Pyoderma gangrenosum‐like lesions provocated by botulinum injections

Abstract

Botulinum toxin (BoNT) is a valuable therapeutic tool with several medical indications and the most popular of all cosmetic procedures worldwide. This is the reason for the growing number of unregistered products that may be the reason for adverse reactions. We present a case of a 51‐year‐old woman, who developed a pyoderma gangrenosum‐like reaction at injection sites after the administration of an unregistered BoNT product by a beautician. The clinical course, the morphology of the lesions, the result of histopathological biopsy, and the response to the treatment meets the criteria for diagnosis of pyoderma gangrenosum. The case presented by us is the first adverse reaction of this type after BoNT administration.

Complications of Botulinum toxin A: An update review

“…Botulinum toxins are commonly used in esthetic practice for beautification of a face, that is, the correction of wrinkles and laxity 1 . The botulinum toxin acts by blocking the acetylcholine release at the site of motor endplate causing muscle paralysis 2,3 . Its action involves the selective paralysis of certain muscles but inadvertent paralysis of adjacent or other muscles can cause adverse effects 4,5 .…”

“…1 The botulinum toxin acts by blocking the acetylcholine release at the site of motor endplate causing muscle paralysis. 2,3 Its action involves the selective paralysis of certain muscles but inadvertent paralysis of adjacent or other muscles can cause adverse effects. 4,5 It has been demonstrated that intradermal injection of botulinum toxin can be considered as an effective method for facial rejuvenation.…”

Paresis Following Type A Botulinum Toxin (Dysport) Injection: A Case Report

“…One of the side effects of Botox injection is eyebrow ptosis, which is a common complication of injecting the frontalis muscle to remove horizontal forehead lines with botulinum toxin. Additionally, ptosis of the upper eyelid is observed when injecting toxin in and around the glabella due to the migration of the injected substance through the orbital septum, resulting in the weakening of the levator palpebrae superioris (2,9). This complication typically occurs when a large amount of botulinum toxin is injected near the upper border of the bone in the midline of the pupil.…”

Clinical guidance of pyoderma gangrenosum 2022

“…PG has also been reported to have been induced by flap surgery for malignant melanoma, 109 orthopedic surgery, 110 trauma, 111 high-frequency therapy, 112 central venous catheterization, 113 and botulinum toxin therapy. 114 Proctostomy is a form of surgical insult, and peri-stromal PG is regarded as a variation of PG caused by surgical stress. 115…”

“…Although PG has been reported to have occurred after various operations, including breast reconstruction, 104 breast reduction surgery, 105,106 thyroid surgery, 107 and cesarean section, 107,108 PG occurs most frequently in the trunk and appears within 7 days after surgery in many patients. PG has also been reported to have been induced by flap surgery for malignant melanoma, 109 orthopedic surgery, 110 trauma, 111 high‐frequency therapy, 112 central venous catheterization, 113 and botulinum toxin therapy 114 . Proctostomy is a form of surgical insult, and peri‐stromal PG is regarded as a variation of PG caused by surgical stress 115 …”