data, and potential biases (e.g., odor unblinding). Safety is generally favorable for low doses, but risks increase with route (IV > topical) and co-administration. Controversies arise from its promotion in alternative medicine (e.g., for cancer), where evidence is insufficient and it may interfere with therapies.

Further high-quality RCTs are needed to clarify optimal dosing, long-term safety, and broader applications. DMSO remains a versatile compound but should be used under medical supervision to mitigate risks.