This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Trial registration NCT02353897.

The most international dosing guidelines on the use of botulinum toxin type A (BTXA) drugs support a 1:1 dose relationship between OnaBTXA and IncoBTXA and 1:2.5 between OnaBTXA and AboBTXA. However, different facial zones demonstrate different doses conversion ratios. The comparative analysis of nine consensuses on the use of Abo-, Ona-, and IncoBTXA in the United States, Russia, and Europe has been performed. We conducted a review of publications adopting the key words "botulinum toxin consensus," "botulinum toxin guideline." Information search has been carried out primarily in specialized databases (DB). To find the relevant RCTs and guidelines/consensuses, the following databases were used: PubMed and Medline that were screened up to May 2008. Results regarding dose ratios for OnaBTXA:AboBTXA and IncoBTXA:AboBTXA showed that in most cases it is characterized both by increase and by decrease compared to the ratio of 1:2.5. The mean value of dose ratios OnaBTXA:AboBTXA adopted in the United States is 1:2.8. The ratio IncoBTXA:AboBTXA according to international and Russian data is 1:1.9. There are some differences in clinical approach of BTXA use in certain countries. In Russia, low doses are recommended for "crow's feet" and forehead. The US consensus recommends a higher dosage to correct perioral wrinkles. Despite many years of experience in using BTXA, there is no strict international uniformity of clinical guidelines. The recommended doses for the individual areas of the face may differ in different countries. Therefore, physicians in their practice should be guided not by international consensuses, but prefer a national guidelines.

No abstract

No abstract

Background: Botulinum toxin (BTX) is widely used in different areas of medicine for treatment of neurological disorders related to muscle hypertonicity and spasticity. However, the results of studies conducted over the past decade suggest that the BTX molecule exerts more complex and diverse effects on the human body, including antinociceptive effect and vascular tone regulation. Main observations: We report case of a 37-year-old healthy Caucasian woman who complained of pale patches on her forehead 5 days after she had been injected with abobotulinumtoxin A. Previously the patient did not receive any BTX injections. Pale patches corresponded to the BTX injection sites and became visible against hyperemic background following intense physical activity. Conclusion: The adverse effect of BTX used for aesthetic indications in the form of facial blanshing at the injections sites is a rare manifestation of individual peculiarities of certain patients.