Abstract
Botulinum toxins (BTXs) comprise a family of neurotoxins designated as types A–G, which are produced by the anerobic bacterium Clostridium botulinum. BTX-A blocks the cholinergic transmission resulting in flaccid paralysis and autonomous nerve dysfunction. It has become a powerful therapeutic tool in a variety of conditions over the last decades. Primarily used in the treatment of strabism, blepharospasm and hemifacial spasms, BTX has only recently been recognized in dermatology. The use of BTX in dermatology includes the treatment of focal hyperhidrosis, hyperfunctional facial lines as well as paralysis of the anal sphincter in the therapy of anal fissures. The mechanism of action is described and the current literature is reviewed.
References
1.
Scott AB, Rosenbaum A, Collins CC: Pharmacologic weakening of extraocular muscles. Invest Ophthalmol 1973;12:924–927.
2.
Scott AB: Botulinum toxin injection of eye muscles to correct strabism. Trans Am Ophthalmol Soc 1981;79:734–770.
3.
Anonymous: Consensus conference. Clinical use of botulinum toxin. National Institutes of Health. Conn Med 1991;55:471–477.
4.
Coffield JA, Considine RB, Simpson LL: The site and mechanism of action of botulinum neurotoxin; in Jankovic J, Hallett M (eds): Therapy with Botulinum Toxin. New York, Dekker, 1994, pp 3–14.
5.
Lacy DB, Stevens RC: Sequence homology and structural analysis of the clostridial neurotoxins. J Mol Biol 1999;291:1091–1104.
6.
Maisey EA, Wadsworth JD, Poulain B, Shone CC, Melling J, Gibbs P, Tauc L, Dolly JO: Involvement of the constituent chains of botulinum neurotoxins A and B in the blockade of neurotransmitter release. Eur J Biochem 1988;177:683–691.
7.
Kao I, Drachman DB, Price DL: Botulinum toxin: Mechanisms of presynaptic blockade. Science 1976;193:1256–1258.
8.
de Paiva A, Meunier FA, Molgo J, Aoki KR, Dolly JO: Functional repair of motor endplates after botulinum neurotoxin type A poisoning: Biphasic switch of synaptic activity between nerve sprouts and their parent terminals. Proc Natl Acad Sci USA 1999;96:3200–3205.
9.
Naumann M, Bergmann I, Hofmann U, Hamm H, Reiners K: Botulinum toxin for focal hyperhidrosis: Technical considerations and improvements in application (letter). Br J Dermatol 1998;139:1123–1124.
10.
Greene P, Fahn S: Development of antibodies to botulinum toxin type A in patients with torticollis treated with injections of botulinum toxin type A; in Das Gupta BR (ed): Botulinum and Tetanus Neurotoxins: Neurotransmission and Biomedical Aspects. New York, Plenum Press, 1993, pp 651–654.
11.
Jankovic J, Brin MF: Therapeutic uses of botulinum toxin. N Engl J Med 1991;324:1186–1194.
12.
Kerner JC: Vergiftung durch verdorbene Würste. Tübinger Blätter für Naturwissenschaften und Arzneykunde 1817;3:1–45.
13.
Kreyden OPH, Böni R, Burg G: Focal essential hyperhidrosis: The therapeutic challenge. Schweiz Med Wochenschr, in press.
14.
Villar RG, Shapiro RL, Busto S, Riva-Posse C, Verdejo G, Farace MI, Rosetti F, San Juan JA, Julia CM, Becher J, Maslanka S, Swerdlow D: Outbreak of type A botulism and development of a botulism surveillance and antitoxin release system in Argentina. JAMA 1999;281:1334–1340.
15.
Passaro DJ, Werner SB, McGee J, MacKenzie WR, Vugia DJ: Wound botulism associated with black tar heroin among injecting drug users. JAMA 1998;279:859–863.
16.
Tacker CO, Shandera WX, Mann JM, Hargrett NT, Blake PA: Equine antitoxin use and other factors that predict outcome in type A foodborne botulism. Am J Med 1984;76:794–798.
17.
Schantz EJ, Johnson EA: Botulinum toxin: The story of its development for the treatment of human disease. Perspect Biol Med 1997;40:317–327.
18.
Brisinda G, Maria G, Bentivoglio AR, Cassetta E, Gui D, Albanese A: A comparison of injections of botulinum toxin and topical nitroglycerin ointment for the treatment of chronic anal fissure. N Engl J Med 1999;341:65–69.
19.
Jost WH, Schrank B: Repeat botulin toxin injections in anal fissure: In patients with relapse and after insufficient effect of first treatment. Dig Dis Sci 1999;44:1588–1589.
20.
Blitzer A, Binder WJ, Aviv JE, Keen MS, Brin MF: The management of hyperfunctional facial lines with botulinum toxin. Arch Otolaryngol Head Neck Surg 1997;123:389–392.
21.
Fagien S: Botox for the treatment of dynamic and hyperkinetic facial lines and furrows: Adjunctive use in facial aesthetic surgery. Plast Reconstr Surg 1999;103:701–713.
© 2000 S. Karger AG, Basel
2000
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.