The role of thermal spring waters (TSWs) in the treatment of dermatological disease has been described by several authors, as have their benefits in treating certain skin conditions, among which atopic dermatitis, contact dermatitis, seborrhea, seborrheic dermatitis, psoriasis, acne, rosacea, and sensitive skin can be cited. It has been postulated that the mechanisms involved include chemical, thermal, mechanical, and immunological effects, and the chemical composition of thermal water is crucial in its skin effects. Thus, in this review, the effects of the different anions, cations, trace elements, and other compounds present in TSW were investigated, showing that the benefits of TSW can be mainly linked to its content of chloride, sulfate, and bicarbonate anions; calcium, sodium, and magnesium cations; and, among its trace elements, boron, selenium, strontium, manganese, and zinc, which are those with greater influence. Other compounds such as SiO2, sulfur anions, and CO2 can also exert specific effects. As a whole, the specific effects can be summarized as anti-inflammatory, antioxidant, wound healing improvement, skin hydration, and skin barrier recovery activities.