Hyaluronic Acid (oral)

Oral hyaluronic acid is sold as «skin hydration from within» with promises to improve turgor and smooth wrinkles. Evidence base is limited: Patel 2017 systematic review (8 RCTs, n=300) and Japanese Kawada 2014 studies showed moderate stratum corneum hydration improvement over 6-12 weeks at 120-240 mg/day doses. All trials are small, mostly Japanese, funded by Kewpie and other manufacturers. Effect on visible wrinkles is not shown. EFSA has not approved any health claim for oral hyaluronic acid – no such claim is in the Reg 432/2012 register. AAD for skin aging recommends SPF, topical retinoids and topical antioxidants; oral hyaluronic acid is not in the recommendations. Evidence-based alternative for hydration is topical products with hyaluronic acid, ceramides and 5-10% urea. If oral hyaluronic acid was recommended as a substitute for sunscreen or topical products, consider seeking a second opinion from a dermatologist.

Oral hyaluronic acid 80-200 mg/day is offered for knee osteoarthritis. Several small Japanese and Spanish RCTs (Tashiro 2012, Sánchez-Macías 2015) showed modest WOMAC pain reduction over 6-8 weeks; no large independent meta-analyses or Cochrane reviews are available. OARSI 2019, NICE NG226 2022, ESCEO 2014 and EULAR 2018 do not include oral hyaluronic acid in osteoarthritis recommendations. Intra-articular hyaluronic acid injection is separate: AEMPS registered products (Adant, Synvisc, Durolane), but pain effect is limited and does not exceed intra-articular saline in some meta-analyses (Rutjes 2012). First-line for knee OA is non-pharmacological (weight loss, exercise), topical NSAIDs, paracetamol as option, intra-articular steroid if insufficient effect. If oral hyaluronic acid was recommended as a substitute for weight loss and exercise, consider seeking a second opinion from a rheumatologist.

Oral hyaluronic acid is sold in beauty complexes «for skin, hair and nails». Evidence base concerns only stratum corneum hydration in small Japanese RCTs; no RCTs with clinical hair or nail endpoints are published. EFSA has not approved any health claim for hyaluronic acid under Reg 432/2012. AAD 2022 for hair loss recommends cause workup (ferritin, TSH, scalp examination), topical minoxidil and finasteride for male androgenetic alopecia; oral hyaluronic acid is not in recommendations. If oral hyaluronic acid was recommended for hair loss without minimal workup, consider seeking a second opinion from a dermatologist.