Hyaluronic acid to help TS induced skin atrophy?

Here's the translation of Dr.Fukaya's new blogpost about skin atrophy. It's a very interesting article, so I would like to share.
Use of topical corticosteroids causes skin atrophy*- in other words, skin thinning and wrinkling. This is a fact. It doesn't depend on individual differences, pathological conditions, whether you have atopic dermatitis, or if you are a healthy person.

There is a research paper on topical corticosteroid induced skin atrophy, which measured skin thickness (the epidermides + the dermis) by echo ultrasound.  You cannot measure thickness of the epidermides alone.

The left image is from Different skin thinning potential of equipotent medium-strength glucocorticoids.
Korting HC et al. Skin Pharmacol Appl Skin Physiol. 2002 Mar-Apr;15(2):85-91..

In this study, healthy subjects use three different types of topical corticosteroid everyday for a while and their skin thicknesses are measured by echo. 
The study reveals that a steroid called Prednicarbate has shown the strongest resistance to skin atrophy. 

Prednicarbate is also known as Dermatop and is available outside Japan

However, there is no data determining whether Dermatop reduces skin atrophy.  So I was on the hunt for a topical corticosteroid which doesn't bring skin atrophy or lessens it
Then I found a very interesting paper, Inhibition of Putative Hyalurosome Platform in Keratinocytes as a Mechanism for Corticosteroid-Induced Epidermal Atrophy.
Barnes L et al. J Invest Dermatol. 2012 Dec 6. doi: 10.1038/jid.2012.439. [Epub ahead of print].

This paper discusses several experiments. I would like to reference some of them.

Hyaluronic Acid, not even an expensive one but one you may get as a cosmetic ingredient with a molecular weight of 50000 to 400000 (HAFi), can curb topical corticosteroid induced skin atrophy when applied topically. 
CP is Dermovate. When applied to mice twice a day for 6 days, the skin in the CP applied area is clearly thinning, but with HAFi(Hyaluronic Acid) the atrophy is held back.
Red objects are the epidermis cells and the thorns are called filopodia. This was a incubation experiment. When CP (Corticosteroid) was added, the number and the size of filopodia become normaler. 
The above images illustrate what is going on around filopodia during this process. 

In the image a, the head of filopodia has HAS 3 active (Hyaluronic synthetic enzyme, active) which produces Hyaluronic Acid (HA).  This HA combines with CD44 in the epidermis cell membrane and send plus signals to CDC42. 

In the image b, the Hyaluronic synthetic enzyme becomes inactive (HAS3 inactive) because of the effects of steroid. Filopodia hasn't spread out or doesn't receive CDC42 Plus. (hence, the epidermis cells become inactive and shrink.)

In the image c, the Hyaluronic synthetic enzyme is still inactive, but Hyaluronic Acid stimulus from the exterior sends plus signals to CDC 42 and therefore filopodia grows. Through this, the epidermis cells become active.

With the above mechanism, corticosteroid induced skin atrophy can be prevented by inexpensive, low molecular weight Hyaluronic Acid. The series of reaction points around filopodia is called 'hyalurosome platform'.

This sounds like a breakthrough to me...  Maybe in the future it may become essential to add Hyaluronic Acid to topical corticosteroid.

The Hyaluronic Acid used for plastic surgery and anti-aging treatments has large molecular weights, and for this reason it is expensive.  

I thought Hyaluronic Acid with molecular weight of 50000 to 400000 can be only used for something like moisturisers in skin lotion. So this data is very interesting.

Perhaps the problem of steroid addiction may be resolved by adding Hyaluronic Acid.

But, the problem with this information is that topical use of Hyaluronic Acid doesn't improve atopic dermatitis itself, and also it is currently on at the level of animal testing. 
So if a patient isn't familiar with topical steroid addiction, it'd be hard to understand the benefit of it. 
On the other hand, if you understand the problem of topical steroid addiction but are unwillingly using topical steroid for your life, use of topical Hyaluronic Acid is recommended

Additional infomation:

There is a data on comparison between HAFi, HAFs, HAFI in the study.
HAFi = Hyaluronic Acid with molecular weight of 50000 to 400000
HAFs = Hyaluronic Acid with the average molecular weight of  11000
HAFI = Hyaluronic Acid with the average molecular weight of 1149000

This graph illustrates the effects from growing filopodia in cultured epidermis cells. HAFi shows the biggest effect. HAFs also shows some positive results but the study says that it couldn't curb the epidermis atrophy caused by dermovate in mice.   
Also, after three types of Hyaluronic Acid are tested, the only Hyaluronic Acid that grew in culture supernatant was HAFi. This means that the epidermis cells which -stimulated by Hyaluronic Acid- produces its own Hyaluronic Acid by HAS3 (with positive feedback), and the acid which produced this effect was HAFi. 

I contacted some pharmacies about skin lotion with Hyaluronic Acid and found that most of them are around the molecular weight of 1000000.  Unfortunately, with these products you won't get a good result.

I found one with molecular weight of 50000 to 110000 (FCH-SU) among Hyaluronic Acid FCH series produced by Kikkoman BiochemiPharma.

 *Here by the term 'skin atrophy' I mean atrophy both in the epidermides and the dermis.
I have looked the Kikkoman BioChemiPharma website, and the one Dr. Fukaya mentioned is sold in the form of powder. Even if I can get it, I wouldn't know how to make it usable to my skin. Dr. Fukaya updated his blog saying he'll be making skin lotion with the Hyaluronic Acid (HAFi) so that it'll be available to everyone.
Update: Now the lotion is available on Dr. Fukaya Shop
My reviews of the lotion here and here.

I have pretty horrible skin atrophy so his article is really interesting. 
Here are some photos of my skin. It became a lot worse over the last few weeks.
It's been 14 months since my last withdrawal and the journey still continues...


  1. I had skin atrophy since twenty years the best solution is drink 2 liters of water per day. 2 cups first thing in the morning

  2. Hi. I had skin atrophy since 20 years...best solution is from my experience is. 1. 2 liters of water per day first 2 cups first thing in the morning and wait for 15 minutes. 2. Vit. C & E to nurish the skin

  3. Perhaps oral hyaluronic acid may be beneficial aswell.


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