Botulinum Toxin Off-Label Use in Dermatology: A Review

Abstract

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.

Two cases of Hidradenitis suppurativa and botulinum toxin type a therapy: A novel approach for a pathology that is still difficult to manage

“…Recently, we have reviewed the multiple uses of botulinum toxin in dermatological conditions, especially those called “fold dermatosis” (Campanati et al, ). Among these is the HS, which precisely involves these body areas.…”

The non-neuronal and nonmuscular effects of botulinum toxin: an opportunity for a deadly molecule to treat disease in the skin and beyond

“…BoNT/A has also shown therapeutic activity in patients with linear IgA bullous dermatosis, lichen simplex, alopecia areata, androgenetic alopecia, facial erythema and flushing (reviewed in Campanati et al . ) and various forms of itch in human skin (Table ) …”

Controversies in off‐label prescriptions in dermatology: the perspective of the patient, the physician, and the pharmaceutical companies

“…A review study published in the Journal of the European Academy of Dermatology showed growing evidence supporting the use of botulinum toxin in non‐cosmetic dermatological disorders such as pruritic dermatosis (pompholyx, idiopathic pruritus, lichen planus), acantholytic disorders (Hailey‐Hailey disease, Darier′s disease), inflammatory dermatosis (hidradenitis suppurativa, flexural psoriasis), scarring, fissures and ulceration (anal fissures, Raynaud′s disease and ulcers), and painful disorders such as vulvodynia and cutaneous leiomyomas . The treatment of keloids and hypertrophic scars, alopecia, facial erythema and flushing, oily skin, Raynaud phenomenon, chromhidrosis and bromhidrosis, and postherpetic neuralgia with botulinum toxin are also under investigation . In psychodermatology, botulinum toxin has been used for the complementary treatment of depression with positive results .…”

“…This potent drug is being used for several off‐label indications of interest for dermatologists. However, further clinical trials are still needed to better understand the efficacy and safety of these new indications and to standardize dose protocols …”