Continuing medical educationInjectable and topical neurotoxins in dermatology: Indications, adverse events, and controversies
Section snippets
Therapeutic indications
Key points The therapeutic use of botulinum toxin has spanned across multiple specialties Disorders of sweating, flushing, and scar prevention are some of the dermatologic therapeutic usages of neuromodulators Other specialties highlighting the use of neuromodulators for therapeutic purposes include psychiatry, neurology, ophthalmology, gastroenterology, and urology/gynecology Off-label usages are common, and new usages are continuously under investigation Hypersensitivity reactions to the product and
Combination cosmetic therapy: Dermal fillers, lasers, and light sources
Key points Combination treatment of neurotoxins and soft tissue augmentation provides greater improvement and longer-lasting results with static facial rhytids Ideally, injecting toxin and waiting a short period of time before performing filler can reduce the total amount of filler required; however, many patients prefer treatment in the same session for convenience Neurotoxin combined with energy based devices is superior to either modality alone Caution is advised injecting toxins concurrently with
Adverse events and complications: Prevention, recognition, and treatment
Key points Injection site discomfort, erythema, bruising, and temporary headaches are the most common side effects Injection into a pilosebaceous unit can reduce pain Many of the functional/cosmetically displeasing adverse events may be prevented with very superficial, low volume injections Dysphagia, hoarseness, and neck flexor weakness are rare risks when injecting the platysma
Neurotoxins have consistently proven to be remarkably safe. Most reactions are a result of injection technique, dosage, or volume,
Controversies
Key points The development of neutralizing antibodies is more complex than previously speculated Antibodies to toxin type A may not always confer resistance to the other serotypes (ie, type B) Proper training requirements should be established and enforced for all physician and nonphysician injectors Muscle atrophy remains a topic of debate with regard to the cosmetic use of botulinum toxin
Summary
The use of neuromodulators continues to revolutionize medicine. The attractive quality of these agents is partly derived from their remarkable safety profile, minimally invasive approach, and overall ease of use for the physician. New indications are continuously emerging in the dermatologic and nondermatologic literature, expanding the utility and popularity of these products across multiple specialties. As the demand for a more youthful appearance continues to rise, neuromodulators will play
References (227)
- et al.
Atrophy of the intrinsic musculature of the hands associated with the use of botulinum toxin-A injections for hyperhidrosis: a case report and review of the literature
J Plast Reconstr Aesthet Surg
(2009) - et al.
Muscle structure and stiffness assessment after botulinum toxin type A injection. A systematic review
Ann Phys Rehabil Med
(2015) - et al.
Botulinum toxin in masticatory muscles: short- and long-term effects on muscle, bone, and craniofacial function in adult rabbits
Bone
(2012) - et al.
Botulinum toxin in ophthalmology
Surv Ophthalmol
(2007) Complications in fillers and Botox
Oral Maxillofac Surg Clin North Am
(2009)- et al.
An overview of botulinum toxins: past, present, and future
Clin Plast Surg
(2011) - et al.
The comparative effectiveness of suction-curettage and onabotulinumtoxin-A injections for the treatment of primary focal axillary hyperhidrosis: a randomized control trial
J Am Acad Dermatol
(2013) - et al.
Duration of efficacy increases with the repetition of botulinum toxin A injections in primary axillary hyperhidrosis: a study in 83 patients
J Am Acad Dermatol
(2013) - et al.
Botulinum toxin type A therapy for palmar and digital hyperhidrosis
J Am Acad Dermatol
(2000) - et al.
Botulinum toxin therapy for palmar hyperhidrosis
J Am Acad Dermatol
(1998)
Quality-of-life assessment in patients with hyperhidrosis before and after treatment with botulinum toxin: results of an open-label study
Clin Ther
Duration of efficacy increases with the repetition of botulinum toxin A injections in primary palmar hyperhidrosis: a study of 28 patients
J Am Acad Dermatol
Botulinum neurotoxin treatment of palmar and plantar hyperhidrosis
Dermatol Clin
Botulinum toxin for hyperhidrosis of areas other than the axillae and palms/soles
Dermatol Clin
Treatment of facial chromhidrosis with botulinum toxin type A
J Am Acad Dermatol
Nonsurgical reshaping of the lower face
Aesthet Surg J
Botulinum toxins for facial wrinkles: beyond glabellar lines
Facial Plast Surg Clin North Am
Botulinum toxin type A (Botox) for the neuromuscular correction of excessive gingival display on smiling (gummy smile)
Am J Orthod Dentofacial Orthop
Gummy smile and botulinum toxin: a new approach based on the gingival exposure area
J Am Acad Dermatol
Botulinum toxin A in the mid and lower face and neck
Dermatol Clin
Cosmetic uses of botulinum toxins for lower aspects of the face and neck
Clin Dermatol
Management of facial erythema of rosacea: what is the role of topical alpha-adrenergic receptor agonist therapy?
J Am Acad Dermatol
Botulinum toxin to improve facial wound healing: A prospective, blinded, placebo-controlled study
Mayo Clin Proc
Use of botulinum toxin type A to improve treatment of facial wounds: a prospective randomised study
J Plast Reconstr Aesthet Surg
Botulinum toxin historical aspects: from food poisoning to pharmaceutical
Int J Dermatol
Increased risk of litigation associated with laser surgery by nonphysician operators
JAMA Dermatol
Effect of botulinum toxin type A injection on lower facial contouring evaluated using a three-dimensional laser scan
Dermatol Surg
Muscle atrophy beyond the clinical effect after a single dose of OnabotulinumtoxinA injected in the procerus muscle: a study with magnetic resonance imaging
Dermatol Surg
Atrophy of corrugator supercilii muscle in a patient induced by the onabotulinum toxin injection
Headache
Hourglass deformity after botulinum toxin type A injection
Headache
Functional repair of motor endplates after botulinum neurotoxin type A poisoning: biphasic switch of synaptic activity between nerve sprouts and their parent terminals
Proc Natl Acad Sci U S A
Botulinum toxin
Botulinum toxin
Botulinum toxin for axillary hyperhidrosis
Dermatol Clin
Botulinum toxin type A and B improve quality of life in patients with axillary and palmar hyperhidrosis
Acta Derm Venereol
Botulinum toxin type a versus topical 20% aluminum chloride for the treatment of moderate to severe primary focal axillary hyperhidrosis
J Drugs Dermatol
Local injection of botulinum toxin A: an alternative therapy for axillary osmidrosis
J Dermatol
Botulinum toxin A for palmar hyperhidrosis: associated pain, duration, and reasons for discontinuation of therapy
Dermatol Surg
Botulinum toxin A for palmar hyperhidrosis
J Eur Acad Dermatol Venereol
Double-blind trial of botulinum A toxin for the treatment of focal hyperhidrosis of the palms
Br J Dermatol
Botulinum toxin in focal hyperhidrosis. An update
Der Hautarzt
Treatment of hyperhidrosis with botulinum toxin
Aesthet Surg J
The place of botulinum toxin type A in the treatment of focal hyperhidrosis
Br J Dermatol
A review of peripheral nerve blockade as local anaesthesia in the treatment of palmar hyperhidrosis
Br J Dermatol
Botulinum toxin for hyperhidrosis: a review
Am J Clin Dermatol
Effects of botulinum toxin-a therapy for palmar hyperhidrosis in plantar sweat production
Dermatol Surg
Efficacy and safety of botulinum toxin type a in the treatment of palmar hyperhidrosis: a double-blind, randomized, placebo-controlled study
Dermatol Surg
A double-blind, randomized, comparative study of Dysport vs. Botox in primary palmar hyperhidrosis
Br J Dermatol
Onabotulinumtoxin type A (Botox((R))) versus Incobotulinumtoxin type A (Xeomin((R))) in the treatment of focal idiopathic palmar hyperhidrosis: results of a comparative double-blind clinical trial
J Neural Transm
Side-effects of intradermal injections of botulinum A toxin in the treatment of palmar hyperhidrosis: a neurophysiological study
Eur J Neurol
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Botulinum Toxin Injections
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2023, Journal of Clinical and Aesthetic DermatologyFabrication, characterization and evaluation of a new designed botulinum toxin-cell penetrating peptide nanoparticulate complex
2023, DARU, Journal of Pharmaceutical SciencesAir-toxin technique: Introduction and analysis of effect using a photoimaging system
2022, Journal of Cosmetic DermatologyCauses of Botulinum Toxin Treatment Failure
2022, Clinical, Cosmetic and Investigational Dermatology
Funding sources: None.
Conflicts of interest: None declared.
Reprints not available from the authors.
Date of release: June 2017
Expiration date: June 2020