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Hyaluronic Acid

HYALURONIC ACID AND ITS SIGNIFICANCE FOR HEALING

Hyaluronic acid, along with other glycosaminoglycans and collagen, is an important component in the mechanism of revival of damaged skin. In a study of 163 volunteers, whose average age was 57 years (ranging from 5-94 years), the results showed that the cutaneous application of hyaluronic acid has a significant regenerative effect. For example, for skin burns and similar skin damage, quick healing without keloid scars was observed.
Antonín Galatík, Hypro Otrokovice, s.r.o., the Czech Republic and Jan Galatík, BIORA, s.r.o., the Czech Republic presented their report on the use of hyaluronic acid in clinical practice at the symposium at VÚRCH Piestany, on September 6, 1995.

Skin regeneration is a complex and multistage process. In the study of the use of hyaluronic acid, more recent findings were revealed that complement the overall picture of the importance of hyaluronic acid in wound healing. Tissue hyaluronic acid, along with other glycosaminoglycans and collagen, creates a significant component of the mechanism necessary for the ability of skin reconstruction. For example, during the first few days after the skin is damaged, hyaluronic acid is the predominant substance contained. The hyaluronic acid is considered to have both regulatory and structural function, although, despite intensive research, its precise role at the cellular level is still not entirely clear. In short, many experimental results show that hyaluronic acid binds to fibrin to form a supportive extra-cellular cement, which can then model the penetration of fibroblasts and formation of granulation tissue.1,2,3 This allows the reconstruction of cells migration, as demonstrated by Abatangelo et al.4 Shows that hyaluronic acid has the ability to support connection-stimulated macrophages, which are necessary for healing. Furthermore, hyaluronic acid transports proteins, such as peptide growth factor, which apparently has a key role in the reconstruction of skin.5 Similarly, some data indicate that storage of fibroblast hyaluronic acid is at least partly the cause of healing without any scars. 6,7,8,9 Experimentally was demonstrated a significant acceleration of healing process in comparison with placebo from 8 to 2 days.10

METHODOLOGY

Clinical studies included patients from six medical facilities. Two departments, surgical and skin, tested a product containing hyaluronic acid for the treatment of burns and other skin defects (ulcera crucis, acne vulgaris, herpes, verucae); the other four departments – eye and rheumatology – tested a product containing hyaluronic acid for treatment of various diseases.

RESULTS

Clinical trials were conducted as an open study. Overall, there were 163 patients, including 116 treated for an eye diagnosis and 47 for burns and other skin defects. This part of the clinical trial was conducted at two departments. One was the surgical department NsP Vysoke Myto, where senior consultant A. Loskotová evaluated the treatment. The second department was the skin department of Military Hospital in Brno, where the evaluation took place under the guidance of senior consultant MUDr. S. Duban.
Evaluation was conducted mainly on the surgical ward NsP Vysoke Myto – 19 patients, the skin department in Brno only 4 patients. According to doctors‘ reports, the use of hyaluronic acid was simple and economical. In addition, dressings were not changed daily, but usually after 2-3 days. There was faster and better healing and epithelization of skin defects after burns without the formation of keloid scars. It was not necessary to perform plastic skin, and healing took place within three weeks. However, early applications were needed to speed up the healing process and to alleviate the pain. This reduced the consumption of analgesics and sedatives by 50%. Hyaluronic acid in all patients was well tolerated and there were no allergic reactions.

RATING HYALURONIC ACID IN INDIVIDUALS WITH SKIN DEFECT

The study took place at the skin department of the Military Hospital in Brno.
1. When viral skin involvement with the application was three times a day, retreat pain occurred mostly after 20 hours; the next day there was a drying, which also extended the duration of remission (a return to original condition), and, in some cases, no more recurrences occurred in the period under review.
2. Acne vulgaris
Hyaluronic acid was applied to the affected area with a mixture of ethanol in a spray. After several days there was a dry and reduced generation of new papulopustul, and the skin was partially rid of comedones. Hyaluronic acid was well tolerated, and there were no side effects. Compared with previously used drugs, it was evaluated as very good. Further development was advised regarding the other application forms (creams, ointments, spirituous preparations).

TOLERANCE

Hyaluronic acid used in skin indications – burns and skin defects of other origin – was very well tolerated, and there were no side effects or allergic reactions. Only a small number of patients (2.5%) with burns were observed with small changes in pigment.

CONCLUSION

Results of the study of 163 persons in six work places demonstrated the application of hyaluronic acid on skin has very good results. Hyaluronic acid speeds up the epithelization and healing without scars regarding skin burns and wounds. The total period of healing is reduced by 50%.

LITERATURE
1. Clark R. Cutaneous tissue repair: Basic biologic considerations. J Am Acad Dermatol (1985) 13, 5:701-725.
2. Weigel PH, Fuller GM, LeBoeuf RD. A model for the role of hyaluronic acid and fibrin in the early events during the inflammatory response and wound healing. J Theor Biol (1986) 119, 2:219-234.
3. Weigel PH, Frost SJ, McGary CT, LeBoeuf RD. The role of hyaluronic acid in inflammation and wound healing. Int J Tissue React. (1988) 10, 6:355-65.
4. Abatangelo G, Martelli M, Vecchia P. Healing of hyaluronic acid-enriched wounds: histological observations. J Surg Res (1983) 35:410-416.
5. Burd DA, Greco RM, Regauer S, Longaker MT, Siebert JW, Garg HG. Hyaluronan and wound healing: a new perspective. Br. J.. Plast Surg. (1991) 44(8):579-84.
6. Longaker MT, Adzick NS. The biology of fetal wound healing: a review. Plast Reconstr Surg (1991) 87(4):788–798.
7. Longaker MT, Chiu ES, Harrison MR, Crombleholme TM, Langer JC, Duncan BW, Adzick NS, Verrier ED, Stern R. Studies in fetal wound healing. IV. Hyaluronic acid-stimulating activity distinguishes fetal wound fluid from adult wound fluid. Ann Surg. (1989) 210(5):667–672.
8. Mast BA et al: Hyaluronic acid is a major component of the matrix of fetal rabbit skin and wounds. Matrix (1991) 11(1):63-68.
9. Mast BA et al: Scarless wound healing in the mammalian fetus. Surgery, Gynecology & Obstetrics (1992) 174:441-450.
10. Laurent C, Anniko M, Hellström S.: Hyaluronan applied to lesioned round window membrane is free from cochlear ototoxicity. Acta Otolaryngol (1991) 11: 506-14.