What It Is and What It Is Used
For
Hyaluronidase is a naturally occurring enzyme that
temporarily depolymerises (breaks down) hyaluronic acid in the extracellular
matrix, increasing tissue permeability and facilitating the spread and
absorption of co-injected fluids or drugs.
Clinical uses:
• Hypodermoclysis: facilitating
subcutaneous fluid administration — used in palliative care and when IV access
is not achievable
• Ophthalmic regional anaesthesia:
improving local anaesthetic spread in peribulbar and retrobulbar blocks
• Hyaluronic acid filler reversal:
treatment of complications from hyaluronic acid-based dermal fillers (including
accidental intravascular injection causing vascular occlusion — a medical
emergency in aesthetic medicine)
Dosing and Administration
Hypodermoclysis:
1,500 IU added to each litre of SC fluid.
Local anaesthetic enhancement (ophthalmic):
Typically 15–75 IU per mL of local anaesthetic solution.
Dermal filler reversal:
150–200 IU injected directly into the affected area;
titrate to clinical effect. Re-evaluate at 24–48 hours. Use the minimum
effective dose — hyaluronidase cannot distinguish between injected filler and
endogenous hyaluronic acid.
Reconstitute with water for injection or normal saline.
Never administer IV. A skin sensitivity test (0.02mL intradermal, observe 20
minutes) is recommended before elective use in procedures where anaphylaxis
risk is a concern.
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💬 |
PATIENT TIP:
Hyaluronidase
is given by a healthcare professional. If you are having it to reverse a
dermal filler complication, results are typically visible within 24–48 hours.
Report any signs of allergic reaction (rash, swelling, difficulty breathing)
immediately after administration. |
Side Effects
|
Frequency |
Side Effects |
|
Common |
Local injection site pain, redness, swelling,
temporary bruising |
|
Uncommon |
Allergic reactions: urticaria, pruritus,
local oedema, flushing |
|
Serious — Seek Urgent Help |
Anaphylaxis (rare): severe allergic reaction
with breathing difficulty, throat swelling, cardiovascular collapse. Local
tissue damage if used in infected, ischaemic, or inflamed tissue. |
Contraindications and
Precautions
• Known hypersensitivity to
hyaluronidase
• Do not use to treat swelling from
insect stings (bee, wasp) — may enhance toxin spread
• Do not inject IV — intravenous
administration is absolutely contraindicated
• Avoid use in infected tissue, acutely
inflamed tissue, or malignant tissue
• Avoid use in ischaemic areas —
spreading may worsen local hypoxia
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⚠ |
CAUTION:
FILLER
REVERSAL: Hyaluronidase dissolves both injected filler and the body's own
natural hyaluronic acid. Use the minimum effective dose. In cases of
suspected vascular occlusion (skin blanching, livedo, severe pain following
filler injection), treat as an emergency — administer promptly and at higher
doses, and arrange urgent ophthalmological assessment if ophthalmic vessels
may be involved. |
Key Drug Interactions
• Adrenaline (epinephrine): counteracts
hyaluronidase spreading activity, may be used to limit local spread if
inadvertent over-spread occurs
• Local anaesthetics: hyaluronidase
increases their systemic absorption, monitor for local anaesthetic toxicity,
particularly if large volumes are used
Frequently Asked Questions
Q: Does hyaluronidase dissolve only filler or natural
tissue too?
It dissolves both.
Hyaluronidase cannot distinguish between injected hyaluronic acid filler and
the body's own hyaluronic acid in surrounding tissues. This is why minimum
effective dosing is important and why results may include some temporary
softening of natural tissue at the treatment site.
Q: How quickly does filler reversal work?
Results are usually
visible within 24–48 hours. In cases of vascular occlusion (an emergency),
hyaluronidase may begin to show effect within hours. A follow-up assessment at
24–48 hours is standard practice.
Q: Is a skin test always needed before use?
A skin sensitivity test
is recommended before elective procedures, particularly the first time a
patient receives hyaluronidase. In emergencies (e.g. vascular
occlusion from filler), the urgency of treatment outweighs the time needed for
a skin test.
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