Vol. 1 No. 2 (2025), Articles
Vol. 1 No. 2 (2025)

Hyaluronic Acid in Wound Management: An Update on Formulations, Mechanisms, and Clinical Applications

Articles
Published 2025-12-22
Biagio Nicolosi
Complex Injury and Burn Center, Department of Health Professions, Meyer Children’s Hospital IRCCS, Florence, Italy
https://orcid.org/0009-0008-6665-1638 (unauthenticated)
Karolina Kruszewska
Department of Clinical Nursing, Medical University of Warsaw, Warszawa, Poland
https://orcid.org/0000-0003-4322-0401 (unauthenticated)
Viviana Gonçalves
Unidade Local de Saúde de São João, Porto, Portugal
https://orcid.org/0000-0002-7030-0506 (unauthenticated)
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Keywords

Hyaluronic Acid
Skin Regeneration
Wound Healing
Molecular Weight
Topical Formulations
Chronic Wounds

How to Cite

Hyaluronic Acid in Wound Management: An Update on Formulations, Mechanisms, and Clinical Applications. (2025). International Journal of Wound Research, 1(2), 128-142. https://doi.org/10.64115/ijwr-2025-10
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Abstract

Introduction. HA underpins hydration, immune modulation, and matrix remodeling in wound healing. Its effects vary by molecular weight and formulation, with direct implications for clinical use. This update aims to analyzed and discuss the current knowledge on HA, with the objective of outlining its mechanisms of action and exploring the clinical implications of the various formulations used in wound care.

Methods. This update integrates key contributions (2000–2024) from PubMed, Scopus, and authoritative wound-care texts on the cutaneous use of HA in adult and pediatric patients. Evidence was organized to describe mechanisms, formulation characteristics (HA-only, HA+Ag, HA+AA, HYAFF scaffolds, injectable HA+6AA), and practice integration across acute and chronic wounds. No systematic review procedures were applied.

Results. High-molecular-weight HA shows protective and anti-inflammatory actions; low- molecular-weight HA promotes angiogenesis and immune activation. Clinically, HA-only topicals aid hydration and epithelialization; HA+Ag addresses bioburden; HA+AA supports stalled/ischemic beds; scaffolded HYAFF provides structure and sustained release for deep/exuding wounds; injectable HA+6AA augments remodeling in complex cases. A TIMERS-aligned framework supports step-up/step-down use and escalation when progression thresholds are unmet.

Discussion. HA is a formulation-dependent therapeutic that benefits wound outcomes when matched to phenotype and phase. Heterogeneity of products and outcomes limits cross-study comparability; head-to-head trials and standardized endpoints are priorities to refine indications across hospital and community pathways.

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