Botulinum toxin type A for the treatment and prevention of hypertrophic scars and keloids: Updated review

Abstract

Botulinum Toxin Type A is a potent neurotoxin that is produced by a gram‐positive bacteria clostridium botulinum. Its utilization in the treatment of various medical condition has expanded over the years in both medical and esthetic uses. It is being preferred by most physicians due to its efficacy and lack of side effects. It can be used as monotherapy or combined therapy. The aim of this review study was to show the role and mechanism of action of Botulinum toxin type A in the treatment and prevention of hypertrophic scars and keloids. The clear mechanisms underlying hypertrophic scars and keloids are still not clearly understood; however, the mechanism of action of Botulinum toxin type A has been shown to include action on wound tension, action on collagen, and action on fibroblasts. Different randomized controlled trials, double‐blind, and placebo‐controlled studies have been conducted to investigate its use in treatment and prevention of hypertrophic scars and keloids, and it still is one of the active areas of research in Dermatology and related fields. Method: In March 2018, we performed a literature search in PubMed for clinical studies, clinical trials, case reports, controlled trials, randomized controlled trials, and systemic reviews. The search terms we used were “BOTULINUM TOXIN” AND “HYPERTROPHIC SCARS” OR “KELOIDS” (from 1980). The search resulted in 1000 articles, out of these 35 articles met our inclusion exclusion criteria. Our inclusion criteria included relevant original articles relevant, critical systemic reviews, and crucial referenced articles, exclusion criteria included duplicates and articles not published in English language. We have reviewed these papers to show the role and mechanism of action of Botulinum toxin type A in the treatment and prevention of hypertrophic scars and keloids.

Successful Treatment of Intralesional Bleomycin in Keloids of Vietnamese Population

“…Keloid is an overactive condition of the skin tissue to early lesions characterised by proliferation of fibroblasts and excessive production of collagen in the lesion, with mechanisms not yet fully understood [1]. Areas most frequently affected are chest, shoulder, ear lobe.…”

Botulinum Toxin A, Effect on Tensile Strength of Skin Wounds; Animal Study

“…The botulinum toxin (TBA) is an exotoxin produced by the bacterium Clostridium Botulinum, a spore forming, gram positive bacteria, that acts by inducing a chemo-denervation at the neuromuscular union, at the presynaptic neuron level, generating an irreversible blockade, preventing the liberation of acetylcholine, resulting in striated muscle denervation, that lasts from 2 to 6 months after it's administration, with the resulting muscular fiber atrophy and the clinical flaccid paralysis [7] [8].…”

“…Eight serologically distinct types of botulinum toxin exist, botulinum toxin type A (BOTOX®; Allergan) was the first commercially available type in the United States [7] [8] [9].…”

Botulinum toxin in treating Hailey‐Hailey disease: A systematic review

“…CO 2 laser therapy as a long‐term treatment option for Hailey‐Hailey disease has been systematically reviewed, offering an effective and safe treatment option with minimal side effects 7 . Botulinum toxin has also been widely used in cosmetic dermatology, noncosmetic dermatology, and nondermatological indications 8‐13 . As early as 2000, it was applied in a patient with Hailey‐Hailey disease and provided a sustained complete remission in the follow‐up 3 weeks later 14 .…”