Rosacea is a chronic cutaneous disorder that is usually found on the face. The disorder is most commonly characterized by flushing, erythema, telangiectasia, edema, papules, and pustules.1 The cause of this inflammatory disorder is unknown, but is thought to include multiple contributing factors. Treatment regimens for rosacea commonly include oral antibiotics, which may cause problematic side effects such as anaphylaxis, photosensitivity, and superinfections. 2 Physicians are constantly searching for innovative treatment options for rosacea, especially those capable of replacing the need for oral antibiotic therapy.
A polysaccharide that is found in skin tissue is hyaluronic acid.3 As high molecular weight hyaluronic acid (HMW-HA) is depolymerized in sites of inflammation or tissue injury, low molecular weight hyaluronic acid (LMW-HA) fragments result. Low-molecular weight hyaluronic acid fragments are hydrophilic, allowing them to penetrate the stratum corneum.4 In addition, LMW-HA has the ability to alter the innate immune response partly stimulating the production of cytokines and chemokines by macrophages and activating T cells and dendritic cells. Effects on cell behavior include leukocyte, fibroblast, and endothelial cell migration and activation.5 The combination makes LMWHA an asset to dermatologic care, having implications in wound care. The benefits of LMW-HA do not end with wound care and may extend to the treatment of inflammatory skin disorders such as seborrheic dermatitis and rosacea.6 LMW-HA interacts with collagen and fibrin and serves as a building block for proteoglycans in the extra cellular matrix. Such interactions affect cell motility, proliferation, and recognition, as well as angiogenesis and the actions of inflammatory cells. Lastly, LMW-HA induces the production of β-defensin 2 (DEFβ2) by stimulating a tissue injury response, ultimately creating an antibacterial effect that allows for regeneration of the cutaneous epithelium and reduction in antigen load. Current research shows a reduction in healing time, edema, and pain, as well as improved appearance and cicatrization with use of LMW-HA.4
Beginning in February 2012, a single-site, unblinded, prospective, observational study of hyaluronic acid sodium salt cream 0.2% (Bionect Cream, Innocutis Holdings, Charleston, South Carolina) for the treatment of facial rosacea was conducted. The final subject completed the 8-week visit in August 2012. The study consisted of a single cohort to which all adult subjects were assigned. The trial was conducted in accordance with the