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uses for new line of topical hyaluronic acid products

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I know some people use hyaluronic acid products, so I thought this might be of interest:

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

Dr. Ditre, assistant professor of dermatology and director, the Cosmetic Dermatology & Skin Enhancement Center, University of Pennsylvania School of Medicine, and Penn Medicine at Radnor, Radnor, Pa., first used the hyaluronic acid gel in a patient who presented with severe erythema and irritation following a course of topical 5-FU treatment. Noting that she typically would have prescribed a low-potency corticosteroid in that situation, Dr. Ditre decided to try the patient with the hyaluronic acid product due to the potential for the steroid's immunomodulatory effects to mitigate the 5-FU treatment irritation effect.

"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.

HA may aid healing process

Dr. Brod, a private practitioner in Lancaster, Pa., performed a vehicle-controlled, split-face study investigating treatment for AKs with a hyaluronic acid cream in combination with topical 5-FU treatment. Seven patients used 5-FU 5 percent cream (Efudex) twice a day for three to four weeks and applied the hyaluronic acid cream to one side of the face and the vehicle contralaterally, waiting 15 minutes between application of the 5-FU and the hyaluronic acid or the vehicle creams.

Patient assessments of symptoms and physician evaluations of redness, crusting and oozing during the treatment course showed the hyaluronic acid product did not ameliorate the adverse reactions to 5-FU. However, when patients returned for follow-up five weeks after the end of therapy, the facial halves treated with the hyaluronic acid cream were judged to be better than the vehicle side based on an AK global improvement score as well as on the cosmetic appearance of the skin, including evaluations of texture and tone.

"The potential pharmacologic actions of hyaluronic acid are not fully elucidated, but there is evidence that it may improve wound healing by stimulating recruitment of inflammatory cells mediating that process. If that is the case, we were not too surprised that there was no reduction in the unpleasant side effects of topical 5-FU. However, it was reassuring to see that the hyaluronic acid cream was compatible when used with 5-FU and encouraging to find it might enhance the outcome," Dr. Brod says.

Although this was just a small pilot study, based on the results Dr. Brod is prescribing the hyaluronic acid cream to be used in conjunction with topical 5-FU treatment. In addition, he has been using it in patients who have been treated with cryosurgery or electrodesiccation and curettage. Its effects in those situations have not been formally studied, but Dr. Brod says it is his clinical impression that the hyaluronic acid product has benefits for hastening the healing process.

Disclosure: Neither Dr. Ditre nor Dr. Brod reports any financial interest in JSJ Pharmaceuticals. Dr. Brod received financial support for his study. Dr. Ditre did not receive any payment for her research.

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