Efficacy and Effectiveness of High Molecular Weight Non‐Cross‐Linked Hyaluronic Acid Plus Succinic Acid Mesotherapy in Rosacea as Adjunct Therapy

Journal of Cosmetic Dermatology
Open Access

Clinical Summary

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What was studied

Adults with moderate rosacea (n=40; ages 40–45; Fitzpatrick I–III) already on ivermectin 1% + metronidazole 0.75% were assigned to receive three monthly sessions of intradermal high–molecular‑weight non‑cross‑linked hyaluronic acid 1.1% plus succinic acid 1.6% (n=20) versus continuing topicals alone (n=20) over 4 months, with planned 6‑month follow‑up.

Key findings

By month 4, the mesotherapy group had ~80% reduction in erythema (p<0.01) versus stable levels in controls, nearly 80% higher skin hydration (p<0.01) versus 10–15% (NS) in controls, ~50% higher skin elasticity, and decreased telangiectasias from month 2 (p<0.01) with no change in controls. Patient symptoms improved (soreness 7.1±1.3 to 1.2±0.3; burning 8.3±2.3 to 2.3±1.2; itching 7.9±1.2 to 1.5±0.2; tingling 6.2±1.8 to 2.1±0.3; all p<0.05), adverse effects were minor with an overall incidence ≤45% across 60 procedures, and reported per‑session costs were lower than laser/IPL in a local survey.

Study limitations

Nonrandomized, unblinded, single‑center study with small sample (n=40) and group assignment based on willingness, risking selection and measurement bias. Short follow‑up, no independent assessment or laser/IPL comparator, biopsy data from one patient, and cost data derived from a limited local survey without formal cost‑effectiveness analysis.

Clinical implications

As an adjunct to standard topicals after inadequate response, monthly HMWNCHA+SA mesotherapy improved erythema, hydration, elasticity, and symptoms versus continuing topicals, with only transient injection‑site reactions and lower reported costs than laser/IPL. If used, counsel patients on the preliminary, nonrandomized evidence base and the need for confirmatory randomized trials.