Related Terms

• Biolon™, Curiosin®, Cystistat®, dermal fillers, DermaLive®, Durolane®, Euflexxa™, Eyestil®, glycosaminoglycan, Healon®, Healon 5®, Healon GV®, Hyalgan®, hyaluron, hyaluronan, hyaluronate, Hylaform®, Hylaform Plus®, hylan, hylan G-F 20, hylan polymers, Hylira IPM Wound Gel™, Juvéderm™, Juvéderm 24HV™, Juvéderm 30™, Juvéderm 30HV™, Juvéderm Ultra™, Juvéderm Ultra Plus™, Orthovisc®, Perlane®, Provisc®, Restylane®, sodium hyaluronate, Supartz™, Suplasyn®, Synvisc®, Vitrax®.

Background

• Hyaluronic acid is polysaccharide (sugar-based) component of connective tissue, including the skin. Its water-binding and elastic properties have skin-plumping effects. Hyaluronic acid also lubricates tissues and joints.

• Hyaluronic acid is used in osteoarthritis treatment, ophthalmic (eye) surgery, and tissue engineering. It may be injected into a joint or into the skin, taken by mouth, or applied topically. Hyaluronic acid fillers are popularly used to minimize the appearance of facial wrinkles and to plump skin in the cheeks and chin.

Scientific Evidence

Tradition/Theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

• Adjunct in surgery (cataract, corneal transplantation, lens implantation, glaucoma filtering surgery), antioxidant, arthritis, disuse muscle atrophy, fractures, hernia, immune system stimulant, inflammatory bowel disease, joint disease, pain, skin conditions, soft tissue injury (torn ligaments and tendons), sprained ankle, urinary tract infections, vaginal dryness, voice strain, wound healing.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

• For general use, 50 milligrams of hyaluronic acid has been taken by mouth once or twice daily with meals.

• For osteoarthritis, 80 milligram capsules of Hyal-Joint® (a natural chicken comb extract containing 60-70% hyaluronic acid) has been taken by mouth daily for eight weeks.

• For dry eye syndrome, hyaluronic acid 0.2% (Hyalist™) has been applied to the eye three or four times daily for 90 days.

• For osteoarthritis, 20 milligrams of hyaluronic acid has been injected into the knee joint weekly for three weeks.

Children (under 18 years old)

• There is no proven safe or effective dose of hyaluronic acid in children.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

• Avoid in individuals with a known allergy or sensitivity to hyaluronic acid. In addition, commercial hyaluronic acid preparations may contain proteins from birds. Individuals with an allergy to avian (bird) proteins (e.g., eggs or feathers) should avoid these products.

Side Effects and Warnings

• Hyaluronic acid may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or those taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

• Use caution if using certain disinfectants, because hyaluronic acid may interact with the quaternary ammonium salts present in some disinfectants.

• Use injectable preparations cautiously in patients prone to easy bruising or bleeding. As with any injection, hyaluronic acid injection may cause skin redness, bruising, infection, or hematoma formation (a local mass of clotted blood). Injection of hyaluronic acid into a joint may cause arthritis or joint symptoms, such as joint pain, stiffness, swelling, and warmth.

• Hyaluronic acid may cause rash when taken by mouth.

• Hyaluronic acid may cause increased pressure in the eye after injection into the eye during eye surgery.

• Avoid use in breast augmentation, or for implantation into bone, tendon, ligament, or muscle.

• Avoid injecting into blood vessels.

• Avoid use in patients with a history of sensitivity to chicken products or known allergy or sensitivity to hyaluronic acid.

• Avoid if pregnant or breastfeeding.

Pregnancy and Breastfeeding

• There is no proven safe or effective dose of hyaluronic acid in pregnant or breastfeeding women.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

• Hyaluronic acid may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin®) or heparin, antiplatelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®). Drugs that increase the risk of bleeding should be discontinued at least one week before a hyaluronic acid injection.

• Hyaluronic acid may interact with disinfectants containing quaternary ammonium salts. Use these disinfectants with caution when using hyaluronic acid.

Interactions with Herbs and Dietary Supplements

• Hyaluronic acid may increase the risk of bleeding when taken with herbs and supplements that may increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may increase the risk of bleeding, including herbs such as St. John's wort or Pycnogenol®. These agents, as well as nonsteroidal anti-inflammatory agents, should be discontinued at least one week before a hyaluronic acid injection.

Author Information

• This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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2. Carruthers, J and Carruthers, A. Hyaluronic acid gel in skin rejuvenation. J Drugs Dermatol. 2006;5(10):959-964. View Abstract

3. Chen, W. Y. and Abatangelo, G. Functions of hyaluronan in wound repair. Wound.Repair Regen. 1999;7(2):79-89. View Abstract

4. Gold, MH. Use of hyaluronic acid fillers for the treatment of the aging face. Clin Interv.Aging 2007;2(3):369-376. View Abstract

5. Kalman, DS, Heimer, M, Valdeon, A, et al. Effect of a natural extract of chicken combs with a high content of hyaluronic acid (Hyal-Joint) on pain relief and quality of life in subjects with knee osteoarthritis: a pilot randomized double-blind placebo-controlled trial. Nutr J 2008;7:3. View Abstract

6. Klein, A. W. and Fagien, S. Hyaluronic acid fillers and botulinum toxin type a: rationale for their individual and combined use for injectable facial rejuvenation. Plast.Reconstr.Surg. 2007;120(6 Suppl):81S-88S. View Abstract

7. Lupo, MP, Smith, SR, Thomas, JA, et al. Effectiveness of Juvederm Ultra Plus dermal filler in the treatment of severe nasolabial folds. Plast.Reconstr.Surg. 2008;121(1):289-297. View Abstract

8. Paker, N, Tekdos, D, Kesiktas, N, et al. Comparison of the therapeutic efficacy of TENS versus intra-articular hyaluronic acid injection in patients with knee osteoarthritis: a prospective randomized study. Adv.Ther. 2006;23(2):342-353. View Abstract

9. Petrella, RJ. Hyaluronic acid for the treatment of knee osteoarthritis: long-term outcomes from a naturalistic primary care experience. Am J Phys.Med Rehabil. 2005;84(4):278-283. View Abstract

10. Rohrich, RJ, Ghavami, A, and Crosby, MA. The role of hyaluronic acid fillers (Restylane) in facial cosmetic surgery: review and technical considerations. Plast.Reconstr.Surg. 2007;120(6 Suppl):41S-54S. View Abstract

11. Rohrich, R. J. Advances in facial rejuvenation: Botulinum toxin A. Hyaluronic acid dermal fillers, and combination therapies--consensus recomendations. Editor's Foreword. Plast.Reconstr.Surg. 2008;121(5 Suppl):1S-2S. View Abstract

12. Rolando, M and Valente, C. Establishing the tolerability and performance of tamarind seed polysaccharide (TSP) in treating dry eye syndrome: results of a clinical study. BMC Ophthalmol. 2007;7:5. View Abstract

13. Tezel, A and Fredrickson, GH. The science of hyaluronic acid dermal fillers. J Cosmet.Laser Ther. 2008;10(1):35-42. View Abstract

14. Uthman, I., Raynauld, J. P., and Haraoui, B. Intra-articular therapy in osteoarthritis. Postgrad.Med J 2003;79(934):449-453. View Abstract

15. Wolfram, D, Tzankov, A, and Piza-Katzer, H. Surgery for foreign body reactions due to injectable fillers. Dermatology 2006;213(4):300-304. View Abstract