Botulin Toxin Use in Rosacea and Facial Flushing Treatment

Botulinum toxin (BTX) is a neurotoxin derived from the Clostridium botulinum bacterium that inhibits the release of acetylcholine at the neuromuscular junction level whose effects has been used for many years to treat a variety of muscular/neuromuscular conditions and more recently also for cosmetic use. BTX has experimented in some dermatological conditions, which include Rosacea and facial flushing treatment with good results. The complex mechanism underlying those results is not completely understood but was proposed a release inhibition of acetylcholine from peripheral autonomic nerves of the cutaneous vasodilatory system combined with the blockade substance P and calcitonin gene-related peptide (CGRP) thus modulating blood vessel dilatation. We analysed the published data on BTX off label applications rosacea and flushing retrieved from PubMed.

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Botulin Toxin Use in Scars/Keloids Treatment

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.783 ◽

2019 ◽

Vol 7 (18) ◽

pp. 2979-2981 ◽

Cited By ~ 4

Author(s):

Jacopo Scala ◽

Aleksandra Vojvodic ◽

Petar Vojvodic ◽

Tatjana Vlaskovic-Jovicevic ◽

Zorica Peric-Hajzler ◽

...

Keyword(s):

Clostridium Botulinum ◽

Published Data ◽

Complex Mechanism ◽

Cutaneous Inflammation ◽

Off Label ◽

Botulin Toxin ◽

Calcitonin Gene ◽

Release Of Acetylcholine ◽

Neuromuscular Conditions ◽

Scar Prevention

Botulinum toxin (BTX) is a neurotoxin protein derived from the Clostridium botulinum bacterium that inhibits the release of acetylcholine at the neuromuscular junction level whose effects has been used for many years to treat a variety of muscular/neuromuscular conditions and more recently also for cosmetic use. BTX has experimented in some dermatological conditions which include scar prevention and treatment with good results. The complex mechanism underlying those results is not completely understood but several mechanisms were proposed: release inhibition of different substances like (TGF)-β, substance P, calcitonin gene-related peptide (CGRP) and glutamate thus modulating cutaneous inflammation and wound healing. We analysed the published data on BTX off label applications on scars and keloids retrieved from PubMed.

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“Micro Botulinum Toxin” for the Treatment of a Deep Dermal Burn After Single IPL and a Second Combined IPL/Nd: YAG Laser Treatment for Skin Rejuvenation and Discoloration

The American Journal of Cosmetic Surgery ◽

10.1177/07488068211012875 ◽

2021 ◽

pp. 074880682110128

Author(s):

Karen Soika

Keyword(s):

Botulinum Toxin ◽

Clostridium Botulinum ◽

Autonomic Nerves ◽

Positive Outcomes ◽

Facial Flushing ◽

Skin Rejuvenation ◽

Aesthetic Medicine ◽

Calcitonin Gene ◽

Release Of Acetylcholine ◽

Neuromuscular Conditions

Botulinum toxin (BTX) is a neurotoxin derived from the Clostridium botulinum bacterium that inhibits the release of acetylcholine at the neuromuscular junction. Botox is not new, and it has been used for many years to treat a variety of muscular/neuromuscular conditions and now more popularly for cosmetic use. Botulinum toxins use has been experimented in some dermatological conditions, which include Rosacea and facial flushing treatment with positive outcomes. The complex mechanism underlying those results is not completely understood but was proposed that a release inhibition of acetylcholine from peripheral autonomic nerves of the cutaneous vasodilatory system combined with the blockade of substance P and calcitonin gene-related peptide (CGRP), thus modulating vasodilatation of blood vessels as the likely mechanism of action. In cosmetic and aesthetic medicine, thermal burns from laser-type treatments are the number 1 lawsuit in this field. However, seldom are reports shared on management of these patient’s burns. This is a case report of such a patient who had a deep dermal burn after 2 consecutive treatments for the goal of correcting skin discoloration and sun damage.

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Therapeutic Use of Botulinum Neurotoxins in Dermatology: Systematic Review

Toxins ◽

10.3390/toxins13020120 ◽

2021 ◽

Vol 13 (2) ◽

pp. 120

Author(s):

Emanuela Martina ◽

Federico Diotallevi ◽

Giulia Radi ◽

Anna Campanati ◽

Annamaria Offidani

Keyword(s):

Systematic Review ◽

Skin Diseases ◽

Meta Analysis ◽

Published Data ◽

Efficacy And Safety ◽

Botulinum Toxins ◽

Epidermolysis Bullosa Simplex ◽

Off Label ◽

Facial Erythema ◽

Notalgia Paresthetica

Botulinum toxin is a superfamily of neurotoxins produced by the bacterium Clostridium Botulinum with well-established efficacy and safety profile in focal idiopathic hyperhidrosis. Recently, botulinum toxins have also been used in many other skin diseases, in off label regimen. The objective of this manuscript is to review and analyze the main therapeutic applications of botulinum toxins in skin diseases. A systematic review of the published data was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Botulinum toxins present several label and off-label indications of interest for dermatologists. The best-reported evidence concerns focal idiopathic hyperhidrosis, Raynaud phenomenon, suppurative hidradenitis, Hailey–Hailey disease, epidermolysis bullosa simplex Weber–Cockayne type, Darier’s disease, pachyonychia congenita, aquagenic keratoderma, alopecia, psoriasis, notalgia paresthetica, facial erythema and flushing, and oily skin. Further clinical trials are still needed to better understand the real efficacy and safety of these applications and to standardize injection and doses protocols for off label applications.

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Guidance for switching from off-label antipsychotics to pimavanserin for Parkinson’s disease psychosis: an expert consensus

CNS Spectrums ◽

10.1017/s1092852918001359 ◽

2018 ◽

Vol 23 (6) ◽

pp. 402-413 ◽

Cited By ~ 3

Author(s):

Kevin J. Black ◽

Henry Nasrallah ◽

Stuart Isaacson ◽

Mark Stacy ◽

Rajesh Pahwa ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Case Series ◽

Published Data ◽

Consensus Recommendation ◽

Clinical Reason ◽

Rebound Effects ◽

Off Label ◽

Receptor Interactions ◽

Daily Dose

Patients with Parkinson’s disease psychosis (PDP) are often treated with an atypical antipsychotic, especially quetiapine or clozapine, but side effects, lack of sufficient efficacy, or both may motivate a switch to pimavanserin, the first medication approved for management of PDP. How best to implement a switch to pimavanserin has not been clear, as there are no controlled trials or case series in the literature to provide guidance. An abrupt switch may interrupt partially effective treatment or potentially trigger rebound effects from antipsychotic withdrawal, whereas cross-taper involves potential drug interactions. A panel of experts drew from published data, their experience treating PDP, lessons from switching antipsychotic drugs in other populations, and the pharmacology of the relevant drugs, to establish consensus recommendations. The panel concluded that patients with PDP can be safely and effectively switched from atypical antipsychotics used off label in PDP to the recently approved pimavanserin by considering each agent’s pharmacokinetics and pharmacodynamics, receptor interactions, and the clinical reason for switching (efficacy or adverse events). Final recommendations are that such a switch should aim to maintain adequate 5-HT2A antagonism during the switch, thus providing a stable transition so that efficacy is maintained. Specifically, the consensus recommendation is to add pimavanserin at the full recommended daily dose (34 mg) for 2–6 weeks in most patients before beginning to taper and discontinue quetiapine or clozapine over several days to weeks. Further details are provided for this recommendation, as well as for special clinical circumstances where switching may need to proceed more rapidly.

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Science, Practice, and Human Errors in Controlling Clostridium botulinum in Heat-Preserved Food in Hermetic Containers

Journal of Food Protection ◽

10.4315/0362-028x-73.5.993 ◽

2010 ◽

Vol 73 (5) ◽

pp. 993-1002 ◽

Cited By ~ 7

Author(s):

IRVING J. PFLUG

Keyword(s):

Drug Administration ◽

Clostridium Botulinum ◽

Toxin Production ◽

Published Data ◽

Science Practice ◽

Canned Food ◽

Human Errors ◽

Human Failure ◽

Canning Industry ◽

Fda Regulations

The incidence of botulism in canned food in the last century is reviewed along with the background science; a few conclusions are reached based on analysis of published data. There are two primary aspects to botulism control: the design of an adequate process and the delivery of the adequate process to containers of food. The probability that the designed process will not be adequate to control Clostridium botulinum is very small, probably less than 1.0 × 10−6, based on containers of food, whereas the failure of the operator of the processing equipment to deliver the specified process to containers of food may be of the order of 1 in 40, to 1 in 100, based on processing units (retort loads). In the commercial food canning industry, failure to deliver the process will probably be of the order of 1.0 × 10−4 to 1.0 × 10−6 when U.S. Food and Drug Administration (FDA) regulations are followed. Botulism incidents have occurred in food canning plants that have not followed the FDA regulations. It is possible but very rare to have botulism result from postprocessing contamination. It may thus be concluded that botulism incidents in canned food are primarily the result of human failure in the delivery of the designed or specified process to containers of food that, in turn, result in the survival, outgrowth, and toxin production of C. botulinum spores. Therefore, efforts in C. botulinum control should be concentrated on reducing human errors in the delivery of the specified process to containers of food.

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Subcutaneous pantoprazole in an elderly, palliative care patient

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2019-001916 ◽

2019 ◽

pp. bmjspcare-2019-001916

Author(s):

Hugues Michelon ◽

Hélène Souchu ◽

Bénédicte Chauvron-Defilippi ◽

Anne Lecoeur ◽

Maryvonne Villart ◽

...

Keyword(s):

Palliative Care ◽

Linitis Plastica ◽

Care Patient ◽

Intravenous Route ◽

Published Data ◽

Clinical Safety ◽

Off Label ◽

Improve Patient ◽

Efficiency Data ◽

Interesting Alternative

Proton pump inhibitors (PPIs) have become the agents of choice for acid-related diseases. In some clinical situations, PPI therapy by oral or intravenous route may be difficult especially among elderly and patients in palliative care. Off-label PPI subcutaneous injection could be the last alternative to improve patient relief, despite limited published data. We report a case of linitis plastica, peritoneal carcinomatosis and occlusive syndrome who suffered from painful regurgitations which rapidly improved after subcutaneous pantoprazole. No related adverse effects were observed during PPI therapy. Despite some limitations, this report suggests that off-label subcutaneous pantoprazole could be an interesting alternative route when intravenous infusion may be difficult or harmful for elderly and patients in palliative care. Nevertheless, clinical safety and efficiency data on larger populations are needed to validate this use in such population.

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Cutaneous Sensory Stimulation Leading to Facial Flushing and Release of Calcitonin Gene-Related Peptide

Cephalalgia ◽

10.1046/j.1468-2982.1992.1201053.x ◽

1992 ◽

Vol 12 (1) ◽

pp. 53-56 ◽

Cited By ~ 24

Author(s):

Peter J Goadsby ◽

Lars Edvinsson ◽

Rolf Ekman

Keyword(s):

Trigger Point ◽

Sensory Stimulation ◽

Clinical Problem ◽

Calcitonin Gene Related Peptide ◽

External Jugular Vein ◽

Facial Artery ◽

Facial Flushing ◽

Related Peptide ◽

Calcitonin Gene ◽

Prostaglandin F

A patient is described with a 17-year history of intractable left-sided facial pain. The pain occurred daily in 5 sec spasms to a maximum of one every 2–3 min and was restricted to the left upper face. It was associated with rhinorrhoea on the left and often with ipsilateral facial flushing. Conventional therapy, including carbamazepine, baclofen and three posterior fossa explorations, had not provided lasting relief. Local facial stimulation by tapping a painful trigger point led to both pain and flushing of the face ipsilaterally. During this flushing, blood was collected and assayed using sensitive radioimmunoassays for several neuropeptides (neuropeptide Y, substance P, vasoactive intestinal polypeptide and calcitonin gene-related peptide). A marked (119%) increase in calcitonin gene-related peptide was noted in the external jugular vein blood ipsilaterally during the flushing with no change in the other peptides measured. To quantitate the effect of calcitonin gene-related peptide on human extracranial vessels, standard pharmacological procedures were used to examine the potency of the peptide as a vasodilator of human facial artery. The 1C50 of calcitonin gene-related peptide for the prostaglandin F2a -precontracted human facial artery was 10-9 mol/1. The relevance of these observations to the clinical problem of migraine is considered.

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Botulinum Neurotoxins (BoNTs) and Their Biological, Pharmacological, and Toxicological Issues: A Scoping Review

Applied Sciences ◽

10.3390/app11198849 ◽

2021 ◽

Vol 11 (19) ◽

pp. 8849

Author(s):

Massimo Corsalini ◽

Francesco Inchingolo ◽

Gianna Dipalma ◽

Angelika Elzbieta Wegierska ◽

Ioannis Alexandros Charitos ◽

...

Keyword(s):

Botulinum Toxin ◽

Clostridium Botulinum ◽

Pharmacological Action ◽

Botulinum Toxins ◽

Common Cause ◽

Wound Botulism ◽

Contaminated Food ◽

Release Of Acetylcholine ◽

Botulinum Neurotoxins ◽

Human Poisoning

Botulinum toxins or neurotoxins (BoNTs) are the most potent neurotoxins known, and are currently extensively studied, not only for their potential lethality, but also for their possible therapeutic and cosmetic uses. Currently, seven types of antigenically distinct toxins are known and characterized, produced by a rod-shaped bacterium, Clostridium botulinum. Human poisoning by botulism (presenting with severe neuromuscular paralytic disease) is usually caused by toxins A, B, E, and F type. Poisoning from contaminated food preparations is the most common cause of noniatrogenic botulism. The spores are highly resistant to heat but are easily destroyed at 80 °C for thirty minutes. Type A and B toxins are resistant to digestion by the enzymes of the gastrointestinal system. After their entry, BoNTs irreversibly bind to cholinergic nerve endings and block the release of acetylcholine from the synapses. In contrast, in wound botulism, the neurotoxin is instead product by the growth of C.botulium in infected tissues. The contamination by BoNT inhalation does not occur by a natural route but it is certainly the most dangerous. It can be caused by the dispersion of the botulinum toxin in the atmosphere in the form of an aerosol and therefore can be deliberately used for bioterrorist purposes (e.g., during CBRN (chemical, biological, radiological, and nuclear) unconventional events). In addition, BoNTs are currently used to treat a variety of diseases or alleviate their symptoms, such as the onabotulinumtoxinA for migraine attacks and for cosmetic use. Indeed, this paper aims to report on updated knowledge of BoNTs, both their toxicological mechanisms and their pharmacological action.

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Calcitonin gene-related peptide elevates calcium and polarizes membrane potential in MG-63 cells by both cAMP-independent and -dependent mechanisms

AJP Cell Physiology ◽

10.1152/ajpcell.00274.2003 ◽

2004 ◽

Vol 287 (2) ◽

pp. C457-C467 ◽

Cited By ~ 24

Author(s):

Douglas M. Burns ◽

Lisa Stehno-Bittel ◽

Tomoyuki Kawase

Keyword(s):

Membrane Potential ◽

Signaling Pathways ◽

Secondary Phase ◽

Calcitonin Gene Related Peptide ◽

Published Data ◽

Maximal Effect ◽

Related Peptide ◽

Calcitonin Gene ◽

Intracellular Ca ◽

20 Nm

Published data suggest that the neuropeptide calcitonin gene-related peptide (CGRP) can stimulate osteoblastic bone formation; however, interest has focused on activation of cAMP-dependent signaling pathways in osteogenic cells without full consideration of the importance of cAMP-independent signaling. We have now examined the effects of CGRP on intracellular Ca2+ concentration ([Ca2+]int) and membrane potential ( Em) in preosteoblastic human MG-63 cells by single-cell fluorescent confocal analysis using fluo 4-AM-fura red-AM and bis(1,3-dibarbituric acid)-trimethine oxanol [DiBAC4( 3 )] bis-oxonol assays. CGRP produced a two-stage change in [Ca2+]int: a rapid transient peak and a secondary sustained increase. Both responses were dose dependent with an EC50 of ∼0.30 nM, and the maximal effect (initially ∼3-fold over basal levels) was observed at 20 nM. The initial phase was sensitive to inhibition of Ca2+ mobilization with thapsigargin, whereas the secondary phase was eliminated only by blocking transmembrane Ca2+ influx with verapamil or inhibiting cAMP-dependent signaling with the Rp isomer of adenosine 3′,5′-cyclic monophosphorothioate (Rp-cAMPS). These data suggest that CGRP initially stimulates Ca2+ discharge from intracellular stores by a cAMP-independent mechanism and subsequently stimulates Ca2+ influx through L-type voltage-dependent Ca2+ channels by a cAMP-dependent mechanism. In addition, CGRP dose-dependently polarized cellular Em, with maximal effect at 20 nM and an EC50 of 0.30 nM. This effect was attenuated with charybdotoxin (−20%) or glyburide (glibenclamide; −80%), suggesting that Em hyperpolarization is induced by both Ca2+-activated and ATP-sensitive K+ channels. Thus CGRP signals strongly by both cAMP-dependent and cAMP-independent signaling pathways in preosteoblastic human MG-63 cells.

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Botox – A New Weapon in a Dentist's Arsenal

Dental Journal of Advance Studies ◽

10.1055/s-0038-1672051 ◽

2016 ◽

Vol 04 (02) ◽

pp. 081-087

Author(s):

Mitasha Sachdeva ◽

Vinay Dua ◽

Puneet Gupta ◽

Gaurav Ahuja

Keyword(s):

Botulinum Toxin ◽

Muscle Contraction ◽

Temporomandibular Disorders ◽

Clostridium Botulinum ◽

Anaerobic Bacteria ◽

Trade Name ◽

Release Of Acetylcholine ◽

Justinus Kerner ◽

German Physician ◽

Gummy Smile

AbstractBotulinum toxin was first used therapeutically by a German physician Justinus Kerner (1786-1862). Trade name BOTOX was given by Allergan, Inc, Irvine, Calif for treating strabismus, blepharospasm, and hemifacial spasm. It is neurotoxin derived from an anaerobic bacteria Clostridium botulinum. The toxin inhibits the release of acetylcholine (ACH), a neurotransmitter responsible for the activation of muscle contraction and its administration results in diminution of tone in the injected muscle. It has found a variety of uses in dentistry like treatment of gummy smile, masseteric hypertrophy, bruxism, temporomandibular disorders and so on. It is a minimally invasive and cosmetically effective method of treating several conditions with excessive muscle contraction.

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