Hyaluronic–Succinic Mesotherapy Cuts Rosacea Redness by 80 %

Rosacea remains a therapeutic challenge, particularly in patients who show minimal response to standard topical regimens.¹ A 2025 study in the Journal of Cosmetic Dermatology by Leguina-Ruzzi et al evaluated whether intradermal mesotherapy with high-molecular-weight non-cross-linked hyaluronic acid (HMWNCHA) combined with succinic acid (SA) could serve as an effective and economical adjunctive treatment.²

After 3 monthly sessions, patients receiving this injectable combination demonstrated an approximately 80 % reduction in facial erythema, 30 % improvement in hydration, and 20 % reduction in telangiectasia relative to controls who continued topical therapy alone. Importantly, no serious adverse events occurred, and treatment costs were substantially lower than laser or IPL therapy, suggesting potential clinical relevance in resource-limited settings.

Study Design and Patient Cohort

This non-randomized, controlled interventional study enrolled 40 adults (aged ≈ 40 years, Fitzpatrick phototypes I–III) with moderate rosacea refractory to at least 4 weeks of standard topical therapy (ivermectin 1 %, metronidazole 0.75 %, photoprotection). Patients without ≥ 1-point improvement on the Investigator’s Global Assessment (IGA) were offered adjunct mesotherapy; 20 accepted and formed the intervention group, while 20 continued topicals as controls.

Exclusion criteria were extensive, eliminating confounding by metabolic, autoimmune, or inflammatory comorbidities, pregnancy, drug use, and other dermatologic disorders.

Intervention Protocol

Each mesotherapy session used 2 mL of Xela Rederm 1.1 % (11 mg/mL HMWNCHA + 16 mg/mL SA; Hyalual, Italy) delivered via papular intradermal technique with 30 G × 13 mm needles. Sessions were spaced one month apart. Patients resumed their topical regimen 12 hours post-injection.

Skin erythema, telangiectasia, hydration, and elasticity were quantified using ImageJ, Corneometer CM825, and ElastiMeter devices under standardized environmental conditions. Subjective sensory symptoms—soreness, burning, itching, tingling—were scored on validated numerical rating scales (0–10).

Outcomes and Clinical Findings

Erythema and telangiectasia: Significant progressive reduction was noted in the intervention arm, with erythema declining to 25 % of baseline by month 2 and to 20 % by month 4 (p < 0.01). Telangiectatic areas diminished in parallel. Controls showed no meaningful change.

Hydration and elasticity: Skin hydration improved by nearly 80 % and elasticity by about 50 % at month 4 (both p < 0.01). These gains likely reflect HA-mediated dermal hydration and SA-induced fibroblast stimulation via mitochondrial energy pathways.

Sensory symptoms: Participants reported large symptomatic relief—mean soreness decreased from 7.1 → 1.2, burning 8.3 → 2.3, itching 7.9 → 1.5, and tingling 6.2 → 2.1 (all p < 0.05). The control group improved only in burning and itching domains.

Safety: Transient post-injection reactions were expected—pain 45 %, erythema 25 %, edema 17 %, bruising 15 %—with no infections or discontinuations.

Ex vivo microscopy of one representative case revealed narrowed dermal vessels and more organized collagen, suggesting structural remodeling.

Economic analysis: Mean cost per mesotherapy session was markedly below that of laser/IPL across 10 Chilean clinics, reinforcing the feasibility of this approach for private-practice or middle-income contexts.

Interpretation and Limitations

Clinically, this study suggests that HMWNCHA + SA mesotherapy may enhance vascular stability, hydration, and cutaneous comfort when added to conventional topical therapy. The combination leverages the anti-inflammatory, antioxidative, and regenerative properties of high-molecular-weight HA and the bioenergetic support of succinic acid.

However, methodological constraints temper conclusions: small sample size, lack of randomization and blinding, short follow-up (six months), and single-center design. Moreover, histologic confirmation was limited to one case. Thus, while findings are encouraging, they warrant multicenter randomized controlled trials with longer observation and comparative arms versus energy-based devices.

Clinical Perspective

For clinicians, this evidence positions HMWNCHA + SA mesotherapy as a low-risk, cost-effective adjunct for patients with persistent erythematotelangiectatic or papulopustular rosacea unresponsive to topical agents. It may be particularly useful where laser access is restricted or contraindicated.

Until larger controlled studies validate these outcomes, practitioners should view this approach as complementary rather than substitutive, applying it within established ROSCO-guided frameworks and informed patient consent.

References

1. Li S, Lin J, Li J, Mo X, Ju Q. Therapeutic landscape of rosacea: From clinical trials to future directions. J Cosmet Dermatol. 2025 May;24(5):e70182. doi: 10.1111/jocd.70182. PMID: 40302699; PMCID: PMC12042065.
2. Leguina-Ruzzi A, Navarro A, Zambrano M. Efficacy and effectiveness of high molecular weight non-cross-linked hyaluronic acid plus succinic acid mesotherapy in rosacea as adjunct therapy. J Cosmet Dermatol. 2025;24(10):e70484. doi:10.1111/jocd.70484