Botulinum Toxin for the Treatment of Refractory Erythema and Flushing of Rosacea

Park, Kui Young; Hyun, Moo Yeol; Jeong, Seo Young; Kim, Beom Joon; Kim, Myeung Nam; Hong, Chang Kwun

doi:10.1159/000368773

Cited by 60 publications

(71 citation statements)

References 14 publications

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“…Chemical denervation by botulinum toxin appears to interfere with normal acetylcholine signaling pathways and can provide symptomatic relief to patients with severe facial flushing. Intradermal botulinum toxin injection seems effective and almost a safe therapy for patients with refractory erythema (it may rarely cause headache) and may be considered a reasonable addition to the therapeutic options, especially when other established therapies have failed [9]. …”

Section: Resultsmentioning

confidence: 99%

Rosacea Management

Abokwidir¹,

Feldman²

2016

Skin Appendage Disord

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Background: Rosacea is a chronic inflammatory skin condition associated with four distinct subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular. Purpose: To review the different kinds of management for all subtypes. Methods: We divided rosacea management into three main categories: patient education, skin care, and pharmacological/procedural interventions. Results: Flushing is better prevented rather than treated, by avoiding specific triggers, decreasing transepidermal water loss by moisturizers, and blocking ultraviolet light. Nonselective β-blockers and α₂-adrenergic agonists decrease erythema and flushing. The topical α-adrenergic receptor agonist brimonidine tartrate 0.5% reduces persistent facial erythema. Intradermal botulinum toxin injection is almost safe and effective for the erythema and flushing. Flashlamp-pumped dye, potassium-titanyl-phosphate and pulsed-dye laser, and intense pulsed light are used for telangiectasias. Metronidazole 1% and azelaic acid 15% cream reduce the severity of erythema. Both systemic and topical remedies treat papulopustules. Systemic remedies include metronidazole, doxycycline, minocycline, clarithromycin and isotretinoin, while topical remedies are based on metronidazole 0.75%, azelaic acid 15 or 20%, sodium sulfacetamide, ivermectin 1%, permethrin 5%, and retinoid. Ocular involvement can be treated with oral or topical antibacterial. Rhinophyma can be corrected by dermatosurgical procedures, decortication, and various types of lasers. Conclusion: There are many options for rosacea management. Patients may have multiple subtypes, and each phase has its own treatment.

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Section: Resultsmentioning

confidence: 99%

Rosacea Management

Abokwidir¹,

Feldman²

2016

Skin Appendage Disord

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“…At 4 weeks' follow-up, the quality of life was significantly improved. Botulinum toxin seems an effective therapy also in refractory erythema and flushing in patients with rosacea, as demonstrated in a report of 2 cases by Park et al [84] . The state of the art concerning the role of BoNT-A in these diseases is still debatable, and published studies revealed contrasting results in terms of efficacy.…”

Section: Facial Erythema and Flushingmentioning

confidence: 86%

Botulinum Toxin Off-Label Use in Dermatology: A Review

Campanati

Martina

Giuliodori

et al. 2017

Skin Appendage Disord

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focal hyperhidrosis, aesthetic medicine and neurological conditions with a strong efficacy and safety profile [1][2][3][4][5][6][7] . The enormous therapeutic potential of this drug contributed to a number of broad applications, especially in dermatological diseases. A large number of these indications are still lacking shared, approved protocols for dilution, doses, and timing of follow-up and retreatment. Also the injection techniques are still debated, depending on the operator's experience, angle of injection and depth. We have previously published a novel injection approach consisting in a needle adaptor that ensures a uniform administration of the toxin [3] . The aim of this review was to collect and analyze the published data concerning the most relevant off-label indications of BoNT-A. MethodsA PubMed search from 1950 to July 2016 was performed to identify any reports on the use of botulinum toxin in off-label indications concerning dermatology. We detected these articles using the terms "botulinum toxin dermatology," "botulinum toxin treatment," "botulinum toxin off-label," and meshed with a secondary search of studies pertaining to each indication. Only studies in English were reviewed. All studies that met the criteria were included and summarized in this review. KeywordsBotulinum toxin · Off-label therapy · Keloids · Hidradenitis suppurativa · Folds dermatitis Abstract Background: Botulinum toxin is a neurotoxin produced by the bacterium Clostridium botulinum which causes a flaccid muscle paralysis. It is currently used for aesthetic treatments and in the focal hyperhidrosis. Recently, botulinum toxin has also been used experimentally in many other dermatological conditions with good results. Objective: To review and analyze the possible botulinum toxin off-label applications published. Methods: A retrospective review of the published data was conducted. Conclusions: this potent drug can lead to several off-label indications of interest for dermatologists. Further clinical trials are still needed to better understand the real efficacy and safety of these applications and to standardize injection and dose protocols.

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“…The cheeks, chin, and supra-eyebrow were injected at each session. 66 Improvements in rosacea flushing were evident 1 week after the second treatment and lasted for 3 months. 66,72 The only side-effect reported was mild pain during injection.…”

Section: Medical Developmentsmentioning

confidence: 99%

“…65,66 Frey’s syndrome is a neurological sequel to parotid surgery that causes sweating and flushing whenever saliva production is triggered. 71 These effects may be due to the inhibition by BoNT-A of acetylcholine and vasoactive intestinal polypeptide, and BoNT-A might therefore be an effective treatment for acne and rosacea.…”

Section: Medical Developmentsmentioning

confidence: 99%

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New Uses of AbobotulinumtoxinA in Aesthetics

Schlessinger¹,

Gilbert²,

Cohen³

et al. 2017

Aesthetic Surgery Journal

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BotulinumtoxinA (BoNT-A) is now widely established for the main approved indication of reducing glabellar lines, and is also widely used off-label to improve the appearance of wrinkles and lines in other parts of the face. The number of aesthetic procedures continues to increase as the patient population becomes more diverse, in particular with increasing numbers of people of color and men. Further developments in treatment may continue to expand the audience for BoNT-A by making procedures more comfortable and by delivering a more natural, less static appearance. These may be achieved through use of combinations of BoNT-A with other aesthetic procedures, tailoring the dose of toxin to the patient’s muscle mass or by using novel injection and application techniques. Beyond amelioration of facial lines, encouraging results have been seen with the use of BoNT-A to improve the appearance of hypertrophic and keloid scars and even to prevent them. Studies have been conducted with scars in various parts of the body and further research is ongoing. Dermatological and other medical uses for BoNT-A are also active areas of research. Injections of BoNT-A have been shown to reduce signs and symptoms of acne, rosacea, and psoriasis, to reduce neuromuscular pain, and to bring about significant improvements in a number of rare diseases that are caused or exacerbated by hyperhidrosis. This paper reviews these new uses for BoNT-A, looking at the rationale for their use and discussing the results of published case studies and clinical trials. These areas have shown great promise to date, but more and larger clinical studies will be required before these treatments become a clinical reality. To this end details are also provided of clinical trials currently listed in the main clinical trials database to highlight research areas of particular interest.

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Botulinum Toxin for the Treatment of Refractory Erythema and Flushing of Rosacea

Cited by 60 publications

References 14 publications

Rosacea Management

Rosacea Management

Botulinum Toxin Off-Label Use in Dermatology: A Review

New Uses of AbobotulinumtoxinA in Aesthetics

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