Biochemical and physical actions of hyaluronic acid delivered by intradermal jet injection route

Abstract

Administration of exogenous hyaluronic acid (HA) by liquid jet injection is considered as a beneficial therapy for dermatology conditions. This paper reviews variety of the factors which would optimize the clinical output of hyaluronic acid in this treatment modality. A pneumatically accelerated jet penetrates the epidermis and spherically spreads micro‐droplets of HA in the dermis without significant damage to the tissue and blood vessels. Kinetic energy of the jet activates two parallel mechanisms of action—mechanical and biological—which act synergistically to initiate and augment the regenerative effect. Jet‐induced micro‐trauma stimulates collagen synthesis and tissue repair without inflammation. Aside from the biophysical stimulation of dermal fibroblast, the biomolecular properties of exogenous HA provide excellent clinical results for skin atrophy, remodeling of dermal scarring, and reverse formation of fibrotic tissue. The effect is mediated by HA‐specific cell receptors and depends on molecular weight and the rheological properties of HA polymer. Skin mechanical properties play a key role in predicting HA dispersion patterns. Tolerability and safety of the treatment approach are determined by the jet's physical impact on the tissue and/or by the safety profile of the injected material. Although pneumatic jet delivery of a hyaluronic acid has a limited use in clinical practice, this treatment approach has a strong potential for extended implementation in esthetic dermatology. The synergistic mechanism has significant advantages of predictable and rapid clinical outcomes with a low discomfort. Additional well‐designed investigations are required for establishing a scientific foundation and guidelines for this treatment modality.

Home-Use Hyaluronic Acid Jet Injectors: Unreliable and Unsafe

“…Another factor that may play a role is the relatively high viscosity of HA, making jet injection more challenging in general. 14 Consequently, also the medical jet injectors delivered only 50.3 and 66.4 mL into the skin, which is substantially lower than reported in similar experiments with saline injections (84.8 mL). 19 This was most probably caused by the high viscosity of HA.…”

“…Moreover, only a few publications briefly mentioned the rare occurrence of adverse events associated with jet injection of HA. 12,14 However, this is based on the assumption of careful adjustment of injection parameters, the use of CE-marked EPIs, and administration by trained physicians. Only 1 article describes the potential risks of "Hyaluron Pens," concerning inflammatory responses, hematomas, and skin staining.…”

Needle‐free jet injection‐induced small‐droplet aerosol formation during intralesional bleomycin therapy

“…EPI was performed perpendicularly on the skin surface with an electronically‐controllable pneumatic jet injector (EnerJet 2.0; PerfAction Technologies Ltd.) at a pressure of 4 bar and an injection volume of 100 μl (device range: 2–6 bar, 50–130 μl, maximum jet stream velocity ≤ 150 m/s) 23 . The selected EPI setting resulted in the highest intradermal drug delivery in a previous study 24 .…”

Re-Densification Effect of Pressure-Injected Peptide-Hyaluronic Acid Combination on Male Androgenic Alopecia

“…The role of the pressure-injected jet on the hair regrowth mechanism is possibly similar to its action in the repair of aging skin. Physical tension applied by the micro-droplets on the surrounding extracellular matrix results in the morphological stretching of fibroblasts and micro-injury to the encountered collagen fibers [43]. The subsequent healing mechanism stimulates collagen synthesis without inflammation or excessive scarring [44].…”