Who Should Not Take Hyaluronic Acid

Oral hyaluronic acid is well tolerated, and there are few absolute contraindications to it. However, there are groups of people who should refrain from the supplement or take it only after consulting a doctor, as well as situations where the problem is created not by hyaluronan itself but by other components of the product. The editorial team has organized these restrictions.

The logic of contraindications for a "natural" substance

Hyaluronic acid is the body’s own molecule, which is synthesized and broken down in large quantities every day. Therefore, in itself it rarely causes problems. Contraindications mostly arise from three causes: the allergenicity of the raw material, a lack of data for certain groups, and theoretical biological considerations.

A lack of data is the most common reason for caution. Clinical studies of oral hyaluronic acid were conducted mainly in adults with osteoarthritis or dry skin. Pregnant women, children, and people with severe chronic diseases were usually excluded from studies.

Theoretical considerations concern primarily oncology: hyaluronan participates in tumor biology through the CD44 receptor. There is no direct evidence of harm from supplements, but the editorial team considers it necessary to speak about this openly.

Finally, one should distinguish contraindications to oral supplements from those to medical injections. The latter is a much broader list, associated with the injection procedure itself.

Who should refrain or consult a doctor

People with allergies.A known allergy to hyaluronic acid or the components of a specific product is a direct contraindication. People with an allergy to birds or eggs should avoid raw material from rooster combs and choose fermentation-derived hyaluronic acid.

Pregnant and breastfeeding women.There are no special safety studies of oral hyaluronic acid in these groups. Since the supplement is not vital, the editorial team advises refraining or making the decision together with a doctor.

Children and adolescents.There is practically no data on the benefit and safety in children, and joint problems in childhood require mandatory diagnosis. The supplement should not be given to children without a doctor’s recommendation.

People with cancer.The role of hyaluronan in the tumor microenvironment is well known from laboratory studies (Toole review, 2004). Despite the absence of clinical evidence of risk from supplements, patients with active cancer or during treatment should discuss any supplements with an oncologist.

When the problem is in the complex, not the hyaluronan

Hyaluronic acid is often sold as part of complexes for joints and skin. In such products, contraindications are determined by the most "problematic" component, and they are easy to overlook.

Glucosamine.It is often made from the shells of crustaceans, so people with an allergy to seafood should check the source. Reports have also been described of enhanced warfarin action against the background of glucosamine, so patients on anticoagulants need a doctor’s consultation.

Chondroitin.Of animal origin (cartilage of cattle, pigs, fish, birds); important for people with allergies and those who avoid certain products for religious or ethical reasons. Interaction with anticoagulants is also possible.

Collagen, plant extracts, vitamins.Animal-derived collagen, turmeric, or ginger in "joint" formulas may have their own restrictions, in particular for people with gallstone disease or on anticoagulants.

• Read the full composition, not just the name on the front.
• Check the source of glucosamine and chondroitin.
• When taking warfarin or other anticoagulants, coordinate the complex with a doctor.
• If in doubt — choose a mono-product of hyaluronic acid.

Contraindications to injectable forms

Intra-articular injections and dermal fillers are medical procedures with their own list of contraindications, which is much broader than for capsules. The decision about them is made by a doctor after examination.

Generally accepted contraindications to intra-articular administration are infection of the joint or skin at the injection site, known hypersensitivity to the preparation, as well as conditions in which the risk of bleeding or infection is unacceptably high. The doctor also assesses whether the procedure makes sense at all: the OARSI (2019) and ACR (2020) guidelines treat viscosupplementation cautiously.

For cosmetic fillers, typical restrictions are active inflammation or skin infection in the injection zone (in particular herpes), pregnancy, a tendency to form keloid scars, autoimmune diseases in the active phase, and previous reactions to fillers.

Self-administered injections of hyaluronic acid purchased outside a medical facility are unacceptable under any circumstances: the risk of infection, vascular complications, and improper administration is too high.

Symptoms that require a doctor, not a supplement

The greatest risk associated with hyaluronic acid is not a side effect, but delayed diagnosis. A person with joint pain buys capsules and waits several months, although the cause may be a condition that requires urgent treatment.

A doctor should be consulted immediately if the joint has turned red, become hot to the touch, swollen sharply, if the pain is accompanied by a fever, if after an injury the joint "locks up" or has become unstable. Such symptoms may indicate infection, gout, inflammatory arthritis, or damage to the meniscus or ligaments.

Athletes should remember that pain that intensifies from workout to workout is a signal to reconsider the load and undergo examination, rather than to increase the number of supplements.

Similarly for the skin: sudden dryness, flaking, rashes, or itching may be signs of dermatitis, thyroid dysfunction, or other conditions that a supplement will not solve.

Editorial conclusions

Oral hyaluronic acid has few absolute contraindications; the main ones are allergy to the product and raw material.

Pregnant women, breastfeeding women, children, and people with cancer should refrain or coordinate use with a doctor due to a lack of data.

In complexes, restrictions are often set by other components — glucosamine, chondroitin, plant extracts — so the composition needs to be read in full.

Also read "Hyaluronic Acid Side Effects," "Hyaluronic Acid: Product Forms and Which to Choose," and "How to Take Hyaluronic Acid: Dosage, Timing, Duration."

References

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2. Fraser JR, Laurent TC, Laurent UB. Hyaluronan: its nature, distribution, functions and turnover. J Intern Med. 1997;242(1):27–33.
3. Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578–1589.
4. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Rheumatol. 2020;72(2):220–233.
5. Kalman DS, Heimer M, Valdeon A, Schwartz H, Sheldon E. Effect of a natural extract of chicken combs with a high content of hyaluronic acid (Hyal-Joint) on pain relief and quality of life in subjects with knee osteoarthritis. Nutr J. 2008;7:3.
6. Oe M, Tashiro T, Yoshida H, et al. Oral hyaluronan relieves knee pain: a review. Nutr J. 2016;15:11.