National report - Experience with a new topical product line containing hyaluronic acid sodium salt 0.2 percent (Bionect, JSJ Pharmaceuticals) indicates it may be useful for optimizing the healing environment when the skin barrier has been disrupted by various dermatologic treatments.
Cherie M. Ditre, M.D., reports on a study that evaluated the aqueous gel formulation of the hyaluronic acid product for its potential to decrease erythema and enhance healing following photorejuvenation with intense pulsed light (IPL) therapy. In addition, Bruce A. Brod, M.D., has studied the cream formulation of the product and found it may enhance therapeutic and cosmetic outcomes when used in conjunction with topical 5-fluorouracil (5-FU) for treatment of actinic keratoses (AKs). The clinical experience of both practitioners suggests topical hyaluronic acid applications - aqueous gel, cream and aqueous spray - may have a variety of other potential uses, including improving the tolerability of topical retinoid treatment or to enhance healing after destructive surgical procedures.
Hyaluronic acid combination treatments
"Hyaluronic acid may enhance skin healing because it is a natural part of the extracellular matrix of the skin and has humectant properties," Dr. Ditre tells Dermatology Times. "However, as described by Harvard researcher Dr. Judah Folkman, hyaluronic acid also appears to block cyclooxygenase-2. By interfering with that inflammatory pathway, I expected it might have activity for minimizing erythema."
The patient began applying the hyaluronic acid gel twice daily, and when she returned after a week, her skin, which had been extremely inflamed, was totally clear.
That experience led Dr. Ditre to design a study investigating the efficacy of the hyaluronic acid gel for reducing erythema and edema post-IPL treatment for photoaging. Patients underwent full-face IPL and were instructed post-treatment to cleanse the entire face twice a day with a gentle liquid cleanser, pat the skin dry and then apply the hyaluronic acid product to one side of the face and the vehicle on the other half, for two weeks. Patients were also counseled to avoid excessive sun exposure.
Evaluations included a variety of laboratory and clinical assessments. The analysis of the results is not yet complete although, based on her clinical observations, Dr. Ditre says the hyaluronic acid product appears to hasten resolution of the erythema reactions post-IPL.
"As an aside, however, while hyaluronic acid itself helps to hold moisture in the skin and this gel formulation is very cosmetically elegant, it is very light, and these patients would probably benefit from using another product for added moisturization," she says, adding that perhaps the cream formulation would be a better choice for these patients.
Dr. Ditre has also been prescribing the hyaluronic acid cream to her acne patients who are using a topical retinoid. She instructs them to combine pea-sized amounts of each product and then apply a thin film of the mixture to the face. Experience with that use has been positive overall.
"This combination appears to work very well for minimizing retinoid-induced irritation, and it can even be a more economical alternative to expensive over-the-counter moisturizers because the hyaluronic acid gel is available only by prescription and may be covered for many patients who have prescription drug insurance plans," Dr. Ditre says.