Hyaluronic Acid Compound Demonstrates Effective Improvement of Keratosis Pilaris

Keratosis pilaris improved, as did overall skin roughness and redness, after treatment with a non-cross-linked hyaluronic acid compound, according to a study published in the Journal of Cosmetic Dermatology.¹

Researchers also reported improvement and promotion of hair shaft growth.

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Background and Methods

A 2020 review published in the Journal of Dermatological Treatment reported the efficacy and safety of several existing treatment modalities for keratosis pilaris, including laser and light therapies, peeling agents, and more.²

Searching for an additional modality to add to the therapeutic armamentarium, researchers sought to assess the efficacy and safety of non-crosslinked hyaluronic acid compound dermal injections in patients with keratosis pilaris via an investigator-blinded, split-body, randomized, intraindividual comparative study.

The study involved patients (n=14) aged 18 years and older with a clinical diagnosis of bilateral upper extremity keratosis pilaris. Patients were excluded from participation if they had undergone treatment for keratosis pilaris within the past 6 months or had utilized topical therapies within 1 month from the study's initiation. A history of keloids and hypertrophic scarring or active skin disease, exposed sores, or cutaneous infections, also made individuals unable to participate.

Participants were randomly assigned to receive treatment on either their left or right upper extremity, with the untreated arm serving as a control. Treatment involved multiple microinjections of a non-cross-linked hyaluronic acid compound every 4 weeks.

Findings

The study sample consisted predominantly of females (10 out of 14), with a small representation of males (4 out of 14). The majority of participants were aged between 20 and 29 years, with a diverse range of Fitzpatrick skin types represented, including types II, III, and IV. Notably, a significant proportion of participants (11 out of 14) had a family history of keratosis pilaris, and about half of the participants (6 out of 14) experienced itching related to the condition.

At the conclusion of the study, researchers evaluated treatment efficacy via physician assessments and an analysis of patient self-reports. Physicians assigned a roughness/bumpiness score of 1.0 (with an interquartile range of 1 to 2) to the treated sides, compared to 2.0 (with an interquartile range of 2 to 3) for the control sides. This difference was deemed statistically significant, indicating a clear improvement in skin texture on the treated sides.

The median total physician score, which included both roughness and erythema, was 3.0 for the treated sides and 4.0 for the control sides, also exhibiting a statistically significant improvement. At the final follow-up visit, patients reported a median roughness/bumpiness score of 1.0 for the treatment side versus 2.0 for the control side. Similarly, erythema scores and overall condition ratings improved on the treated sides, aligning with the physicians’ assessments.

Upon the completion of dermoscopic evaluations, researchers reported substantial improvements in the appearance of both follicular plugs and perifollicular erythema on the treated sides. The count of follicular plugs decreased by 73.3%, and perifollicular erythema showed a 20% reduction.

Despite these improvements, hyperpigmentation showed minimal change.

Histopathological examinations supported these results, with pathological features of hyperkeratosis and follicular plugging improving significantly by the time of the final follow-up visit.

Researchers did not report any unexpected adverse events related to the treatment. However, 2 participants (14.3%) experienced transient post-inflammatory hyperpigmentation.

Conclusions

Study authors noted that this research represents the first time non-crosslinked sodium hyaluronate complex's utility has been demonstrated and proposed in keratosis pilaris.

"These findings have significant clinical implications and may establish a novel therapeutic paradigm," according to Li et al. "Additionally, this approach may offer innovative insights and strategies for utilizing hyaluronic acid in the treatment of other dermatological conditions characterized by rough skin and hair growth abnormalities."

Further research, they noted, will be necessary moving forward in order to make any determinations of long-term efficacy.

References

1. Li Y, Wang SW, Liu YH, et al. Efficacy and safety of non-cross-linked hyaluronic acid compound in the treatment of keratosis pilaris: a split-body randomized clinical trial. August 23, 2024. https://doi.org/10.1111/jocd.16532
2. Maghfour J, Ly S, Haidari W, et al. Treatment of keratosis pilaris and its variants: a systematic review. J Dermatolog Treat. 2020; 2020: 1-12.