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Hyaluronidase – Enzyme, Effects and Medical Uses

Hyaluronidase is an enzyme that breaks down hyaluronic acid. It is used medically as an adjuvant and as an antidote for filler-related complications.

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Things worth knowing about "Hyaluronidase"

Hyaluronidase is an enzyme that breaks down hyaluronic acid. It is used medically as an adjuvant and as an antidote for filler-related complications.

What is Hyaluronidase?

Hyaluronidase is an enzyme capable of breaking down hyaluronic acid and other glycosaminoglycans found in the extracellular matrix. Hyaluronic acid is a natural component of connective tissue, synovial fluid, and skin. By enzymatically degrading this substance, hyaluronidase increases tissue permeability, facilitating the spread of fluids or medications through the tissue.

Mechanism of Action

Hyaluronidase catalyzes the hydrolytic cleavage of glycosidic bonds within the hyaluronic acid chain. This temporarily reduces the viscosity of the interstitial tissue, creating a so-called spreading effect. This increased tissue permeability is reversible, as the body resynthesizes hyaluronic acid over time through natural biological processes.

Medical Applications

Adjuvant Therapy

In conventional medicine, hyaluronidase is used as an adjuvant (supporting agent) to improve the absorption and distribution of injected medications or subcutaneously administered fluids (hypodermoclysis). Typical applications include:

Subcutaneous infusion therapy (hypodermoclysis), particularly in elderly patients
Supporting the spread of local anesthetics, such as in ophthalmology
Enhancing the absorption of subcutaneously or intramuscularly injected drugs

Treatment of Filler Complications

One of the most significant applications is in aesthetic medicine. Since many dermal fillers are based on hyaluronic acid, hyaluronidase can be used to reverse unwanted outcomes, overcorrections, or dangerous complications following filler injections. Serious indications include:

Vascular occlusion caused by accidental intraarterial injection
Swelling, nodule formation, or asymmetry after hyaluronic acid filler treatments
Necrosis or impending tissue damage

In these emergency situations, prompt injection of hyaluronidase is critical to prevent irreversible tissue damage.

Ophthalmology

In eye surgery, hyaluronidase is commonly combined with local anesthetics for retrobulbar or peribulbar nerve blocks. This ensures more uniform anesthesia and improves the distribution of the anesthetic agent within the orbital tissue.

Dosage and Usage Notes

The dosage of hyaluronidase varies considerably depending on the indication. For hypodermoclysis, a typical dose is 150 IU (international units) per liter of infusion fluid. For the treatment of filler complications, higher doses (e.g., 150 to 1500 IU or more) may be injected directly into the affected area depending on the severity of the complication. The precise dosage should always be determined by an experienced medical professional.

Side Effects and Risks

Hyaluronidase is generally well tolerated but may cause the following side effects:

Local reactions such as redness, swelling, or pain at the injection site
Allergic reactions, including anaphylaxis in rare cases (a skin test prior to use is advisable)
Excessive breakdown of endogenous tissue at high doses
Facilitated spread of infections or toxins through the tissue (contraindicated in areas with active infection)

Contraindications

Hyaluronidase should not be used in the following situations:

Known hypersensitivity to hyaluronidase or any component of the preparation
Infections, inflammation, or malignant tumors in the injection area
Intravenous administration (not suitable for i.v. injection)

References

Becker M. et al. - Hyaluronidase in aesthetic medicine: indications, dosing, and safety. Journal of the German Society of Dermatology, 2021.
World Health Organization (WHO) - Model Formulary for Essential Medicines, 22nd edition, 2021. Available at: https://www.who.int
Cavallini M. et al. - Use of hyaluronidase in aesthetic medicine for the treatment of complications. Aesthetic Plastic Surgery, 2013; 37(3): 558-563.

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