Hyaluronidase in Dermatology: Uses Beyond Hyaluronic Acid Fillers

Hyaluronidase is commonly used to decrease overcorrection or periorbital edema secondary to HA filler placement, although one study reported the successful decrease in periorbital edema in patients with idiopathic edema, not necessarily treated with HA fillers.⁵³ The effects of hyaluronidase on the edema is therefore not necessarily linked to previous HA filler placement.⁵³ This can be particularly beneficial as an adjunct during and post periorbital surgery for tumor excision to decrease the common complication of periorbital edema.⁵³

Hematoma
Hyaluronidase is licensed by the European Union for reabsorption of subcutaneous hematomas.⁸ Swelling and hematoma post facial contusion are frequently reported posttraumatic sequelae and can leave patients with intolerable cosmetic results.⁵⁴ A case report presented a patient with a post-traumatic hematoma successfully treated with three injections of hyaluronidase 1500IU/2ml (given at weekly intervals).⁵⁴ All hematomas resolved with no adverse cosmetic effects. A different presentation with post-traumatic facial fibrosis in another patient was successfully treated with four hyaluronidase 1500IU/2ml injections, significantly improving fibrotic dimpling.⁵⁴ Hyaluronidase liquified the solidified hematoma allowing for absorption and hematoma dissolution, preventing fibrosis.⁵⁴ Hyaluronidase is thought to inhibit fibroblast proliferation, degrading HA and reducing fibrosis.⁵⁴ Hyaluronidase could plausibly be of therapeutic benefit in highly symptomatic or functionally impairing post-procedural hematomas in dermatology.

Hyaluronidase has demonstrated significant promise when used outside of its licensed use in numerous dermatological conditions spanning medical, surgical, and cosmetic disciplines. As an adjunct to anesthesia, it has demonstrated the ability to disperse the LA over a larger area in a faster timeframe. It may also reduce tissue distortion caused by LA administration, particularly of perioral and periocular skin, which is of particular utility in dermatologic surgery. Hyaluronidase may play a useful role in keloid and hypertrophic scarring, distributing established therapies more effectively while degrading the aberrant ECM. Its use in the pre-treatment of conditions such as DFSP and as combination therapy in KS may be of further interest to dermatologic surgeons. Conditions with excess mucin deposition and fibrosis such as scleroderma could allow for lifechanging results in improving microstomia and fibrotic tissue.

Hyaluronidase appears to be a safe and cost-effective treatment, with few adverse effects. We would like to draw the attention of dermatologists to the increasing uses of hyaluronidase and to consider it in cases resistant to common conventional treatments.

The authors have reported no relevant conflicts of interest.

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