Two Sides of the Same Coin - Botulinum Toxin as Both Neurotoxin and Beauty Enhancer

In the modern day, the botulinum toxin has become one of the most important beauty marvels. But what exactly is the botulinum toxin, how is it produced and what are it’s clinical applications?

In today’s world the beauty of human figure has became one of the most important concerns. The use of cosmetics has been affected by the influence of social media and the internet, furthermore the quick changes in beauty norms have created a constant craving for beauty amongt both genders but particularly females.

One of the most widespread used agents in cosmetics is botulinum toxin, commonly referred to by it’s brand name Botox. It is a neurotoxin generated by clostridium botulinum bacteria which are of seven different forms; BoNT-A, B, C, D, E, F and G, among which BoNT-A and BoNT-B are currently used.

The use of botulinum toxin as a medical treatment was first documented in the literature by AB Scott in a case report, demonstrating significant improvement in the treatment of strabismus.

The U.S. Food and Drug Administration granted approval for botulinum toxin for the treatment of strabismus in 1989 (1).

Botulinum toxin, like other natural compound such as atropine and paclitaxel, was first employed for as a potent biological weapon 70 years ago. (2)

Since then, the BoNT has been indicated in several disorders, like chronic migraine, urinary incontinence from detrusor overactivity, hyperhidrosis, and cosmetics (3).

There are many promising reports about the use of BoNT for off-lable purposes, indicating its potential effectiveness in other diseases, which are not widely recognized.

      Dermatological conditions like rosacea, anal fissure, Raynaud phenomenon, and hidradenitis 

 

 

This action allows BoNT to potentially block both sympathetic and parasympathetic nerve terminals. (8)

Reports suggest that the serious side effects of BoNT are more frequently observed in therapeutic applications rather than cosmetic indications. This is likely due to the median dose of botulinum toxin being four times higher for therapeutic uses compared to cosmetic indications.

Dysphagia, muscle weakness, and allergic reactions are among the serious side effects associated with using botulinum toxin for cosmetic purposes. (9)

Another serious complication could be botulism, which is dose -dependent and caused by botulinum toxin diffusion into nearby muscles from the injected muscle. (10)

The risk of botulism transmission to humans is based on the possible contamination of meat or milk and milk products with C. botulinum spores. (11)

The reputation for lethality emphasizes the importance of careful handling and administration of botulinum toxin, whether in medical or cosmetic context.

 

 

Roles of BoNT in Dermatology

• Hidradenitis suppurativa (HS), also known as acne inversa

The initial report on using botulinum toxin type A for treating acne inversa was published in 2005. (12)

 

 

• Rosacea

Blocking the release of Ach appears to be an explanation for how botulinum toxin works in rosacea. Nevertheless, the precise mechanism of botulinum toxin’s effectiveness in treating rosacea is still not fully understood. (13)

 

• Anal Fissure

As per guidelines from the American College of Gastroenterology and the American Society of Colon and Rectal surgeon, botulinum toxin is suggested as a second -line treatment for fissures that don’t respond to topical GTN or diltiazem. (14)

 

 

• Androgenetic Alopecia

The potential mechanism of action of botulinum toxin type A in treating androgenic alopecia (AGA) could involve inhibiting the secretion of TGF-B1 from hair follicles through intradermal injection. (15,16,17)

• Plaque Psoriasis

A single administration of BoNT-A did no effectively eliminate psoriatic lesions. However, additional doses of BoNT may provide greater benefit. (18)

 

 

• Inverse Psoriasis

Zanchi et al. investigated the effectiveness of botulinum toxin type -A in treating inverse psoriasis. Additionally, 87% of patients showed improvement in intensity and infiltration, and no serious side effects were noted. (19)

 

• Hypertrophic Scars and Keloids

Botulinum toxin A, by regulating the balance between fibroblast proliferation and cell apoptosis and by immobilizing the muscles, thus reduces the tension of the skin tissue during the healing process, which seems to be effective in the aesthetic improvement of postoperative scars. (20)

 

 

Contraindications

Patients with neuromuscular conditions like myasthenia, Eaton-Lambert syndrome, and multiple sclerosis should avoid receiving Botox injection. Additionally, it’s not recommended for women who are menstruating or pregnant, individuals who are allergic to albumin or botulinum toxin, those with blood disorders or abnormal coagulation function, or individuals who are emaciated due to thin muscle. (21)

 

Conclusion

The effectiveness of botulinum toxin for the treatment of the mentioned diseases and others have been demonstrated by numerous studies at present. Additional clinical trials are required to verify the results of some of these studies. While botulinum toxin offers many benefits, its use does not come without risks. To prevent complications and provide adequate treatment, dermatologists must have professional knowledge of both approved and off-label uses of botulinum toxin. Establishing agreement on treatment protocols for each indication is crucial for standardized regimens with specific doses of BoNT.

 

About Dunya Mohammed Arif Dunya Mohammad is a pharmacist and MSc. holder in clinical pharmacology. She received her master’s degree from the College of Medicine at the University of Slemani in 2019. Currently, she teaches at the Faculty of Pharmacy at Qaiwan International University.