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Practical Aspects Of Cosmetic Botulinum Toxin

Geva E Mannor
Published 2005 · Medicine

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Botulinum toxin is a potent natural poison and also a useful therapy for some neuromuscular conditions. It is a controlled, temporary, and targeted muscle weakening agent. It has been safely used with very mild side effects for more than 20 years by ophthalmologists. Dr. Alan Scott first treated a patient with strabismus in 1977 and published his first clinical paper in 1980. In 1989, the U.S. Food and Drug Administration (FDA) approved botulinum toxin treatment of both strabismus and facial spasms. Botulinum toxin type B was approved by the FDA in 2000. In 2002, the FDA approved BOTOX Cosmetic (the same formulation of botulinum toxin A) for treatment of glabellar hyperdynamic lines. Although clinical botulism still occurs, to date, there have been no reported deaths from unadulterated botulinum toxin overdose. It is estimated conservatively that for a 70-kg person, 2800 units of botulinum toxin A (BOTOX) would be lethal. This translates to approximately 28 vials of botulinum toxin injected systemically. In typical cosmetic practice, less than 1 vial is injected into a patient. Drugs that may interact with botulinum toxin include aminoglycosides (ie, streptomycin, gentamicin, tobramycin), aminoquinolines (ie, chloroquine and hydroxychloroquine), calcium channel blocking agents, cyclosporine, nicotinic receptor antagonist blockers (ie, curare), nicotinic receptor agonist blockers (ie, succinyl choline), and D-penicillamine. There may be cross-reactivity with antibodies in certain conditions as Eaton-Lambert, myasthenia gravis, and amyotrophic lateral sclerosis (ALS). Contraindications to botulinum toxin include pregnancy and nursing; diseases of the neuromuscular junction, like Eaton-Lambert, myasthenia gravis, and ALS; any interacting drugs listed above; allergy to egg albumin; or a history of allergy to botulinum toxin. There have been case reports of systemic reactions to botulinum toxin treatment, including generalized botulism-like illness and myasthenic
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