Botulinum Neurotoxin Type A in the Treatment of Facial Seborrhea and Acne: Evidence and a Proposed Mechanism

Abstract

Intradermal injection of botulinum neurotoxin is a frequently performed procedure in aesthetic dermatology to improve facial skin tone, texture, fine wrinkles, and enlarged pores. In practice, botulinum neurotoxin type A is also used to reduce skin oiliness of the face. There is increasing evidence that acetylcholine plays specific roles in sebum production, suggesting that botulinum neurotoxin type A may reduce sebum production by interfering with cholinergic transmission between sebaceous glands and autonomic nerve terminals. Botulinum neurotoxins can also inhibit several pathogenetic components of acne development, suggesting that botulinum neurotoxins can be used as a safe and effective treatment modality for acne and other skin disorders related to overactivity of sebaceous glands. This review aims to explore the current evidence behind the treatment of facial seborrhea and acne with botulinum neurotoxin type A.

Use of botulinum toxin type A associated with nonthermal microneedling for treating erythematoustelangiectatic rosacea: A case report

“…There is now increasing evidence that rosacea is an inflammatory disease characterized by an abnormal innate immune response, major vascular changes, and increased colonization by Demodex mites, along with a genetic predisposition and multiple external aggravating factors [1]. Overall, erythematoustelangiectatic rosacea is characterized mainly by vascular components, then, the findings of the present work are in line with the botulinum toxin type A mechanisms of action described in the review by Rho, Gil [9]:…”

“…As seen, botulinum toxin type A can be a potential tool to treat abnormal sebaceous gland activities such as erythematoustelangiectatic rosacea [9,10]. Meanwhile, at the current data, there are no studies reporting effects of nonthermal microneedling for treating rosaceaor associating it with drug delivery.…”

Non-pharmacologic treatment for acne vulgaris

“…[51] Botulinum neurotoxin A (BoNTA) can inhibit several pathogenic elements of acne development. Therefore, its intradermal injection can be performed to reduce sebum production and face oiliness by interfering with cholinergic transmission or adrenergic response by suppression of secretion of catecholamines and substance P. [11,51] Moreover, BoNTA can prevent formation of comedones through inhibition of adhesion of infundibular keratinocytes with better clearance of hair follicle opening. [11] Clinically, improvement of perinasal acne was observed 1-2 weeks after injecting 20-25 units of onabotulinumtoxin A into the paranasal facial expression muscles with persistence of acne clearing up to 4 months.…”

“…Therefore, its intradermal injection can be performed to reduce sebum production and face oiliness by interfering with cholinergic transmission or adrenergic response by suppression of secretion of catecholamines and substance P. [11,51] Moreover, BoNTA can prevent formation of comedones through inhibition of adhesion of infundibular keratinocytes with better clearance of hair follicle opening. [11] Clinically, improvement of perinasal acne was observed 1-2 weeks after injecting 20-25 units of onabotulinumtoxin A into the paranasal facial expression muscles with persistence of acne clearing up to 4 months. [52] LASERS AND LIGHT SOURCES Different light sources including; xenon, fluorescent, halogen, tungsten lamps and lasers, have been developed as more efficacious and safer treatment for acne vulgaris.…”

“…[6,8] The most commonly non-pharmacological therapies are dietary control, counseling dermocosmetics, comedone extraction, chemical peels, cryotherapy, platelet rich-plasma (PRP), botulinum neurotoxin A (BoNTA), light-based therapies or laser and photodynamic therapy (PDT). [6,7,[9][10][11]…”