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What is Hyaluronic Acid?
Hyaluronic acid (HA) is a naturally occurring glycosaminoglycan found throughout the body’s connective, epithelial, and neural tissues. It plays a crucial role in various biological processes, including tissue hydration, lubrication, and cellular function. This article explores the multifaceted applications and benefits of hyaluronic acid in medical and cosmetic fields. Other names include: Acide Hyaluronique, Ácido Hialurónico, Glycosaminoglycan, Glycosaminoglycane, Hyaluran, Hyaluronan, Hyaluronate de Sodium, Hyaluronate Sodium, Hylan, Sodium Hyaluronate.
Biological Role of Hyaluronic Acid
Hyaluronic acid is a major component of the extracellular matrix, contributing to tissue hydration and elasticity. It is known for its ability to retain water, making it essential for maintaining skin moisture and joint lubrication. HA is also involved in wound healing and tissue repair processes.
Medical Applications of Hyaluronic Acid
Wound Healing
Hyaluronic acid has been shown to enhance wound healing by promoting extracellular matrix remodeling and collagen maturation. In a study on human gingival tissues, HA application significantly improved early wound healing scores and upregulated genes involved in collagen turnover3. Additionally, HA has been found to improve post-extraction wound healing in patients with poorly controlled type 2 diabetes, demonstrating higher wound closure rates and better clinical healing scores5.
Treatment of Gingivitis
HA’s anti-inflammatory and antiedematous properties make it effective in treating plaque-induced gingivitis. A randomized double-blind study showed significant improvements in clinical indices and crevicular fluid variables in patients using HA gel compared to a placebo4.
Peri-Implantitis
Hyaluronic acid has been used to manage peri-implantitis, a condition characterized by inflammation around dental implants. A study demonstrated that HA gel reduced the relative abundance of peri-implantitis-related microorganisms and decreased microbial diversity, suggesting a protective action against bacterial colonization1.
Radiation Dermatitis
Despite its many benefits, HA’s efficacy in preventing radiation dermatitis has been questioned. A study comparing HA gel to a petrolatum-based gel found that HA-treated skin developed a higher rate of Grade 2 dermatitis, indicating no benefit in this context7.
Osteoarthritis
Intra-articular injections of hyaluronic acid have been used to treat knee osteoarthritis. A comparative study found that HA’s analgesic effects were comparable to those of steroids shortly after treatment, with significant long-term benefits in pain reduction9.
Cosmetic Applications of Hyaluronic Acid
Skin Rejuvenation
Hyaluronic acid is widely used in cosmetic dermatology for skin hydration and rejuvenation. A study using a stabilized HA-based gel with a multineedle injector showed significant improvements in skin hydration and elasticity, with no serious adverse events reported10.
Sebum Regulation
HA has also been found to decrease lipid synthesis in sebaceous glands, making it a potential treatment for conditions characterized by excessive sebum production. Clinical studies have shown that HA can significantly reduce sebum levels in oily skin6.
Vaginal Dryness
For postmenopausal women experiencing vaginal dryness, HA vaginal gel has been shown to be as effective as estriol cream in alleviating symptoms, providing a non-hormonal alternative for treatment8.
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👄Can hyaluronic acid be used to treat gingivitis and peri-implantitis effectively?
Adverse Effects of Hyaluronic Acid
Local Inflammatory Response
HA injections can trigger local inflammation, although it is generally biocompatible1.
Injection Technique-Related Adverse Events
The rate of local adverse events is influenced by the injection technique rather than the chemical composition of HA. Techniques that increase tissue dissection or rapid injection rates can lead to higher incidences of local adverse events5.
No Serious Adverse Events in Some Applications
In studies involving intra-articular injections for knee and ankle osteoarthritis, no serious adverse events were reported, indicating a good safety profile in these contexts4 7 8.
Effect on Microbiome
HA treatment in peri-implantitis patients showed a reduction in peri-implantitis-related microorganisms, suggesting a protective effect, but no adverse microbiome changes were noted6.
Systemic Migration and Long-term Effects
There is evidence of systemic migration of HA to organs like the liver and kidney, but the long-term effects of this migration are not well-documented1.
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How has Hyaluronic Acid Improved Patient Outcomes?
Rehabilitation and Functional Improvement
HA therapy significantly improves functional outcomes and muscle peak torque in patients undergoing anterior cruciate ligament (ACL) reconstruction, especially when administered 8 weeks post-surgery1.
Wound Healing
HA enhances wound closure rates and overall wound healing in patients with poorly controlled type 2 diabetes following tooth extraction2.
Reproductive Health
The addition of HA to embryo transfer mediums improves clinical pregnancy rates in patients with recurrent implantation failure (RIF) undergoing frozen-thawed embryo transfer cycles3.
Application of HA gel after dilation and curettage (D&C) for miscarriage improves subsequent reproductive outcomes, including higher ongoing pregnancy rates and reduced time to conception5.
Osteoarthritis Treatment
Both low- and intermediate-molecular-weight HA significantly improve pain and functional scores in patients with knee osteoarthritis, with no significant difference between the two types4.
HA injections provide a small clinical improvement in pain for hip osteoarthritis, although corticosteroids show a more significant effect10.
Intra-articular injections of HA are less effective than platelet-rich plasma (PRP) in improving functional outcomes and delaying the need for hip arthroplasty in patients with hip osteoarthritis6.
PRP injections are superior to HA in providing sustained functional improvement in knee osteoarthritis over a year7.
Aesthetic and Cosmetic Outcomes
HA gel fillers, alone or in combination with onabotulinumtoxinA, significantly improve patient satisfaction and self-perception in lower facial rejuvenation8.
Combined treatment of HA and botulinum toxin for chin retrusion shows better surface-volume improvement and aesthetic outcomes compared to HA alone9.
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Hyaluronic Acid Mechanisms of Action
Anti-inflammatory and Chondroprotective Effects
HA has been shown to have chondroprotective and anti-inflammatory properties, which can improve the quality of repair tissue in articular cartilage lesions and limit degenerative changes within the knee joint5.
Inhibition of Platelet Aggregation
HA can inhibit platelet aggregation, which may contribute to its effectiveness in preventing postoperative intraperitoneal adhesions3.
Reduction of Lipid Synthesis
HA downregulates lipid synthesis in sebaceous glands by interacting with the CD44 receptor, leading to decreased sebum production2.
Enhancement of Wound Healing
HA promotes wound healing by enhancing extracellular matrix remodeling, collagen maturation, and reducing inflammation. It also increases microvessel density early in the healing process, which supports tissue repair6 7.
Mechanical Stress and Collagen Production
HA injections can induce mechanical stress in the dermal extracellular matrix, leading to increased collagen production and changes in skin physiology4.
Neuroprotective Effects
HA reduces neurotoxic damage by blocking calcium influx through TRPV1 channels, preventing calcium overload and protecting nerve cells9.
Microbiome Modulation
HA can reduce the relative abundance of peri-implantitis-related microorganisms and decrease microbial diversity in advanced stages of the disease, suggesting a protective action against bacterial colonization8.
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Common Complaints Associated with Hyaluronic Acid Use
Injection-Related Pain and Spotting
Patients receiving PRP combined with noncrosslinked hyaluronic acid for vulvovaginal atrophy reported injection-related pain and vaginal spotting1.
Injection Site Pain
In the treatment of osteoarthritis of the knee, injection site pain was more commonly reported in the HA group compared to the placebo group, leading to withdrawal in some cases5.
No Significant Improvement in Some Conditions
Short-term topical hyaluronic acid was not associated with significant improvement in vaginal elasticity in patients with vulvovaginal atrophy1.
No significant difference was found between hyaluronic acid and a simple emollient in the treatment of acute radio-induced dermatitis, although there was a trend towards improvement in pain and skin colorimetry3.
General Tolerability
Despite some adverse events, HA treatments were generally well tolerated and provided sustained relief of pain and improved patient function in conditions like osteoarthritis of the knee5.
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Disclaimer
The content in this blog post was generated using Consensus, an AI-powered academic search engine, and is based on publicly available scientific literature. While we strive to provide accurate, up-to-date, and well-researched information, this content is intended for informational and educational purposes only.
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