Ethosomal drug delivery systems have numerous applications in the veterinary, cosmetic, and pharmaceutical industries. Several passive and active procedures have been developed to improve the skin's permeability for transdermal drug delivery. The ethanol action and the ethosome effect on the stratum corneum lipid bilayer are involved in the penetration mechanism of ethosomal formulations. Considering that ethanol was used to prepare the ethanol formulation, the vesicles' deformability is boosted. Ethosomes, as opposed to conventional liposomal formulations, enhance medication distribution to the skin in both occlusive and non-occlusives situations. Using ethanol as a carrier, the drug is entrapped into the epidermal membrane. The drug enters the receptor compartment during in vitro skin permeation experiments and in MT-2 cells. In addition, ethanol is used to deliver the drug via the skin or the skin membrane. In this review, we provide an overview of the current research progress in the field of ethanol-based delivery systems.