Background: Injections of botulinum toxin type A in the forehead have never been reported to cause hair side effects. Objective: The aim of this paper is to report a new type of alopecia, which we have seen in women undergoing periodic injections of botulinum toxin type A for forehead wrinkles, and to differentiate it from other types of hair loss. Methods: We conducted an observational study on 5 females recruited from a private and an institutional practice who complained of progressive recession of the hairline after periodic injections of botulinum toxin type A in the forehead. Results: Alopecia of the frontal hairline was evident in all 5 patients, with absence of skin atrophy or scarring and progressive hair miniaturization at trichoscopy. Conclusion: Dermatologists should be aware of the possible occurrence of frontal alopecia after repeated injections of botulinum toxin type A for forehead wrinkles.

Keywords:
Alopecia, Botulinum toxin, Wrinkles, Frontal alopecia
1.
Carruthers A, Sadick N, Brandt F, et al: Evolution of facial aesthetic treatment over five or more years: a retrospective cross-sectional analysis of continuous onabotulinumtoxinA treatment. Dermatol Surg 2015;41:693-701.
2.
Rivers JK, Bertucci V, McGillivray W, et al: Subject satisfaction with onabotulinumtoxinA treatment of glabellar and lateral canthal lines using a new patient-reported outcome measure. Dermatol Surg 2015;41:950-959.
3.
MacDonald A, Clark C, Holmes S: Frontal fibrosing alopecia: a review of 60 cases. J Am Acad Dermatol 2012;67:955-961.
4.
Rudnicka L, Olszewska M, Rakowska A, Slowinska M: Trichoscopy update 2011. J Dermatol Case Rep 2011;5:82-88.
5.
Wabbels B, Stanzel BV: Unilateral loss of eyebrows and repeated botulinum toxin injections: questionable correlation in essential blepharospasm. Ophthalmologe 2015;112:174-176.
6.
Cho HR, Lew BL, Lew H, Sim WY: Treatment effects of intradermal botulinum toxin type A injection on alopecia areata. Dermatol Surg 2010;36(suppl 4):2175-2181.
7.
Freund BJ, Schwartz M: Treatment of male pattern baldness with botulinum toxin: a pilot study. Plast Reconstr Surg 2010;126:246e-248e.
8.
Carruthers J, Carruthers A: Botox: beyond wrinkles. Clin Dermatol 2004;22:89-93.
9.
Lowe NJ, Lowe P: Botulinum toxins for facial lines: a concise review. Dermatol Ther (Heidelb) 2012;2:14.
10.
Hosp C, Naumann MK, Hamm H: Botulinum toxin treatment of autonomic disorders: focal hyperhidrosis and sialorrhea. Semin Neurol 2016;36:20-28.
11.
Kim DW, Lee SK, Ahnn J: Botulinum toxin as a pain killer: players and actions in antinociception. Toxins (Basel) 2015;7:2435-2453.
12.
Paus R: Frontiers in the (neuro-)endocrine controls of hair growth. J Investig Dermatol Symp Proc 2007;12:20-22.
© 2016 S. Karger AG, Basel
2016
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.