Botox in dermatology

Potential role of the cell-penetrating peptide-conjugated soluble N-ethylmaleimide-sensitive factor attachment protein receptor motif of vesicle-associated membrane protein 2-patterned peptide in novel cosmeceutical skin product development

AIM

This study aimed to investigate and verify the effect of cell-penetrating peptide (CPP)-conjugated soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) motif of vesicle-associated membrane protein 2 (VAMP2)-patterned peptide (INCI name: Acetyl sh-Oligopeptide-26 sh-Oligopeptide-27 SP, trade name: M.Biome-BT) on improving skin function in vitro.

METHODS

The cytotoxicity of CPP-conjugated SNARE motif of VAMP2-patterned peptide (CVP) was investigated using the 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyl tetrazolium bromide (MTT) assay against B16-F10 cells and human dermal fibroblasts (HDFs) and a reconstructed skin irritation test. The anti-wrinkle activity of M.Biome-BT was determined by assessing the release of norepinephrine and dopamine in PC-12 cells via ELISA. The skin-whitening effects of CVP were assessed in B16-F10 cells by measuring the intra- and extracellular melanin contents and expression levels of melanin production-related genes, such as microphthalmia-associated transcription factor (MITF), tyrosinase (TYR), tyrosinase-related protein-1 (TRP-1), and TRP-2.

RESULTS

CVP is not cytotoxic to B16-F10 cells and HDFs, and no skin irritation was observed. CVP treatment considerably diminished K+ -induced norepinephrine and dopamine secretion compared with the non-treated control group (62% and 40%, respectively). Additionally, the inhibition ability of CVP on norepinephrine and dopamine release was comparable to that of botulinum neurotoxin type A (BoNT/A). CVP also increased intracellular melanin content in a dose-dependent manner, whereas extracellular melanin content decreased (76%-85%). However, CVP treatment did not affect the mRNA expression of MITF, TYR, TRP-1, and TRP-2. These results suggest that CVP does not inhibit melanin production; however, it may induce a whitening effect by inhibiting melanin transport.

CONCLUSIONS

Taken together, our findings indicate that CVP could be used as an active and safe cosmeceutical ingredient for antiaging applications.

Botulinum toxin (Botox) A for reducing the appearance of facial wrinkles: a literature review of clinical use and pharmacological aspect

Background: Botulinum toxin (Botox) consists of 7 types of neurotoxins; however, only toxins A and B are used clinically. Botox A is used for several disorders in the field of medicine, particularly in dermatology, for cosmetic purposes. It is produced by the bacterium Clostridium botulinum and can be used as a treatment to reduce the appearance of wrinkles in the upper areas of the face, elevate the eyebrows and treat problems such as hyperhidrosis, lichen simplex, pompholyx (dyshidrotic eczema) and acne vulgaris.

Objectives: This article provides a literature review regarding the general issue of Botox as a treatment for reducing facial wrinkle.

Discussion: Botox works by blocking the release of acetylcholine, resulting in paralysis of the local muscles, which usually occurs 24 hrs to two weeks following Botox injection. This effect will last three to six months. The optimal dose of cosmetic Botox in dermatology is 20 units. Botox is relatively safe and does not result in any adverse side effects. However, in certain circumstances, the effect of Botox will gradually resolve, resulting in reduced muscle paralysis over time.

Conclusion: Botox is good and safe medicine to reduce the appearance of facial wrinkles.

Gummy smile and botulinum toxin: a new approach based on the gingival exposure area

BACKGROUND

Gummy smile (GS) is an aesthetic disorder for some patients, which can be corrected by injection of botulinum toxin.

OBJECTIVE

We sought to classify GS according to the area of gingival exposure and the respective muscles involved in order to perfect the botulinum toxin injection technique for each patient.

METHODS

Sixteen patients with GS were evaluated before receiving botulinum toxin injections. Based on the area of excessive gum displayed and identification of the muscles involved, 4 different types of GS were identified: anterior, posterior, mixed, and asymmetric. AbobotulinumtoxinA (Dysport, Ipsen Biopharm Limited, Wrexham, UK) was injected using a different injection technique for each type of GS, based on the main muscles involved. With the aid of two computer programs, the area of gum exposed was measured before and after the application of abobotulinumtoxinA, to evaluate the level of improvement.

RESULTS

There was a decrease in the degree of gum display in all patients. The general average improvement achieved was 75.09%. Two patients showed slight adverse effects that were easily corrected with additional doses of abobotulinumtoxinA.

LIMITATIONS

For this study, there was no sample size calculation and no statistical analysis of the cases.

CONCLUSION

The authors conclude that it is important to identify the type of GS and therefore the main muscles involved, so that the correct injection technique can be used. AbobotulinumtoxinA was shown to be effective and safe for use in all types of GS in the present sample.

Sterility assessment of multiple use botulinum A exotoxin vials: A prospective simulation

BACKGROUND

A preponderance of evidence now indicates that storage of reconstituted botulinum toxin solution for longer than the 4 hours recommended by the manufacturer does not result in loss of effectiveness.

OBJECTIVE

Then purpose of this study was to assess whether serial re-extraction of reconstituted botulinum toxin solution from vials undergoing prolonged storage is associated with increased risk of microbial contamination.

METHODS

Consecutive 100-U vials of botulinun A exotoxin were reconstituted with 2.5 mL each of normal saline with preservative (benzyl alcohol). Within 1 week after reconstitution, each vial was used to treat 1 to 3 patients, for a total of 60 to 80 U used. Thereafter, each vial was stored in a plastic kidney basin in an unlocked, multiuse medication refrigerator. Two weeks later, a randomly assigned nurse removed the vial from the refrigerator and withdrew and discarded 0.1 mL (5 U) using the same technique used for therapeutic extractions. Iterations of this withdrawal and discarding procedure were continued until a 0.1-mL aliquot could not be withdrawn without prying off the metal cover. Once this threshold was reached, the vial was sent to the microbiology laboratory for sterility testing using a thioglycolate broth.

RESULTS

In all, 127 vials were handled per protocol. On average (mean), vials underwent 4.5 access procedures, including 1.6 therapeutic extractions for a total of 76 U removed during a period of 7 weeks. Sterility analysis with thioglycolate broth indicated no evidence of contamination.

LIMITATIONS

Preservative-containing saline was used for reconstitution.

CONCLUSION

Routine refrigerator storage of medication vials containing reconstituted botulinum toxin does not result in microbial contamination of the contents even after serial re-extraction of solution from these vials, and after handling of such vials by multiple personnel. Storage and subsequent reuse of botulinum toxin appears safe for at least 7 weeks after reconstitution.

Managing adverse events associated with botulinum toxin type A: a focus on cosmetic procedures

Botulinum toxin A (BTXA) has become a widely used drug in cosmetic dermatology, not only to treat focal hyperhidrosis but also hyperkinetic facial lines, platysma bands, décolleté bands, and other skin features. The spectrum of possible adverse effects of BTXA is broad but fortunately those that have been observed with cosmetic use of this product are generally mild and transient. The major tools for preventing adverse effects from BTXA are knowledge and skill. Use of correct injection techniques is mandatory since most unwanted effects are caused by incorrect technique. Knowledge of the target structures, e.g. the facial and extrafacial muscles, allows physicians to select the optimal dose, time and technique. The most common adverse effects are pain and hematoma. In the periocular region, lid and brow ptosis are important adverse effects. Adverse effects such as pain, hematoma, ecchymosis, and bruising may also occur in the upper and lower face and at extrafacial sites. Other possible adverse effects seen in other indications that the user of BTXA in cosmetic dermatology should be wary of include induction headaches and possible interaction with concomitant medications. Induction of neutralizing antibodies due to cosmetic BTXA treatment has not been observed. This article also outlines recommendations regarding use of BTXA. Of these, the most important for avoiding most unwanted adverse effects are the proper techniques of dilution, storage, and injection, as well as the careful exclusion of patients with any contraindications. Pain, hematoma, ecchymosis, and bruising can be prevented by cooling the skin before and after BTXA injection. Upper lid ptosis may be partly corrected using apraclonidine or phenylephrine eyedrops. If simple rules relating to the indications for and application of BTXA are followed, this is a safe and effective drug in cosmetic dermatology.

Type A botulinum toxin in the upper aspect of the face

The use of botulinum toxin type A (BTX-A) for facial rejuvenation was first systematically developed by Carruthers and Carruthers on the upper aspect of the face. In the early 1990s, the first studies of the cosmetic use of BTX-A were published. BTX-A was only approved in 2002, however, by the U.S. Food and Drug Administration when extensive cosmetic studies were evaluated. The treatment of facial wrinkles with BTX-A has truly changed the concepts held by physicians regarding facial rejuvenation, mainly on the upper aspect of the face. It is one of the most common cosmetic procedures currently performed by physicians.

Multicenter, double-blind study of the efficacy of injections with botulinum toxin type A reconstituted up to six consecutive weeks before application

BACKGROUND

It is recommended that botulinum toxin be used immediately or within 2 weeks after its reconstitution because its efficacy might be compromised by prolonged storage.

OBJECTIVES

To evaluate the efficacy of botulinum toxin type A (BTX-A) reconstituted over 6 consecutive weeks for the treatment of glabellar frown lines.

METHODS

Four vials of BTX-A were reconstituted each of 7 days over a period of 6 weeks, totaling 28 vials, corresponding to seven reconstitution dates. During this period, the BTX-A was stored according to the manufacturer's instructions. On the day after the last reconstitution, all of the reconstituted vials were injected in patients from four dermatologic centers taking part in this study. A total of 88 patients were treated on the same day and were followed every 2 weeks for 4 months. All patients were photographed at all stages. A number of professionals assessed the efficacy of reconstituted BTX-A based on the reduction of the maximum frowning capacity of the treated muscles.

RESULTS

Of the 88 patients who were selected, 3 were excluded. Three forms of evaluation were applied, and no statistically significant differences were found in the results presented.

CONCLUSION

BTX-A may be applied up to 6 weeks after reconstitution without losing its effectiveness. Other factors, which are probably individual, may influence the response to BTX-A injections.

Advances in cosmetic oculoplastic surgery

According to the American Society for Aesthetic Plastic Surgery, in the year 2000 over 5.7 million cosmetic surgical and nonsurgical procedures were performed in the United States. This was a 25% increase above the total number performed in 1999. The most popular of these procedures was botulinum toxin injection, followed by chemical peels and microdermabrasion. As the field of plastic and reconstructive surgery changes, so does the scope of the oculoplastic surgeon. This review article summarizes those developments in aesthetic surgery that are recent additions to the practice of aesthetic oculoplastic surgery. It highlights the most recent literature discussing brow and midface lifts, skin lasers, microdermabrasion, upper and lower blepharoplasty, chemical peels, botulinum toxin, and fat sculpturing.