Botulinum toxin (BoNT) is a neurotoxin produced by the Clostridium botulinum bacterium, which possesses a well-known efficacy and safety profile in focal idiopathic hyperhidrosis treatment. BoNT includes seven different neurotoxins; however, only toxins A and B are clinically utilized. It is now used as an off-label therapy for numerous skin diseases. Scar prevention, hyperhidrosis, rhytides, eccrine nevus, alopecia, psoriasis, Darier disease, bullous skin disease, pompholyx, and Raynaud’s phenomenon are few among the novel indications of BoNT in cosmetic and notably noncosmetic elements of dermatology.

In cosmetology, BoNT is regarded as safe and effective for reducing facial wrinkles, particularly in the uppermost tierce of the face. BoNT A is well-known for its ability to reduce wrinkles. Although BoNT is usually safe, it is important to be mindful of the injection site because the toxin might spread and negatively affect areas that should not have been treated. Clinicians must be acquainted with site-specific complications when injecting BoNT into the feet, hands, or neck. 

To employ BoNT accurately in clinical practice, clinicians must have a thorough understanding of the functional anatomy of the mimetic muscles. Dermatologists should be aware of approved and off-label uses of BoNT to provide patients with pertinent treatment and decrease associated morbidity. 

BoNT’s clinical efficacy in an off-label setting, and any potential long-term safety considerations, should be evaluated by well-designed clinical trials.

Source: Naik PP. Utilities of botulinum toxins in dermatology and cosmetology. Clin Cosmet Investig Dermatol. 2021;14:1319-30.