This article describes the gradual improvement of skin with treatment by hyaluronic acid injections, mainly used for cosmetic indications prevoiusly. However, there is now evidence that these injections can improve the quality of the skin – the mechanism is described in the article! I have used these type of superficial, light injections mainly to hydrate areas exposed to sundamage, or scars, but I can now see that there is a possibility to treat even those patients within Reumatology who have skin which is extremely thin from yeasr of taking cortisone . The fragile skin is quite a problem as damages occur more easily. It would be great to try to apply my knowlege in such a way- most of those patients have already given up on improvement.
These findings suggest that, in addition to its cosmetic benefits, hyaluronic acid may be beneficial in skin-wasting diseases that involve collagen deficiencies, such as those associated with HIV or steroid use.
Objective To determine whether endogenous synthesis of new extracellular matrix may contribute to the degree and duration of clinical benefits derived from cross-linked hyaluronic acid dermal filler injections.
Design In vivo biochemical analyses after filler injections.
Setting Academic referral center.
Participants Eleven healthy volunteers (mean age, 74 years) with photodamaged forearm skin.
Interventions Filler and vehicle (isotonic sodium chloride) injected into forearm skin and skin biopsy specimens taken 4 and 13 weeks later.
Main Outcome Measures De novo synthesis of collagen, the major structural protein of dermal extracellular matrix, was assessed using immunohistochemical analysis, quantitative polymerase chain reaction, and electron microscopy.
Results Compared with controls, immunostaining in skin receiving cross-linked hyaluronic acid injections revealed increased collagen deposition around the filler. Staining for prolyl-4-hydroxylase and the C-terminal and N-terminal epitopes of type I procollagen was enhanced at 4 and 13 weeks after treatment (P<.05). Gene expression for types I and III procollagen as well as several profibrotic growth factors was also up-regulated at 4 and 13 weeks compared with controls (P<.05). Fibroblasts in filler-injected skin demonstrated a mechanically stretched appearance and a biosynthetic phenotype. In vitro, fibroblasts did not bind the filler, suggesting that cross-linked hyaluronic acid is not directly stimulatory.
Conclusions Injection of cross-linked hyaluronic acid stimulates collagen synthesis, partially restoring dermal matrix components that are lost in photodamaged skin. We hypothesize that this stimulatory effect may be induced by mechanical stretching of the dermis, which in turn leads to stretching and activation of dermal fibroblasts. These findings imply that cross-linked hyaluronic acid may be useful for stimulating collagen production therapeutically, particularly in the setting of atrophic skin conditions.
Author Affiliations: Departments of Dermatology (Drs Wang, Garza, Kang, Orringer, Fisher, and Voorhees) and Pathology (Dr Varani), University of Michigan Medical School, Ann Arbor. Dr Garza is now with the Department of Dermatology, University of Pennsylvania, Philadelphia.