Hyaluronic acid has become something of a darling in the beauty and supplement industries. You’ll find it in serums, moisturisers, joint supplements, and even eye drops. But what does the actual research say about this substance?

First discovered in the 1930s by Karl Meyer, who isolated it from cattle eyes and named it after “hyalos” (the Greek word for glass, referring to its transparent appearance), hyaluronic acid is a naturally occurring molecule in your body. It belongs to a class of compounds called glycosaminoglycans, and it’s found throughout your tissues—skin, joints, eyes, and connective tissue.

What makes hyaluronic acid interesting is its ability to hold water. A single gram can bind up to six litres of water, which explains why it plays such a crucial role in keeping tissues hydrated and joints lubricated. As we age, our natural production declines, which has led to a booming market in supplements and topical products.

But here’s the thing: popularity doesn’t equal efficacy. Let’s look at what the clinical evidence actually shows.

What is hyaluronic acid?

Hyaluronic acid (also called hyaluronan) is one of the main components of the extracellular matrix—the structural scaffolding that surrounds your cells. It’s found in nearly every tissue and body fluid, with particularly high concentrations in skin, synovial fluid (the lubricant in joints), and the vitreous humour of the eye 1.

Beyond providing structural support, hyaluronic acid is involved in cell signalling, wound healing, and tissue repair. It helps regulate cell adhesion and movement, and contributes to the mechanical properties of tissues—essentially helping them stay elastic and resilient.

The body’s hyaluronic acid levels decrease with age. Sun exposure, smoking, and air pollution accelerate this decline. This has led to various supplementation approaches: injectable fillers (used cosmetically and for joints), topical creams and serums, and oral supplements. Each delivery method has different levels of evidence behind it.

What does the research actually show?

1. May help diabetic foot ulcers heal faster

Diabetic foot syndrome is a serious complication affecting 15-25% of people with diabetes over their lifetime. These ulcers heal slowly and can lead to amputation when infections develop.

A meta-analysis of four randomised controlled trials involving 328 patients found that topical hyaluronic acid preparations increased wound healing rates compared to standard care 2.

My take: The evidence is promising but limited. Four small trials aren’t enough to draw firm conclusions, but the results were consistent across studies. If you’re managing diabetic foot ulcers, this might be worth discussing with your wound care specialist as an adjunct treatment—not a replacement for proper medical care.

2. Can improve skin hydration and reduce wrinkles

This is what most people think of when they hear “hyaluronic acid.” Several randomised, double-blind, placebo-controlled studies have examined both oral and topical forms.

For oral supplementation, a 12-week study in 60 adults with crow’s feet found that hyaluronic acid improved wrinkle depth and skin condition measures like radiance and suppleness 3. A separate review found that oral hyaluronic acid increased skin moisture in people with dry skin 4.

Topical hyaluronic acid has also been shown to improve skin moisture content, elasticity, and wrinkle depth 5.

Worth noting: The beauty industry has run away with these findings, but the improvements are modest—we’re talking about measurable changes on clinical instruments, not dramatic transformations. If you’re expecting to look ten years younger, you’ll be disappointed. That said, both oral and topical forms appear to offer genuine, if subtle, skin benefits.

3. May ease sinusitis symptoms

Rhinosinusitis (inflammation of the nose and sinuses) affects millions of people. Acute sinusitis involves symptoms like nasal blockage, facial pain, and loss of smell lasting under 12 weeks. Chronic sinusitis is the same picture but persisting beyond 12 weeks.

A systematic review of five studies found that nebulised hyaluronic acid (delivered as a fine mist directly to the nasal passages) improved quality of life and reduced symptoms in sinusitis patients 6.

The catch: This is a localised treatment requiring special equipment, not something you can replicate with oral supplements or standard nasal sprays. The evidence is encouraging but the studies were small.

4. Helps with dry eye symptoms

Dry eye disease is extremely common—about 25% of eye clinic patients report symptoms. The condition causes discomfort (burning, gritty sensation, eye fatigue) and can interfere with daily activities.

A 3-month randomised controlled trial in 54 patients compared hyaluronic acid eye drops alone versus drops combined with oral hyaluronic acid capsules (240 mg daily). The combination group showed significantly better results on multiple measures: ocular surface disease index, tear break-up time, and corneal staining scores 7.

In practice: Hyaluronic acid eye drops are already widely available and commonly recommended by ophthalmologists. The oral supplementation angle is newer and adds another potential layer of support. If you’re dealing with persistent dry eyes alongside other skin or joint concerns, oral hyaluronic acid might address multiple issues at once. For more on eye health supplements, see our article on lutein benefits.

5. Benefits for osteoarthritis (with caveats)

Osteoarthritis affects 60-80% of people over 65 and involves cartilage loss, bone changes, and synovial inflammation. Since hyaluronic acid is a major component of joint fluid, supplementation seems logical.

A randomised, double-blind study of 60 people over 50 with knee osteoarthritis found that oral hyaluronic acid (200 mg daily for 12 months) combined with quadriceps strengthening exercises improved pain, stiffness, quality of life, and mobility compared to exercise alone 8.

However—and this is important—the benefits were only statistically significant in participants under 70. Those over 70 showed no meaningful improvement, possibly due to differences in cellular metabolism.

My assessment: Hyaluronic acid may help younger osteoarthritis sufferers as part of a comprehensive approach that includes exercise. For older patients, the evidence is less convincing. Joint injections of hyaluronic acid (viscosupplementation) have a larger evidence base but that’s a different intervention entirely.

For other evidence-based joint supplements, see our articles on glucosamine and chondroitin.

6. May improve gastroesophageal reflux symptoms

Gastroesophageal reflux disease (GERD) causes heartburn and acid regurgitation when stomach contents back up into the oesophagus. Standard treatment involves proton pump inhibitors (PPIs), but some patients don’t respond adequately.

A 14-day randomised, double-blind, placebo-controlled study in 20 patients with non-erosive GERD who weren’t responding well to PPIs found that an oral combination of hyaluronic acid and chondroitin sulphate significantly improved heartburn and acid regurgitation symptoms. Notably, symptoms disappeared faster and more completely in the treatment group 9.

Reality check: This was a very small, very short study. The combination product makes it impossible to know how much hyaluronic acid contributed versus chondroitin sulphate. Interesting preliminary data, but I wouldn’t change my reflux management based on one 20-person trial.

7. Helpful addition to periodontal treatment

Periodontitis is inflammatory gum disease affecting 20-50% of the global population. It destroys the supporting structures of teeth and has links to cardiovascular disease, diabetes, and other systemic conditions.

A 12-week randomised trial in 33 patients with moderate to severe chronic periodontitis found that applying hyaluronic acid gel after professional scaling and root planing (deep cleaning) significantly improved bleeding on probing, pocket depth, and clinical attachment levels compared to scaling alone 10.

In practice: This is a professional dental treatment, not a home remedy. If you’re undergoing periodontal treatment, ask your dentist whether hyaluronic acid gel might enhance your outcomes.

8. Reduces recurrent urinary tract infection frequency

This is where hyaluronic acid gets particularly interesting for bladder health. Recurrent urinary tract infections plague many women—roughly 25-35% will experience recurrence within 3-6 months of an initial infection.

A double-blind study of 57 women with recurrent UTIs compared intravesical (bladder instillation) hyaluronic acid and chondroitin sulphate against placebo. The results were striking: the treatment group experienced an 86.6% reduction in UTI incidence compared to just 9.6% in the placebo group. Quality of life and symptoms improved significantly, and the mean time to recurrence extended from 52.7 days to 185.2 days 11.

Worth noting: This is a specialised treatment requiring medical administration, not an oral supplement. It works by replenishing the glycosaminoglycan layer that lines the bladder, which may be defective in women prone to recurrent infections.

For other approaches to UTI prevention, see our article on D-mannose.

9. May help interstitial cystitis symptoms

Interstitial cystitis (also known as painful bladder syndrome) is a chronic condition causing urinary urgency, frequency, and bladder/pelvic pain. It affects roughly 2.7% of women and 1.2% of men, and the exact cause remains unclear.

One leading theory involves defects in the bladder’s protective mucosal layer (the glycosaminoglycan layer), allowing urine components to irritate the underlying tissue. Since hyaluronic acid and chondroitin sulphate are major components of this layer, intravesical instillation has been studied as a treatment.

A non-blinded study found that bladder instillations of hyaluronic acid and chondroitin sulphate improved various interstitial cystitis symptoms: urgency scores decreased from 5.6 to 3.2, mean voided volume increased from 129.7 ml to 162 ml, and overall symptom indices improved 12.

The catch: This study lacked blinding and a control group, which are significant methodological weaknesses. The placebo effect can be substantial in conditions like interstitial cystitis where symptoms fluctuate naturally. Still, the biological rationale is sound, and more rigorous trials have since supported this approach as part of multimodal treatment. The NHS recognises bladder instillation therapy as a treatment option for interstitial cystitis 13.

What are the side effects?

Hyaluronic acid has an excellent safety profile overall. It’s a substance the body produces naturally, which likely contributes to its tolerability.

Oral supplements may cause mild gastrointestinal effects in some people: stomach upset, acid reflux, or decreased appetite. These appear to be uncommon and generally resolve on their own.

Topical products (creams, serums, eye drops) are generally very well tolerated. Allergic reactions are possible but rare.

Injections carry additional risks related to the injection itself: bruising, swelling, redness, pain at the injection site, and occasionally infection. Cosmetic filler injections can cause more serious complications including nodules, asymmetry, and (rarely) vascular occlusion. Injectable hyaluronic acid should only be administered by qualified practitioners 14.

Animal-derived products: Hyaluronic acid can be sourced from animal tissues (typically rooster combs) or produced via microbial fermentation. If you have allergies to poultry products, opt for fermentation-derived hyaluronic acid.

Safety precautions (5 contraindications)

1. Pregnancy, breastfeeding, and children There’s insufficient safety data for these groups. It’s not that harm has been demonstrated, but the research simply hasn’t been done. Avoid supplementation until more data is available.

2. Bleeding disorders or anticoagulant medications Some evidence suggests hyaluronic acid might affect blood clotting. If you have a bleeding disorder or take blood thinners (warfarin, aspirin, clopidogrel, etc.), discuss with your doctor before supplementing.

3. Cancer history Some laboratory research suggests hyaluronic acid may promote cancer cell growth and metastasis 15. This doesn’t mean oral supplements cause cancer, but if you have active cancer or a history of malignancy, it’s prudent to avoid supplementation until the implications are better understood.

4. Allergies to animal products or preservatives Check product labels carefully. Animal-derived hyaluronic acid may trigger reactions in sensitive individuals. Some products contain additional preservatives or ingredients that could cause problems.

5. Injectable treatments require medical supervision Never attempt to inject hyaluronic acid products yourself or have unqualified individuals perform injections. Serious complications can occur, including infection, tissue death from vascular occlusion, and permanent disfigurement. Always use qualified medical practitioners and verify the source and safety of products.

The bottom line

Hyaluronic acid is a genuinely useful molecule with reasonable evidence supporting several applications. The strongest evidence exists for:

Dry eye treatment (eye drops, possibly combined with oral supplements)
Skin hydration and modest wrinkle improvement (both oral and topical)
Intravesical instillation for recurrent UTIs and interstitial cystitis
Adjunctive use after periodontal treatment

More preliminary evidence suggests potential benefits for diabetic foot ulcers, osteoarthritis (particularly in younger patients), sinusitis, and GERD.

If you’re considering hyaluronic acid supplements, keep your expectations realistic. This isn’t a miracle anti-ageing cure or a substitute for proper medical treatment of serious conditions. But as a well-tolerated supplement with multiple potential applications, it may be worth trying—particularly if you’re dealing with more than one of the conditions mentioned above.

For joint health specifically, combining hyaluronic acid with other evidence-based supplements like glucosamine and collagen may provide synergistic benefits, though more research is needed on combined approaches.