Madarosis and Facial Alopecia Presumed Secondary to Botulinum A Toxin Injections

Abstract

: This is the first case report documenting an idiosyncratic unilateral madarosis and facial alopecia as adverse side effects presumed secondary to botulinum A toxin injections.

Serious and Long-Term Adverse Events Associated with the Therapeutic and Cosmetic Use of Botulinum Toxin

“…According to a case report, one patient experienced madarosis and facial alopecia after 18 months of treatment with botulinum toxin for oromandibular dystonia [28]. No data were identified for adverse events appearing a long time after cessation of exposure to the drug.…”

“…The serious adverse events identified in case reports varied from idiosyncratic adverse reactions like anaphylactic shock to dose-dependent adverse reactions like cervical kyphosis and botulism [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38]. They were attributed to various types and preparations of botulinum toxin.…”

“…In addition, botulism-like generalized weakness has been reported in a patient treated for axillary and palmar hyperhidrosis [12]. Serious adverse events related to the therapeutic use of botulinum toxin include severe velopharyngeal insufficiency, brachial plexopathy, remote muscle weakness, botulism-like generalized muscle weakness, necrotizing fasciitis, crisis of myasthenia, generalized paralysis, marked bilateral blepharoptosis, impairment of speech and chewing, Guillain-Barré syndrome, severe dysphagia, iatrogenic botulism, generalized skin rash, aspiration pneumonia, unilateral facial madarosis and alopecia, and palatal palsy [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38]. It is interesting that one of the patients presented with generalized weakness 5 years after continued use of botulinum toxin [19].…”

Alopecia and Associated Toxic Agents: A Systematic Review

“…Recently, however, unilateral madarosis and facial alopecia were reported as a result of long-term use of botulinum A injections for the treatment of orofacial dystonia [50]. In addition, subjective nonscarring frontal alopecia has also been described by Di Pietro and Piraccini [51] in a case series of 5 female patients who had all undergone periodic botulinum A injections for forehead wrinkles.…”

“…By preventing the release of the neurotransmitter acetylcholine (ACh) at the neuromuscular junction (NMJ), the toxin produces a flaccid paralysis that has been exploited for medical purposes, such as anti-aging, and treating hyperhidrosis, muscle spasticity, and migraines [50, 63]. Several reports have described frontal alopecia after the use of botulinum toxin; however, the mechanism remains unknown.…”