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      Botulinum Toxin for the Treatment of Refractory Erythema and Flushing of Rosacea

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          Abstract

          Background: Persistent erythema and severe rosacea flushing can cause significant physical discomfort and emotional stress to patients. Currently, no satisfactory treatments are available. Methods: We report two cases of refractory flushing and erythema of rosacea that were successfully treated with intradermal botulinum toxin injections. Results: Good cosmetic results were achieved for both patients. The side effects during and after treatment were mild pain and localized bruising; these symptoms resolved within several days without further treatment. Conclusion: Intradermal botulinum toxin injection may be an effective treatment for refractory erythema and rosacea flushing that deserves further study in a larger patient population.

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          Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea.

          Thomas L Drake, Christopher Powell, Mark T Dahl … (2002)
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            Clinical Uses of Botulinum Neurotoxins: Current Indications, Limitations and Future Developments

            Kan-Sheng Chen (2012)
            Botulinum neurotoxins (BoNTs) cause flaccid paralysis by interfering with vesicle fusion and neurotransmitter release in the neuronal cells. BoNTs are the most widely used therapeutic proteins. BoNT/A was approved by the U.S. FDA to treat strabismus, blepharospam, and hemificial spasm as early as 1989 and then for treatment of cervical dystonia, glabellar facial lines, axillary hyperhidrosis, chronic migraine and for cosmetic use. Due to its high efficacy, longevity of action and satisfactory safety profile, it has been used empirically in a variety of ophthalmological, gastrointestinal, urological, orthopedic, dermatological, secretory, and painful disorders. Currently available BoNT therapies are limited to neuronal indications with the requirement of periodic injections resulting in immune-resistance for some indications. Recent understanding of the structure-function relationship of BoNTs prompted the engineering of novel BoNTs to extend therapeutic interventions in non-neuronal systems and to overcome the immune-resistance issue. Much research still needs to be done to improve and extend the medical uses of BoNTs.
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              Different types of botulinum toxin in humans.

              Roberto Eleopra, Ornella Rossetto, Cesare Montecucco … (2004)
              In humans, botulinum neurotoxin (BoNT) serotype A (BoNT/A) is a useful therapeutic tool, but different BoNT serotypes may be useful when a specific immune resistance related to BoNT/A is proved. BoNT serotype F (BoNT/F) was injected into human muscles but its effects are shorter compared to BoNT/A, whereas BoNT serotype B (BoNT/B) is effective in humans only if injected at very high doses. BoNT serotype C (BoNT/C) has a general profile of action similar to BoNT/A. Nevertheless, a comparison between these different BoNTs in human has not yet been reported. To establish the general profile of these different BoNTs in humans and the spread in near and untreated muscles we conducted an electrophysiological evaluation in 12 healthy volunteers by injecting BoNT/A (BOTOX 15MU), BoNT/B (NeuroBloc 1500MU), BoNT/F (15MU), BoNT/C (15MU) and a saline solution (placebo) in the abductor digiti minimi muscle (ADM) in a double-blind manner. The compound muscle action potential (CMAP) amplitude variation, before and at 2, 4, 6 and 8 weeks after the injections, was evaluated in the ADM, the fourth dorsal interosseus, the first dorsal interosseus and the abductor pollicis brevis APB. We detected an earlier recovery for BoNT/F when compared to the other BoNTs. No significant differences in the local or distant BoNT spread was observed among the different serotypes. We conclude that in humans, BoNT/B and BoNT/C have a general profile similar to BoNT/A and as such these serotypes could be alternative therapies to BoNT/A. BoNT/F might be useful when only a short duration of neuromuscular blockade is required. Copyright 2004 Movement Disorder Society
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                Author and article information

                Journal
                Journal ID (publisher-id): DRM
                Journal ID (nlm-ta): Dermatology
                Journal ID (doi): 10.1159/issn.1018-8665
                Title: Dermatology
                Publisher: S. Karger AG
                ISSN (Print): 1018-8665
                ISSN (Electronic): 1421-9832
                Publication date Subscription-year: 2015
                Publication date (Print): April 2015
                Publication date (Electronic): 03 March 2015
                Volume: 230
                Issue: 4
                Pages: 299-301
                Affiliations
                aDepartment of Dermatology, Chung-Ang University College of Medicine, and bGoodDay Skin and Laser Clinic, Seoul, South Korea
                Author notes
                *Beom Joon Kim, MD, Department of Dermatology, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-ku, Seoul 156-755 (South Korea), E-Mail beomjoon@unitel.co.kr
                Article
                Publisher ID: 368773 Other ID: Dermatology 2015;230:299-301
                DOI: 10.1159/000368773
                PubMed ID: 25765295
                SO-VID: 8269d7f8-7706-42c4-9835-49f7af1620b0
                Copyright © © 2015 S. Karger AG, Basel
                License:

                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.

                History
                Date received : 25 May 2014
                Date accepted : 24 September 2014
                Page count
                Figures: 2, References: 15, Pages: 3
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Oncology & Radiotherapy,Pathology,Surgery,Dermatology,Pharmacology & Pharmaceutical medicine
                Keywords: Flushing,Botulinum toxin,Erythema,Refractory,Rosacea
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy, Pathology, Surgery, Dermatology, Pharmacology & Pharmaceutical medicine
                Keywords: Flushing, Botulinum toxin, Erythema, Refractory, Rosacea

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