Rx helpful in combatting skin irritation, inflammation

Topically applied hyaluronic acid sodium salt 0.2 percent appears useful in combating skin irritation and inflammation caused by treatments such as intense pulsed light, plasma skin resurfacing and medium-depth peels, as well as topical retinoids, tazarotene and 5-FU, an expert says.

“The idea came to me: What would happen if one used HA topically?”
— Cherie M. Ditre, M.D. University of Pennsylvania Radnor, Pa.

By John Jesitus
Senior Staff Correspondent

New York — Topically applied hyaluronic acid (HA) appears helpful in healing a variety of treatment-induced skin breakdowns, according to an expert.

Previous research has reported on the impact of topical HA applied after retinoid administration and, in one controlled study, after intense pulsed light (IPL) treatments, says Cherie M. Ditre, M.D., director of cosmetic dermatology and of the Skin Enhancement Center and assistant professor of dermatology, University of Pennsylvania School of Medicine, Radnor, Pa. However, Dr. Ditre says recent case studies provide insight into the many patient variables that may exist in clinical practice, as well as into use of topical HA after treatment with 5-fluorouracil (5-FU).

Dr. Ditre tells Dermatology Times she has used topically applied HA sodium salt 0.2 percent (Bionect®, JSJ Pharmaceuticals) for about two years, starting with a patient who experienced irritation after treatment with Efudex (5-FU, Valeant Pharmaceuticals).

Because Dr. Ditre had previously heard a lecture by Judah Folkman, M.D., on the use of oral HA and doxycycline to combat erythema and inflammation of the skin, “The idea came to me: What would happen if one used HA topically?”

The idea made sense, because HA partially blocks the COX-2 inflammation pathway, Dr. Ditre says. After prescribing topical HA to the patient who’d experienced irritation from 5-FU, she says, “Lo and behold, she returned one week later and looked great. She was thrilled, because I didn’t need to prescribe any steroids” to combat the inflammation.

Since then, Dr. Ditre says she’s treated approximately 15 IPL study patients with topical HA (publication pending), and another 100 or so who experienced irritation mainly after using topical retinoids.

“I’ve also used it with patients whose skin reacted to various forms of 5-FU,” she says. “It was well-tolerated in the IPL study,” Dr. Ditre says. “The other important factor is that after procedural treatments, no patients had to stop using it because it irritated or bothered their skin — just the opposite; it seemed to calm their skin down.”

Regarding dosing, she says she typically instructs patients to rub two pea-sized amounts of the prescription HA product over their entire faces twice daily for about a week.

For patients with retinoid dermatitis in particular, Dr. Ditre adds, “I have them combine it with their Retin-A (tretinoin, OrthoNeutrogena) or Tazorac (tazarotene, Allergan) at night to try and mitigate some of the irritation.”

After IPL treatments, Dr. Ditre recommends using topical HA for seven to 10 days on the face and 14 days for the chest, back and hands.

“Have patients put it on right after the procedure and send them out with the dressing on that day”, Dr. Ditre says.

After medium-depth peels using trichloroacetic acid or Jessner’s peel, she recommends starting patients on HA sodium salt two days after treatment, applying the product twice daily for seven to ten days until the skin is completely re-epithelialized.

This regimen decreases pain and redness and noticeably speeds healing, Dr. Ditre says, “One can expect improvement in seven to 10 days.”

After electro-desiccation and curettage for skin cancers, basal cell carcinomas, Dr. Ditre advises altering topical HA sodium salt with an antibiotic to promote healing.

For Chronic venous stasis ulcers, she recommends applying the product twice daily until the wound re-epithelializes, which can take one to three months, depending on the ulcer’s severity.

In the future, Dr. Ditre says she plans to try the product for post-sunburn patients, and perhaps those with rosacea. As for selecting a formulation, Dr. Ditre recommends giving patients a sample gel, cream and spray so they can choose the one they prefer.

Disclosure: Poster presentation supported by JSJ Pharmaceuticals, although Dr. Ditre reports no financial interest in the company or its products, or in any others mentioned in this article.

Published in Dermatology Times, January 2008 – An Advanstar Publication, Printed in U.S.A.