Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.
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®.
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.
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Results of human study showed that a hyaluronic acid product, Juvéderm Ultra Plus®, reduced the appearance of nasolabial folds (creases between the nose and lips) more so than a bovine collagen-based filler. Additional research is needed to confirm these early findings.
Dry eye syndrome
Early human study showed that a hyaluronic acid preparation, applied to the eye, reduced symptoms of dry eye syndrome and was well tolerated. Additional studies are needed.
Intra-articular (intrajoint) hyaluronic acid injections have been reported to be highly effective in the treatment of osteoarthritis in humans. A small study also found that oral hyaluronic acid therapy helped reduce pain and increase physical functioning in adults with knee osteoarthritis. Additional research is needed in this area.
*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).
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.
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.
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.
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.
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.
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).
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.
Carruthers, J. D., Glogau, R. G., and Blitzer, A. Advances in facial rejuvenation: botulinum toxin type a, hyaluronic acid dermal fillers, and combination therapies--consensus recommendations. Plast.Reconstr.Surg. 2008;121(5 Suppl):5S-30S. View Abstract
Carruthers, J and Carruthers, A. Hyaluronic acid gel in skin rejuvenation. J Drugs Dermatol. 2006;5(10):959-964. View Abstract
Chen, W. Y. and Abatangelo, G. Functions of hyaluronan in wound repair. Wound.Repair Regen. 1999;7(2):79-89. View Abstract
Gold, MH. Use of hyaluronic acid fillers for the treatment of the aging face. Clin Interv.Aging 2007;2(3):369-376. View Abstract
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
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
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
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
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
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
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
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
Tezel, A and Fredrickson, GH. The science of hyaluronic acid dermal fillers. J Cosmet.Laser Ther. 2008;10(1):35-42. View Abstract
Uthman, I., Raynauld, J. P., and Haraoui, B. Intra-articular therapy in osteoarthritis. Postgrad.Med J 2003;79(934):449-453. View Abstract
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
Copyright © 2013 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.
March 22, 2017