Oh, hyaluronic acid, your time has come, my friend… Once renowned as the magic bullet of the beauty industry, the biggest darling of the skincare world, you’ve become one the most ubiquitous ingredients in personal care products. And now you’re under fire as the newest no-no. Is all of this bad press warranted, though? I think you deserve a fair trial before we send you to the chopping block like some dermatological Anne Boleyn. So, let’s look at the evidence.
What even is Hyaluronic Acid?
Hyaluronic acid (HA) is a natural humectant produced in the skin, and often synthesized in a lab for use in personal care and cosmetic injectable products. It’s known for its plumping & smoothing effect on skin’s texture, as well as its healing properties in medical treatments.
Ok great, but what’s a humectant?
Humectants bind moisture to themselves and help protect your skin’s naturally acidic pH. How they are able to source the moisture they collect is highly dependent on where you live. ALL humectants draw water from whatever source is most readily available. In a humid climate, there is plenty to draw from in the air (we’re looking at you, Florida). In dry climates, humectants will pull water from your skin, since it’s lacking in the air (hellooooo, California & Colorado). This leads to a temporary boost of hydration that might leave you dryer than when you started, if it’s not sealed in properly. This is because humectants are just one member of the hydration team; they need assistance from occlusives (ingredients that lock moisture in) to trap the moisture they’ve captured or that moisture will simply evaporate. Your skin’s natural moisture is a mix of oil and water, so the skincare you use should mimic that. Location, location, location + formulation, formulation, formulation!!!
So why is HA under fire?
Our skin is a barrier, and barrier functionality is one of the critical components of healthy skin as a whole. Questions have arisen as to whether certain derivatives, molecular weights, and formulations of HA may upset the barrier function, causing irritation in some. Examining the root cause of these claims and concerns more closely will help establish whether or not HA is right for you, as well as guidelines for proper use.
Irritation from HA can come from over and improper use. To prevent overuse, you don’t need it in every product you use – much like your diet, you shouldn’t rely on one nutrient for your health. Skincare regimens should be balanced, using an array of ingredients, not leaning on one ingredient as the cure.
Another source of irritation may be from the molecular weight of the type of Hyaluronic Acid in your product. Low molecular weight versions of Hyaluronic Acid (such as sodium hyaluronate, the salt derivative of hyaluronic acid) are able to penetrate deeper into the skin. Though this derivative is very stable, if you’re sensitive to it, the fact that it penetrates deeper might trigger a reaction you wouldn’t necessarily get from a medium or high molecular weight formulation.
While hyaluronic acid is generally a well-tolerated ingredient, as with just about any skincare ingredient, some people are going to be naturally sensitive to it. Aloe is also a well-tolerated humectant, but some people are sensitive/allergic to it, too. If you need help figuring out if any ingredient is irritating your skin, patch testing can help. This is a best practice we support at MADEWITH. You can read MADEWITH’s approach to patch testing in our Patch Testing article.
Bacterial & Fungal Issues
The claim that hyaluronic acid is triggering bacterial and fungal infections particularly caught me off guard. The thought here is that true hyaluronic acid is a polysaccharide (a type of sugar), so it can be food for the little inhabitants in and on our skin. This claim is generally associated with HA injectables used as line fillers and plumpers. But it seems to be more of an issue of human error on the part of the person injecting the patient. As stated in NIH/World Journal of Clinical cases: “The risk of infection is increasing because of improper disinfection of the patient’s skin, incorrect injection technique, decreased general immunity, and the presence of pathogens.”
On the contrary, hyaluronic acid is used to trigger healing post-surgery, and in treatments for dermatitis.  It’s also been used as an antifungal agent. I spoke with Lynn Dudley, a functional medicine PA-C at Turning Point Integrative Health on the topic and she gave me the following insight into topical HA use, ”I work as a functional/integrative medicine practitioner so I take an inside-out approach to skincare. Meaning that I view the skin as a window or a reflection of what’s going on inside the body. So I first work on the body (usually gut health) when addressing skin concerns. And when we get to the point of recommending topical products, we definitely opt for ‘clean’ ingredients, organic when possible, no parabens, no phthalates, etc. Hyaluronic acid is considered to be a natural ingredient for the most part because it is produced by the body. For that reason, I think it can be a helpful ingredient for moisture retention and plumping wrinkles with minimal downside when used correctly.”
The key takeaways here is:
If you’re prone to fungal infections, you may want to avoid injectable forms of HA. But if you are set on using an injectable HA, make sure you’re going to a reputable doctor, physician’s assistant, or nurse practitioner.
A lot of the negative buzz right now is around the temporary effects of HA and its derivatives. As I’ve mentioned earlier in this article, every humectant’s moisture-binding benefits are temporary and can only be truly utilized by teaming them up with an occlusive to seal the moisture in. The debate should lie more in whether or not there are cumulative benefits to HA, when formulated with complimentary ingredients. Obviously, we should all be doing things to boost our own natural HA levels through healthier diets (root vegetables, leafy greens, citrus fruits, nuts, seeds, and red fruits & vegetables), though I find most of us rarely do everything we should do. Sometimes you need the temporary boost of a pair of Spanx to get into that LBD if you haven’t been properly hitting the gym. There’s certainly nothing wrong with that.
If you have established that HA isn’t right for you, no problem. There are myriad humectants to choose from. Here is a list of some of the most commonly used moisture-binders in personal care products: aloe vera, honey, allantoin, glycerin, sodium PCA, sorbitol, panthenol, and seaweed & algae extracts.
Should we all be tossing out every HA product in our regimens? The short answer is no. The long answer is everyone’s skin is different: what’s good for your best friend may not be right for you. As with any ingredient, don’t overuse it and patch test it first. If you need help figuring out if a hyaluronic acid product is right for you, your MadeWith Mentor is here to help you navigate the expansive skincare universe.
 The Journal of Materials Science: Materials in Medicine. Influence of hyaluronic acid on bacterial and fungal species, including clinically relevant opportunistic pathogens. Andrea Ardizzoni • Rachele G. Neglia • Maria C. Baschieri • Claudio Cermelli • Manuela Caratozzolo • Elena Righi • Beniamino Palmieri • Elisabetta Blasi. (2011). https://iris.unimore.it/retrieve/handle/11380/680447/46553/Influence%20of%20Hyaluronic%20acid%20on%20bacterial%20and%20fungal%20species%20including%20clinically%20relevant%20species.pdf;jsessionid=60CDF709CFDC98A7898392B0C91B327A.suir-unimore-prod-01
 Clinical, Cosmetic and Investigational Dermatology Journal. Puviani M, Campione E, Offidani AM, De Grandi R, Bianchi L, Bobyr I, Giannoni M, Campanati A, Bottagisio M, Bidossi A, De Vecchi E, Eisendle K, Milani M. Effects of a cream containing 5% hyaluronic acid mixed with a bacterial-wall-derived glycoprotein, glycyrrhetinic acid, piroctone olamine and climbazole on signs, symptoms and skin bacterial microbiota in subjects with seborrheic dermatitis of the face. (2019). https://www.dovepress.com/effects-of-a-cream-containing-5-hyaluronic-acid-mixed-with-a-bacterial-peer-reviewed-fulltext-article-CCID
 NIH/World Journal of Clinical cases. Majocchi’s granuloma caused by Trichophyton rubrum after facial injection with hyaluronic acid: A case report. Jie Liu, Wen-Qiang Xin, Lan-Ting Liu, Chao-Feng Chen, Lin Wu, and Xiao-Ping Hu. (2020). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7479567/
 Microbiologia Medica. In Vitro Effects of Glycyrrhetinic Acid and Hyaluronic Acid on the growth of vulvovaginal Candida albicans and others. Martina Stevan, Eleonora Fusato, Decio Armanini, Giulio Bertoloni, Francesco De Seta, Christian Leli, Mario Rassu. https://www.pagepressjournals.org/index.php/mm/article/view/6974/7082