Hyaluronic Acid Side Effects: Are the Benefits Worth the Risk? (2022)

  • Hyaluronic acid, also called hyaluronan, is naturally produced by the human body and is an essential component in skin hydration.
  • It can also be found in skin care products, dermal fillers and supplements.
  • Replenishing the skin with hyaluronic acid is effective in combating the natural aging process.
  • While this substance is very safe, there are certain instances where it should be avoided.

Hyaluronic acid is a molecule that binds easily with water to keep the skin, joints, eyes and other connective tissues moisturized and lubricated. It has a low molecular weight, which means it can easily penetrate the skin. It is best known as a moisturizer, and can help plump up skin to reduce fine lines and wrinkles. Because it is naturally found within the body, hyaluronic acid side effects are uncommon and occur most often as a result of the application method.

This substance attracts and locks in moisture to skin, making it an effective anti-aging treatment. It is formulated within skin care products, can be injected into the skin, or taken orally as a supplement.

Contents

Is Hyaluronic Acid Safe?

Yes, because it is naturally found within the body. When combined with other substances, an allergic reaction may develop, but this substance on its own should not cause any adverse effects.

That said, there are two instances where supplementing with hyaluronic acid should be discouraged. First, for those with pre-existing conditions such as liver disease, as it may hinder a diagnosis. Second, in the case of injections, it may cause side effects for those who have a hypersensitive immune system.

Side Effects of Hyaluronic Acid

Side effects will vary depending on the application method. Oral and topical use do not cause adverse reactions, however injections—such as in the case of dermal fillers—are more likely to do so, but only rarely as a result of the product itself.

When using any product for the first time, it is recommended to perform a patch test in a discreet area to determine any sensitivities.

Topical application

Topical application of hyaluronic acid moisturizes the skin and reduces wrinkles; it is safe and effective for all skin types. Any side effects that occur from topical use will likely be caused by other ingredients found in the product, such as fragrances or drying ingredients like alcohols.

If you have sensitive or allergy-prone skin, be sure to read the ingredients label of your product in order to avoid potential triggers. For oily or acne-prone skin, opt for a water-based hyaluronic product rather than oil-based, as they are less likely to clog pores.

Oral supplements

In terms of skin care, oral hyaluronic acid offers benefits similar to topical forms. It combats the dryness and wrinkling that result from aging, ultimately improving skin health and appearance. One study demonstrated that these supplements significantly moisturize the skin and relieve signs of aging in as little as 12 weeks.

One difference from topical application is that, as an oral supplement, this acid is proven to reduce pain and discomfort related to osteoarthritis, joint pain and in particular, knee pain.

Oral supplementation of hyaluronic acid is very safe, and has not been found to cause any side effects; one study showed that consuming 200 mg daily for one year produces no adverse side effects, while another demonstrated that 240 mg daily is safe to ingest.

Injections

Hyaluronic acid injections, such as Restylane and Juvederm, are often used as dermal fillers. These have a higher risk of side effects than any other forms of this substance. In some rare cases, individuals have demonstrated a hypersensitivity to these fillers, which resulted in granulomatous reactions.

This reaction is an attempt to block off a foreign substance from the rest of the body. Similar to an allergic reaction, it activates the immune system, but it causes different symptoms. Nodules form under the skin in an attempt to physically contain the substance, however, these are not painful.

This reaction is not specific to hyaluronic acid injections; anyone with a hypersensitive immune system would face the same risk with any type of injection. This reaction can be remedied by removing the filler with hyaluronidase gel, however, that too may cause an allergic reaction.

Side effects from fillers are much more likely to occur due to the injection procedure itself, and not the hyaluronic acid. Some symptoms that can occur include:

  • Redness
  • Swelling
  • Bruising
  • Itching
  • Pain
  • Rash around the injection site
  • Infection

Hyaluronic Acid Effects on the Liver

There is no evidence that topical application, consumption or injection of hyaluronic acid negatively affects the liver.

However, high hyaluronic acid levels are considered an indicator for predicting chronic liver diseases including fatty liver, severe fibrosis, inflammation, cirrhosis and hepatitis C. If you take this substance in amounts that can alter your natural levels, you are no longer able to use it as an indicator to detect abnormalities. Those with pre-existing liver conditions should avoid hyaluronic acid altogether.

Does Hyaluronic Acid Increase Your Risk of Cancer?

There is no evidence to suggest that hyaluronic acid, in any form, can cause or increase your risk of developing cancer. However, there is a concern that as a supplement, it can be damaging to those who already have cancer by theoretically, promoting the proliferation of cancer cells.

Improper Uses of Hyaluronic Acid

Applying hyaluronic acid to dry instead of damp skin, can have a dehydrating effect. Since it moisturizes by attracting water, in a dry environment it will pull moisture from the deeper layers of the skin. This can result in skin feeling dry, tight and uncomfortable.

Additionally, getting too many injections in the same area—regardless of ingredient—increases the risk of developing an infection at the injection site.

Interactions With Other Skin Care Products

Most skin care products can be combined with hyaluronic acid without any risk. However, you should avoid using it in combination with products that have a pH of less than 4 or higher than 11; studies have found that at these levels, its efficacy begins to diminish.

Some examples of common skin care ingredients that work best outside of the 4–11 pH range include alpha hydroxy acids such as glycolic and lactic acid, or beta hydroxy acids like salicylic acid.

Who Should Avoid Using Hyaluronic Acid?

Those with a history of liver disease and cancer should avoid using hyaluronic acid products.

Additionally, while there have been no cases to date of any adverse effects of this substance on pregnant or breastfeeding women, there is not enough research available to definitively prove that it is safe in these circumstances.

Takeaway

Overall, the benefits of hyaluronic acid products far outweigh the risks. It is safe in topical and oral forms for all skin types. In addition to providing significant moisturizing and anti-aging effects, it also helps to maintain healthy joints.

What side effects do exist are limited, and often have little to do with the substance itself. In rare cases, there is a risk of an overactive immune response to hyaluronic acid filler injections which can cause hard, red bumps to form under the skin.

For those with, or are suspected of having, serious health issues such as liver disease, using hyaluronic acid interferes with diagnoses and as such, should be avoided altogether.

Sources

  • Kawada, C., Yoshida, T., Yoshida, H., Matsuoka, R., Sakamoto, W., Odanaka, W., … Urushibata, O. (2014). Ingested hyaluronan moisturizes dry skin. Nutrition journal, 13, 70. doi:10.1186/1475-2891-13-70
  • Lafaille, P., & Benedetto, A. (2010). Fillers: contraindications, side effects and precautions. Journal of cutaneous and aesthetic surgery, 3(1), 16–19. doi:10.4103/0974-2077.63222
  • Oe, M., Tashiro, T., Yoshida, H., Nishiyama, H., Masuda, Y., Maruyama, K., … Fukui, N. (2016). Oral hyaluronan relieves knee pain: a review. Nutrition journal, 15(11). doi:10.1186/s12937-016-0128-2
  • Tashiro T, Seino S, Sato T, Matsuoka R, Masuda Y, Fukui N. (2012). Oral administration of polymer hyaluronic acid alleviates symptoms of knee osteoarthritis: a double-blind, placebo-controlled study over a 12-month period. Scientific World Journal. doi: 10.1100/2012/167928
  • Wu L, Liu X, Jian X, et al. Delayed allergic hypersensitivity to hyaluronidase during the treatment of granulomatous hyaluronic acid reactions.J Cosmet Dermatol. 2018;17(6):991–995. doi:10.1111/jocd.12461
  • Maleki, A., Kjøniksen, A.‐L. and Nyström, B. (2008), Effect of pH on the Behavior of Hyaluronic Acid in Dilute and Semidilute Aqueous Solutions. Macromol. Symp., 274: 131-140. doi:10.1002/masy.200851418

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